The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting
Abstract
Background Postural orthostatic tachycardia syndrome (POTS) affects primarily young women and impairs quality of life. We found that in a research setting, exercise training along with lifestyle intervention is effective as a nondrug therapy for POTS. Objective To evaluate the efficacy of our exercise training/lifestyle intervention in POTS patients in a community environment. Methods We established a POTS registry and enrolled 251 patients (86% women, aged 26 ± 11 [SD] years) through their physicians. A 3-month program involving mild- to moderate-intensity endurance training (progressing from semirecumbent to upright, 3-5 times/wk, 30-45 min/session) plus strength training was implemented along with increasing salt/water intake. The program was delivered to the physicians, who oversaw training in their patients. A 10-minute stand test was performed at the physician's office and patient quality of life was assessed using the 36-Item Short Form Health Survey. Results One hundred and three patients completed the program. Of those that completed, 71% no longer qualified for POTS and were thus in remission. The increase in heart rate from supine to 10-minute stand was markedly lower (23 ± 14 vs. 46 ± 17 beats/min before intervention; P Conclusions A training/lifestyle intervention program can be implemented in a community setting with physician supervision and is effective in the treatment of POTS. It remains to be determined whether exercise can be an effective long-term treatme…
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Exercise training has been demonstrated to expand blood volume and increase cardiac size and mass in POTS patients and result in a prominent decrease in symptoms.
“the positive response these patients have to exercise training, which has been demonstrated to expand blood volume and increase cardiac size and mass in POTS patients and result in a prominent decrease in symptoms (4,63,64).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [64]
Research has demonstrated that physical reconditioning with a short-term (3 month) progressive exercise training program leads to improvement or remission of POTS in the majority of patients.
“Research has demonstrated that physical reconditioning with a short-term (3 month) progressive exercise training program leads to improvement or remission of POTS in the majority of patients (4,64).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [64]
Exercise therapy is most successful when the program is supervised by experienced trainers or physical therapists that understand the pathophysiology of POTS, though it has also been demonstrated to be highly effective when administered in a community setting.
“Exercise therapy is most successful when the program is supervised by experienced trainers or physical therapists that understand the pathophysiology of POTS, though it has also been demonstrated to be highly effective when administered in a community setting (64).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [64]
In a follow-up of a small number of patients who participated in the exercise program in a community setting, the effectiveness persisted for at least 1 year.
“In a follow-up of a small number of patients who participated in the exercise program in a community setting, the effectiveness persisted for at least 1 year (64).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [64]
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 George et al., 2016
Only 41% of POTS patients in the community setting are able to complete a standardized 3-month program involving mild-moderate intensity endurance training 3-5 times per week at 30-45 min per session.
“Unfortunately, only 41% of POTS patients in the community setting are able to complete a standardized 3-month program involving mild-moderate intensity endurance training 3-5 times per week at 30-45 min per session (63).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [63]
50-70% of POTS patients who complete 3 months of endurance training exhibit hemodynamic changes that no longer meet criteria for POTS.
“In fact, 50-70% of POTS patients who complete 3 months of endurance training exhibit hemodynamic changes that no longer meet criteria for POTS (42, 62, 63).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [63]
Exercise training may be very effective and has been shown to alleviate symptoms of POTS-related deconditioning.
“Exercise training may be very effective and has been shown to alleviate the symptoms of POTS-related deconditioning [66,67].”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [67]
The two most common forms of sinus tachycardia for which the underlying condition is not well understood are POTS and IST.
“The two most common forms of sinus tachycardia for which the underlying condition is not well understood are POTS 49,50,170 and IST49,55.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [170]
Clinically, idiopathic sinus tachycardia comprises two principal diagnostic categories, POTS and IST.
“Clinically, ‘Idiopathic sinus tachycardia’ comprises two principal diagnostic categories, POTS and IST.49,50,75,167,170”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [170]
Exercise is an HRS Class IIA indication for POTS but remains a target of study, and its value in IST is unknown.
“Exercise is an HRS Class IIA indication for POTS but remains a target of study49,50,125,170,173; its value in IST is unknown.49,50,125”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [170]
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- Authors
- George, S. A., Bivens, T. B., Howden, E. J., Saleem, Y., Galbreath, M. M., Hendrickson, D., Fu, Q., & Levine, B. D.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Texas Health Dallas (US)
- Corresponding author
- Levine, Benjamin D.
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 13
- Issue
- 4
- Pages
- 943-950
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2195983391
- Cited by
- 127
- References
- 36
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 20 · 2023: 12 · 2022: 16 · 2021: 10 · 2020: 16 · 2019: 9 · 2018: 13 · 2017: 9 · 2016: 1 · 2015: 1
- FWCI
- 8.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- postural orthostatic tachycardia syndrome, exercise training, lifestyle intervention, endurance training, resistance training, community-based intervention, quality of life, heart rate response to standing, long-term treatment efficacy
- MeSH terms
- Adult, Blood Pressure, Postural Balance, Exercise Therapy, Female, Humans, Male, Quality of Life, Registries, Treatment Outcome, Tilt-Table Test, Postural Orthostatic Tachycardia Syndrome
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