Exercise for POTS
Written by Kristen McCluskey, Women's Health Exercise Physiologist at Meri Exercise Physiology
Understanding POTS
Postural Orthostatic Tachycardia Syndrome, more commonly known as POTS, is a condition that affects the autonomic nervous system and cardiovascular function. It is characterised by an abnormal increase in heart rate when moving from lying or sitting to a standing position. This response often comes with a range of challenging symptoms, making daily life difficult for many individuals.
The term "postural orthostatic" refers to how the body reacts to changes in posture. In people with POTS, the shift to standing often results in a drop in blood pressure. To compensate, the heart rate accelerates significantly, usually exceeding 100 beats per minute, leading to what’s known as tachycardia. Many people with POTS also have smaller heart size and reduced blood volume compared to those without the condition. These factors contribute to poor cardiovascular fitness and can make routine activities such as eating, showering, or attending school or work feel exhausting.
Common Symptoms and Who It Affects
POTS tends to affect more women than men, especially those of childbearing age, although anyone can develop the condition. The symptoms can vary widely, but often include:
Fluctuating blood pressure
Elevated heart rate
Lightheadedness or dizziness
Nausea
Excessive sweating
Anxiety
Exercise intolerance
Unfortunately, there are currently no medications specifically for POTS listed on Australia’s Pharmaceutical Benefits Scheme, which can make effective management more challenging.
How Exercise Can Help Manage POTS
While physical activity often triggers symptoms in people with POTS, structured and supervised exercise can actually be one of the most effective ways to manage the condition. Under the guidance of a qualified professional like an exercise physiologist, exercise can gradually improve physical capacity and symptom tolerance.
With consistent training over a period of three months, many people with POTS experience increased blood volume and improved heart function. Research has shown that supervised exercise can significantly reduce symptoms—and in some cases, individuals may no longer meet the diagnostic criteria for POTS. However, it's important to note that exercise isn’t a cure; symptoms can return if the exercise regimen is stopped.
Exercise also provides added benefits such as better mental health and enhanced overall quality of life.
Recommended Exercises for POTS Management
When starting an exercise program for POTS, it’s best to begin with aerobic and strength training exercises that focus on the lower body and minimize the impact of gravity. Ideal forms of cardio include:
Recumbent cycling
Rowing
Swimming
For strength work, floor-based exercises are a great place to start, as they help avoid symptom flare-ups. Examples include:
Glute bridges
Planks
Side-lying leg raises
As exercise tolerance builds, resistance bands, light weights, and seated resistance training can be gradually introduced. The key is slow and consistent progression under professional supervision.
Thanks for reading! I hope this helped you better understand POTS and how movement can play a powerful role in managing it. If you’re living with POTS and not sure where to start, know that you’re not alone—and support is available.
Take care and move gently,
Kristen x
Women's Health Exercise Physiologist | Meri Exercise Physiology
References
Australian POTS Foundation. (2021). What is POTS? https://potsfoundation.org.au/
Bruce, B. K., et al. (2016). Improvement in functioning and psychological distress in adolescents with postural orthostatic tachycardia syndrome following interdisciplinary treatment. Clinical Pediatrics, 55(14), 1300–1304.
Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience, 215, 20–27.
Fu, Q., et al. (2011). Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension, 58(2), 167–175.
Johnson, J. N., et al. (2010). Postural orthostatic tachycardia syndrome: a clinical review. Pediatric Neurology, 42(2), 77–85.
Karas, B., et al. (2000). The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pacing and Clinical Electrophysiology, 23(3), 344–351.
Shibata, S., et al. (2012). Short-term exercise training improves the cardiovascular response to exercise in the postural orthostatic tachycardia syndrome. The Journal of Physiology, 590(15), 3495–3505.
