Postural tachycardia syndrome, or PoTS, is a blood circulation disorder identified by a dramatic increase in heart rate from sitting down or standing up. This may cause one to feel dizzy or even faint.
Research states that 1 in every 100 American teenagers is affected by PoTS. In other words, there are around 3 million adults suffering from PoTS in the United States alone. Moreover, studies have discovered that PoTS is more prevalent in women than men. So much so that for every 1 male PoTS patient, there are 5 female PoTS patients. It is also observed to affect women younger than 35 years old more frequently.
Among the many treatments of this condition, that range all the way from medication to dietary changes, exercise has been an effective tool. According to data analyzed by crowdsourcing AI-powered platform StuffThatWorks, exercise is one of the most effective and tried treatments for PoTS, helping in relieving the symptoms of the condition in most patients that try it.
Today, we will see how exercise can be effective against this disorder, in addition to what exercise program is the best.
Exercise as a Treatment for PoTS
Patients suffering from PoTS are unable to stand for normal periods of time. This leads to severe functional impairment and disability to perform physical activities. The exact reason behind PoTS and its occurrence is unclear and widely debated. As of now, exercise training is considered the prime non-pharmaceutical treatment for PoTS syndrome.
Physical deconditioning or loss of fitness is not only a significant aspect of PoTS syndrome but also worsens the symptoms in the patient. PoTS patients face difficulty in maintaining an upright posture and display low exercise tolerance.
A strong piece of evidence for physical deconditioning and its relationship with PoTS is the fact that patients have a lower oxygen intake level than healthy individuals. Exercise training, or more specifically, endurance training is observed to have long-term benefits for PoTS patients and therefore serves as an effective treatment for this disorder.
When exercising, PoTS patients display higher heart rates than healthy people doing the same exercise. This is caused by the cardiac origins of PoTS, meaning that patients have smaller heart muscle mass and feature relatively smaller heart chambers.
This difference in size prompts the heart to pump faster in order to supply a normal amount of blood – inevitably leading to an abnormal heart rate. Having said that, the same study concludes that exercise training not only improved the situation of PoTS patients but even cured it in some cases.
Research on Treating PoTS With Exercise
Frustratingly enough, medical experts do not have a consensus on any specific drug treatment for PoTS as of now. Therapeutic methods other than exercise have been tried but they showed minimal to limited success. However, owed to its remarkable results, more research is being carried out on exercise and how it affects PoTS patients.
It has been shown that exercise training increases the blood and plasma volume in PoTS patients. It also expands the abnormally small heart size and low muscle mass. Ultimately, these changes diminish PoTS symptoms to negligible levels. This is why exercise training is so popularly recommended as an effective PoTS treatment.
In a 2011 study, titled “Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome,” researchers found that 53% of the PoTS patients no longer met the medical criteria of having the syndrome after 3 months of exercise training.
Furthermore, many additional studies have been done to confirm these results, concluding that exercise is indeed an effective treatment for PoTS. Even the severe cases of this syndrome can be relieved through repeated exercise training over longer periods of time.
What Exercise Program to Follow?
The Levine Protocol, as illustrated in the 2012 study titled “Short-term exercise training improves the cardiovascular response to exercise in the postural orthostatic tachycardia syndrome,” is a supervised exercise program prescribed for PoTS patients. It combines enhanced physical activity with an increased salt and water intake and goes on for 3 months.
Patients are asked to increase their water consumption to 3 liters per day. Likewise, they are asked to slowly enhance their sodium intake to 7-10g per day. It must be noted here that an average diet contains around 4g of sodium, so increasing it to the needed amount would require patients to consume 1.5 to 2 more tablespoons of salt every day. Also, this must be done gradually and under the supervision of a medical practitioner.
Patients need to enhance their physical activity as well. Two 30 minute sessions, that include weight and cardio training, are recommended every day.
Cardio Training
Patients must use a heart rate monitor to keep their target heartbeat to 75% of the maximum. A 10-minute warmup and cool-down period before and after the cardio exercises is also highly recommended. Here is what they need to do:
- 1st Month (choose one of the following)
- Rowing
- Recumbent biking
- Swimming/kicking laps using a kickboard
- 2nd Month
- Attempt treadmill without any incline
- Upright biking
- Attempt elliptical
- 3rd Month
- Treadmill
- Elliptical
- 4-6th Month
- Considering that the patients have normalized the aforementioned exercises, they must ask their physicians what to try next. Jogging may be a viable option.
Weight Training
Sessions should be 10 to 15 minutes long and done only once per week. (Can be increased to two 20-40 minute sessions/week later). Do 10 reps of:
- Seated leg curl
- Seated leg press
- Calf raise
- Leg extension
- Seated row
- Chest press
If the patients do not have any seated training equipment, the following are some alternatives.
- Resistance bands
- Physioball
- Floor exercises such as Pilates
To Wrap Up
PoTS syndrome affects millions of people worldwide. There are no apparent causes or dedicated cures, but many research papers and case studies recommend exercise as an effective treatment. The Levine Protocol is a viable exercise program that many physicians recommend. However, the patients need to confirm with their doctor before starting/ quitting any treatment.