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Cited by 110Cardiovascular Syncope and Autonomic DisordersCardiovascular and exercise physiologyHeart Rate Variability and Autonomic Control

Short‐term exercise training improves the cardiovascular response to exercise in the postural orthostatic tachycardia syndrome

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Shibata, Shigeki, Fu, Qi, Bivens, Tiffany B., Hastings, Jeffrey L., Wang, Wade, Levine, Benjamin D.·2012·The Journal of Physiology
DOI 10.1113/jphysiol.2012.233858PMC PMC3547265
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Abstract

Key points: Recent studies have suggested the presence of cardiac atrophy as a key component of the pathogenesis of the postural orthostatic tachycardia syndrome (POTS), similar to physical deconditioning; exercise intolerance is associated with a reduced stroke volume (SV) in POTS which may be the cause of the high heart rate (HR) at rest and during exercise. We determined whether physical ‘reconditioning’ with exercise training improves exercise performance in POTS. A lower SV resulted in a higher HR in POTS at any given oxygen uptake ( ) during exercise while the cardiac output ( )– relationship remained normal. was lower in POTS than healthy sedentary controls. After 3 months of training in POTS, HR became lower at any given due to increased SV without changes in the – relationship. increased due to increased peak SV, and was proportional to total blood volume. HR recovery from exercise was faster after training than before training. Thus, exercise training improves physical fitness and cardiovascular responses during exercise in POTS. Abstract Recent studies have suggested the presence of cardiac atrophy as a key component of the pathogenesis of the postural orthostatic tachycardia syndrome (POTS), similar to physical deconditioning. It has also been shown that exercise intolerance is associated with a reduced stroke volume (SV) in POTS, and that the high heart rate (HR) observed at rest and during exercise in these patients is due to this low SV. We tested the hypotheses that (a) circulatory control during exercise is normal in POTS; and (b) that physical ‘reconditioning’ with exercise training improves exercise performance in patients with POTS. Nineteen (18 women) POTS patients completed a 3 month training programme. Cardiovascular responses during maximal exercise testing were assessed in the upright position before and after training. Resting left ventricular diastolic function was evaluated by Doppler echocardiography. Results were compared with those of 10 well‐matched healthy sedentary controls. A lower SV resulted in a higher HR in POTS at any given oxygen uptake ( ) during exercise while the cardiac output ( )– relationship was normal. was lower in POTS than controls (26.1 ± 1.0 (SEM) vs. 36.3 ± 0.9 ml kg −1 min −1 ; P < 0.001) due to a lower peak SV (65 ± 3 vs. 80 ± 5 ml; P = 0.009). After training in POTS, HR became lower at any given due to increased SV without changes in the – relationship. increased by 11% ( P < 0.001) due to increased peak SV ( P = 0.021) and was proportional to total blood volume. Peak HR was similar, but HR recovery from exercise was faster after training than before training ( P = 0.036 for training and 0.009 for interaction). Resting diastolic function was mostly normal in POTS before training, though diastolic suction was impaired ( P = 0.023). There were no changes in any Doppler index after training. These results suggest that short‐term exercise training improves physical fitness and cardiovascular responses during exercise in patients with POTS.

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  • Treatments that improve symptoms of POTS might decrease the occurrence of syncope.

    “Treatments that improve symptoms of POTS might decrease the occurrence of syncope, although this is unknown (24,514–523).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [516]

    The Introduction describes near-syncope as a POTS symptom, and the Conclusion reports improved exercise responses after training. Neither section, nor the additional passages searched for syncope and post-training symptoms, addresses whether treatments that improve POTS symptoms might reduce the occurrence of syncope. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • The three-month Dallas Program, involving aerobic exercise and resistance training, improves orthostatic and exercise tachycardia, symptoms, and quality of life in POTS.

    “The three-month Dallas Program, which involves aerobic exercise coupled with resistance training, improves orthostatic and exercise tachycardia, symptoms, and quality of life [13;62;63].”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [63]

  • In POTS patients, short-term structured exercise reduces orthostatic tachycardia and improves quality of life, systemic hemodynamics, blood volume, left ventricular mass, and exercise tolerance.

    “Regardless, structured short-term exercise programs can reduce orthostatic tachycardia and improve quality of life, systemic hemodynamics, blood volume, left ventricular mass, and exercise tolerance in POTS patients (Shibata et al., 2012).”

    From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Shibata et al., 2012

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Authors
Shibata, S., Fu, Q., Bivens, T. B., Hastings, J. L., Wang, W., & Levine, B. D.
Affiliations
Texas Health Dallas (US)
Corresponding author
Levine, Benjamin D.
ORCID
Venue
The Journal of Physiology
Publisher
Wiley
Published
2012-06-27
Volume
590
Issue
15
Pages
3495-3505
ISSN
  • 0022-3751 (ISSN-L)
  • 1469-7793
DOI
10.1113/jphysiol.2012.233858
PMC
PMC3547265
OpenAlex
W2119970398
Cited by
109
References
63
Citations by year
2026: 5 · 2025: 10 · 2024: 10 · 2023: 12 · 2022: 12 · 2021: 7 · 2020: 12 · 2019: 4 · 2018: 7 · 2017: 8 · 2016: 4 · 2015: 2 · 2014: 9 · 2013: 4 · 2012: 3
FWCI
5.86
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • The Journal of Physiology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Space Biomedical Research Institute
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (HL075283, K23HL075283)
  • National Center for Research Resources (RR 00633, M01RR000633)
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
exercise training, cardiac atrophy, stroke volume, heart rate, cardiac output, exercise intolerance, left ventricular diastolic function, blood volume, post-exercise recovery, physical reconditioning, cardiovascular response to exercise, sedentary controls, maximal exercise test, Doppler echocardiography, oxygen consumption
MeSH terms
Adult, Exercise Therapy, Female, Heart Rate, Humans, Male, Stroke Volume, Exercise, Ventricular Function, Left, Postural Orthostatic Tachycardia Syndrome

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