Managing POTS through exercise

Struggling with exercise since being diagnosed with POTS? This one’s for you.

What is POTS? 

POTS or Postural Orthostatic Tachycardia Syndrome is a form of dysautonomia or a disorder of the autonomic nervous system. This refers to the nervous system that regulates functions we are not consciously aware of. This includes blood pressure, heart rate and body temperature. Heart rate increases of 30 beats per minute when changing position from sitting to standing is common and often used as a form of diagnosis for this condition. 

Research has shown that people can develop POTS following a viral infection, pregnancy, surgery or trauma, however there is no specific known cause. You can also develop POTS as a secondary condition if you have any of the following primary conditions: adrenal disorders, anaemia, chronic fatigue, gastric bypass surgery, Vitamin deficiency, Tumours and spinal disorders. Women between the ages of 15-50 years old are more likely to develop this condition and it can be hereditary, however there is no specific gene link. 1

Types of POTS

• Neuropathic- Damage to nerve fibres that manage blood flow to your limbs and abdomen 
• Hyperadrenergic- increased levels of the stress hormone norepinephrine.
• Hypovolemic- this refers to low blood levels 1

How is it diagnosed? 

Firstly you would speak with your GP regarding your current symptoms.They may perform further tests such as a urine test, blood test, referral to a Cardiologist who will perform an ECG as well as an autonomic breathing test to rule out any other conditions. 

They will then need to rule out orthostatic hypotension which refers to a drop in blood pressure when going from sitting to standing. They will then have you perform a 10 minute standing test or tilt table test which looks at measuring your heart rate after sitting for a period of time then standing for up to 10 mins. POTS is often diagnosed after seeing an increase in heart rate of 30 beats per minute in adults as well as the combination of symptoms reported. 1

Common symptoms of POTS include and are not limited to: 

• Dizziness or lightheadedness 
• Feeling faint or fainting 
• Chest pain 
• Feeling of heart palpitations
• Shortness of breath 
• Shaking and sweating 
• Fatigue 
• Brain fog 
• Purple hands or feet 
• Gastrointestinal upset 
• Blurred or tunnel vision 1

How to manage POTS 

• Increased salt intake- this helps to increase blood volume and decrease heart rate- referral to a dietician for specific dietary advice is recommended 
• Increased hydration can reduce HR by 8-15 bpm due to an increase in blood volume 
• Consuming smaller meals more frequently throughout the day- blood moves to your digestive tract to assist with digestion, the smaller your meals the less volume of blood is required to be directed to the digestive system, thus helping to reduce symptoms 
• Compression garments- These help to push blood from your limbs up to your heart which help to reduce the increase in heart rate which occurs when changing position 
• Medication- different medication types have different goals. The main goals of medication prescription is to help increase blood volume, help the kidneys to  retain sodium, reducing heart rate and blood vessel contrition.  Managing levels of fatigue- such as lying down when feeling tired, reducing amount of tasks completed throughout the day, not standing for long periods of time 
• Exercising regularly- implementation of an exercise programme designed by an Accredited Exercise Physiologist 1,2

How does exercise fit in? 

Research has shown that exercise is an effective form of treatment for people with POTS and has shown to be more effective than medication alone. Exercise should be implemented slowly and be progressive in nature. An accredited exercise physiologist would be best to work with to develop and implement a safe and effective exercise regime for you. The program should initially be conservative and start slowly with a few exercises before gradually and periodically increasing intensity and volume of exercise. 

Exercises that are effective in management of POTS include progressive resistance training, aerobic endurance exercises such as recumbent cycling or swimming as well as Pilates. Avoid activities that are of high impact as they may exacerbate your symptoms. 

Continue to monitor levels of fatigue and symptoms by implementing an activity diary, to determine your triggers and help you better manage your flare ups. 1,2

If you’d like more information regarding POTS or if you have been diagnosed with POTS and would like to book an appointment then please contact us on 4707 7671. 

References

John Hopkins Medicine. (2023). Postural Orthostatic Tachycardia Syndrome (POTS). Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots

Fu, Q., & Levine, B. D. (2015). Exercise in the postural orthostatic tachycardia syndrome. Autonomic neuroscience : basic & clinical, 188, 86–89. https://doi.org/10.1016/j.autneu.2014.11.008