With many in our community hearing that physical therapy can be beneficial, we wanted to compile and make available some of the research from a few recent studies. We hope that some of this provides you with better insight into how and why physical therapy may be beneficial for you or a loved one navigating POTS, and give you more tools to reduce symptoms and thrive.

• Following the completion of the unsupervised 3-month exercise program, which used the Levine protocol, 71% of the 41% who were able to complete the program experienced significant improvement in POTS symptoms (Miranda et al., 2018; George et al., 2016).

• To avoid uncomfortable rises in heart rate (HR) during exercises, it may be helpful to develop techniques specific to how individuals can warm-up, recover, and cool down while also pacing themselves (Miranda et al., 2018).

• Cardiac atrophy and hypovolemia are two examples of cardiac deconditioning which can contribute towards the disability and severity of POTS (Fu et al., 2018).

• The use of exercise training, in combination with volume expansion, should be started as early as possible (as tolerated and when indicated) given the importance of physical rehabilitation (Fu et al., 2018).

• It can be helpful to take advantage of horizontal exercises to minimize symptom exacerbation and allow for increased tolerance to exercise. Some of these can include rowing, using a recumbent bicycle, and even swimming (Fu et al., 2018).

• Providers can increase the overall duration and intensity of exercise progressively, with the addition of more positional changes and upright exercise as tolerated (Fu et al., 2018).

• Exercise training, as compared to strictly using propranolol, can have a significant positive impact on upright hemodynamics and overall quality of life (Shephard, 2012).

• Exercise training improves stroke volume, heart rate, and cardiac output (Fu & Levine, 2015). More specifically, heart rate lowers, stroke volume increases, and cardiac output increases (Fu & Levine, 2015).

• Autonomic circulatory control is improved, evidenced by a reduction in the amount of time required for heart rate recovery (the amount of time it takes for the heart rate to come back down to baseline after exercising) (Fu & Levine, 2015).

• It may be helpful to screen individuals who have had concussions for POTS, as starting a POTS exercise regimen more quickly may prove to be beneficial (Miranda et al., 2018).

• Exercise training (even when short-term) seems to increase baroreflex sensitivity (helps control autonomic nervous system responses); this , in turn, seems to help lower the standing HR in individuals with POTS (Galbreath et al., 2011).

Sources:

Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of pots. Autonomic Neuroscience, 215, 20–27. https://doi.org/10.1016/j.autneu.2018.07.001 

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

Galbreath MM, Shibata S, Vangundy TB, Okazaki K, Fu Q, Levine BD. (2011). Effects of exercise training on arterial-cardiac baroreflex function in POTS. Clin Auton Res. 21:73–80

George SA, Bivens TB, Howden EJ, et al. (2016). The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting. Heart Rhythm; 13(4):943–950.

Miranda, N. A., Boris, J. R., Kouvel, K. M., & Stiles, L. (2018). Activity and exercise intolerance after concussion: Identification and management of postural orthostatic tachycardia syndrome. Journal of Neurologic Physical Therapy, 42(3), 163–171. https://doi.org/10.1097/npt.0000000000000231 

Shephard, R. J. (2012). Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Yearbook of Sports Medicine, 2012, 231–233. https://doi.org/10.1016/j.yspm.2011.09.012