Exercise and non-pharmacological treatment of POTS
Open accessAbstract
Recent research has demonstrated that cardiovascular deconditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible. The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms. As patients become increasingly fit, the duration and intensity of exercise should be progressively increased, and upright exercise can be gradually added as tolerated. Supervised training is preferable to maximize functional capacity. Other non-pharmacological interventions, which include: 1) chronic volume expansion via sleeping in the head-up position; 2) reduction in venous pooling during orthostasis by lower body compression garments extending at least to the xiphoid or with an abdominal binder; and 3) physical countermeasure maneuvers, such as squeezing a rubber ball, leg crossing, muscle pumping, squatting, negative-pressure breathing, etc., may also be effective in preventing orthostatic intolerance and managing acute clinical symptoms in POTS patients. However, randomized clinical trials are needed to evaluate the efficacies of these no…
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A progressive exercise program with recumbent aerobic exercise and leg resistance training transitioning to upright exercise has been shown to improve quality of life and reduce orthostatic heart rate in many POTS patients.
“Along with increased water and salt intake, a progressive exercise program with recumbent aerobic exercise and leg resistance training transitioning to upright exercise has been shown to improve quality of life and reduce orthostatic HR in many patients (Fu and Levine, 2018, 2015; George et al., 2016; Sheldon et al., 2015; Shibata et al., 2012).”
From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Fu and Levine, 2018
The combination of abdominal binders and lower extremity compression stockings is thought to be more effective than lower extremity compression alone due to the disproportionally greater volume in the splanchnic circulation than in the legs.
“The combination of abdominal binders and lower extremity compression stockings is thought to be more effective than lower extremity compression alone due to the disproportionally greater volume in the splanchnic circulation than in the legs (51).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [51]
Up to 25% of adult patients with POTS were found to be unable to work.
“Up to 25% of adult patients with POTS were found to be unable to work182”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [182]
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“Exercise and non-pharmacological interventions should be considered for most patients if tolerated (Sheldon et al. 2015), because they are simple and cost-effective and have no or minimal side effects.”
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- Authors
- Fu, Q., & Levine, B. D.
- Affiliations
- Texas Health Dallas (US)
- Corresponding author
- Fu, Qi
- Venue
- Autonomic Neuroscience
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 215
- Pages
- 20-27
- ISSN
- 1566-0702 (ISSN-L)
- PMC
- PMC6289756
- OpenAlex
- W2810136578
- Cited by
- 174
- References
- 88
- Citations by year
- 2026: 24 · 2025: 25 · 2024: 32 · 2023: 23 · 2022: 31 · 2021: 15 · 2020: 14 · 2019: 7 · 2018: 2
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Autonomic Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K23 HL075238)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- postural orthostatic tachycardia syndrome, exercise training, cardiovascular deconditioning, cardiac atrophy, hypovolemia, volume expansion, supervised exercise, orthostatic intolerance, non-pharmacological treatment
- MeSH terms
- Exercise Therapy, Humans, Postural Orthostatic Tachycardia Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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