In some people with POTS, deconditioning that occurs as a result of prolonged illness may further exacerbate symptoms. Some of Dr. Levine's studies have demonstrated a lower stroke volume in people with POTS, which can be improved with exercise. Dr. Levine emphasizes that the position of your body during exercise is important. Starting POTS patients with recumbent exercise like swimming, rowing, and recumbent bicycle is important.
CHOP Modified Exercise Program for POTS
Originally developed by Dr. Levine, this modified exercise protocol from the Children's Hospital of Philadelphia is a widely used guideline for people with POTS to work to increase their stamina.
Build up the number of minutes spent exercising very slowly. Many with POTS have exercise intolerance and orthostatic intolerance (symptoms increase when standing). Start them with five minutes of recumbent exercise per day and then add one minute to the exercise regimen per week. Eventually, try to have your patient build up to 30 minutes per day for at least three days per week.
Recumbent aerobic exercises are recommended: swimming, recumbent stationary bike or rowing machine. For patients with both POTS and Ehlers-Danlos Syndrome, be aware that exercising like the rowing machine that require pulling may lead to subluxations or dislocations.
Mix strength training with aerobic exercise. Two days per week should be devoted to strength training of the legs and core. Focus on exercises that can be done in a chair or on the floor, like a seated leg press, leg curl, leg extension, calf raise, chest press, and seated row. Exercises for the core might include abdominal crunches, back extensions, and side planks.
Exercise to tackle insomnia. If sleep is an issue, exercising in the late afternoon or early evening is the best time to combat insomnia.
Increase Blood Volume and Flow
Increase the salt intake. 6-10 grams of salt in pill form (SaltSticks, Thermotabs, other types) is often required in addition eating salty snacks and over-salting food. Salt helps POTS patients retain water in their blood vessels which elevates blood pressure to normal levels (or prevents it from falling when they stand). Naturally salty foods to try include cold cuts, cured meat, and store bought soups. For POTS patients taking Florinef, Thermotabs are a great way to get both salt and potassium.
Drink, drink, drink. Individuals with POTS should be drinking AT LEAST 2-4 LITERS of water, milk, Pedialyte, Gatorade, Propel etc. per day. When consuming high amounts of salt, you MUST have fluids to accompany them to prevent dehydration.
Drink a bottle of water in 1-2 minutes before getting out of bed. Drinking while pumping your leg muscles can make it easier for POTS patients to get out of bed without fainting.
Try compression hose, abdominal binders and/or gloves with at least 20-30 mm Hg of pressure to help maintain blood flow back to the heart. Recent research suggests that compression garments for the thigh, buttocks, and abdomen give the best therapeutic effect.