A recent article published in the Heart Rhythm Journal evaluated the usefulness of an exercise training intervention in a community setting (George SA.. Levine B, Heart Rhythm 2016;13:943-950). 40% of 250 patients completed the 3 month exercise program supervised by physicians, in addition to increasing salt and water intake, and their symptoms marked improved, such that 70% of those completing this no longer met criteria for POTS.
The key messages for exercise are to focus on :-
- Regular and sustained exercise, starting slowly, but aiming to increase to 30 minutes per session at least every other day
- Initially avoid upright positions. Rowing machines provide an excellent aerobic and all body workout, and recumbent bicycle and swimming are good alternatives.
- Setting realistic expectations : This is crucial as patients are likely to feel worse initially, for as long as 4-6 weeks after starting regular activity before they start to notice any improvement. Persistence and belief is key to continuing on the program.
It goes without saying that the conservative strategies should be maximised: fluid intake, front-loaded at the start of day, aiming for 3L/day with increased salt intake (6-10g a day).
For more information about POTS, visit the POTS.org.uk website or book in a consultation with our specialist on 0207 436 0669 at the LCC.
Written by Boon Lim, Consultant Cardiologist and Clinical Lead for the Imperial Syncope Diagnostic Unit.