Exercise is a recommended component of treatment for any autonomic disorder including POTS. Your doctor or physical therapist will assign goals and stipulate target heart ranges to achieve but not exceed.
If you are exercising at home, you will likely need a “workout buddy” so you are not alone if you experience any negative symptoms. This is especially important if you’ll be at a local gym. A knowledgeable personal trainer or physical therapist is invaluable to your progress, and many hospitals maintain rehabilitation facilities that employ such people.
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Such a setting also allows for vital signs to be monitored during your workout, data that is valuable to your physician in assessing your progress. In cases of severe deconditioning, a brief stay in an in-patient physical therapy program is an option as well.
Unless your physical therapist or personal trainer understands POTS, you could be assigned inappropriate upright exercises like walking on a treadmill or riding an upright exercise bike.
The best exercises are those that cause no orthostatic stress. Reclined stretches, yoga positions, and weight lifting as well as seated exercises on recumbent bikes or rowing machines are good choices, as is swimming.
The patient must build up tolerance over time and should not attempt upright exercises for several months. (Note that this varies from case to case.)
Dysautonomia International provides the following home exercises tips. REMEMBER, never start an exercise program without consulting your doctor!
Beginning Gentle Movements
Remember to be patient with yourself, especially if you are suffering from reconditioning as a consequence of a long period of inactivity. Remember that even 1-2 minutes a day is progress, so long as you stay with it and work to increase your tolerance.
Leg Pillow Squeeze – In a reclining position, place a folded pillow between your needs. Squeeze and hold for 10 seconds. Repeat.
Arm Pillow Squeeze – Fold the pillow and squeeze it between your hands in a “praying” position for 10 seconds. Repeat.
Alphabet Toes – In a reclining position, lift your leg slightly and write your name in the air with your toes. Build toward doing the whole alphabet several times a day.
Side Leg Lifts – Lie on your side and lift your leg up and then down without touching your legs together. Repeat.
Front Leg Lifts – Lying on your back, lift your leg until your toe is pointed at the ceiling. Repeat and then switch to the other leg.
Remember that any kind of stretching will help your blood to move around your body and will take stress off of your joints. Go through your whole body simply performing mild stretches with your feet, legs, back, arms, and neck. Going through this sequence when you wake up in the morning is a great way to start the day. Use the same technique to help relax before going to sleep at night.
Many patients will be able to begin at this level if they have not experienced a long period of deconditioning. Plan on stretching 5-10 minutes to warm up before doing the exercises.
Discuss a target heart rate with your doctor. Most patients can tolerate 75-80% of their maximum heart rate, but this can be affected by currently prescribed medications.
Purchasing a heart rate monitor is a good idea to more accurately work within your set target range. The most accurate units are the ones that place the sensor on the chest where it is held in place with a strap. Finger-based units are not as accurate for patients experiencing problems with peripheral blood flow.
Rowing – For indoors a rowing machine is excellent, but if possible, plan on graduating to using a kayak or similar boat outdoors. Start slowly, going 2-5 minutes per day. Work toward 45 minutes per day, 5 days a week, with 30 minutes performed within the target heart rate zone.
Recumbent Biking – Recumbent exercise bikes allow riders to pedal in a seated position. As with rowing, begin with just a few minutes per day, working up to 45 minutes a day, five days a week, with 30 minutes at the target heart rate.
Swimming – The pressure of being in the water helps to prevent orthostatic symptoms so even those patients with forms of dysautonomia that have kept them bedridden for years are able to stand upright in a pool for as much as an hour. Begin by stretching and strength training in the water with an exercise “buddy” and work toward actual swimming sessions. It’s possible to get a well-rounded cardio routine in the water that will tone your legs and build the muscles of your core.
Weight Training – Weight training is extremely useful to increase muscle tone and strength, which in turn leads the body to use oxygen more efficiently. Place particular emphasis on the leg and core muscles. Begin with weight machines that allow you to work in a reclined or seated position Be cautious about lifting your arms over your head.
Achieving a level of conditioning that allows for 45 minutes of exercise (including cardio) for at least 3 days a week with emphasis on leg and core strength is an excellent goal. Some patients recover so well that they are able to jog, run, or walk several miles per week.