POTS Fitness Guide: How to Build Endurance and Strength

Oct 7

4 Practical Tips to Find Your Ideal Exercise Routine with Postural Orthostatic Tachycardia Syndrome

By Brennan Seevers, DPT - Moore MyoWorx Denver

How to exercise with POTS — *Walking is great exercise. Find a time of day that you feel the best, and isn't overly hot. You can gradually increase the distance based on how you feel after.*

Living with Postural Orthostatic Tachycardia Syndrome (POTS) presents unique challenges when it comes to exercise.

Many patients find themselves caught between conflicting advice and the reality of managing their symptoms. At Moore Myoworx in Denver, we aim to clarify the relationship between exercise and POTS, offering practical insights for maintaining physical activity as part of your recovery journey.

POTS falls under the umbrella of dysautonomia, a condition affecting the autonomic nervous system responsible for regulating heart rate, blood pressure, and other involuntary functions. Depending on how severe your POTS symptoms are, your daily activity level may have dramatically shifted. While some experience mild lightheadedness and dizziness, others who are much more severe, can experience a significant loss of function. It’s important to pace yourself based on your physical abilities and symptom load, and slowly integrate endurance building into your daily routine to continue to see consistent results.

Understanding the Challenge of POTS

For POTS patients, the mere thought of exercise can be daunting. Common concerns include:

Fear of symptom flare-ups
Uncertainty about appropriate exercise types and intensity
Difficulty finding consistent energy levels
Confusion about contradictory medical advice

Despite these challenges, research consistently shows that targeted physical activity plays a crucial role in managing POTS and improving quality of life.

There’s a common misconception surrounding exercise that a workout is only effective if you are sore afterwards. This is entirely not the case. With any type of training to build endurance, it is important to progress at a rate that is both moderately challenging but manageable. The ideal progression is increasing by a few reps every few days to gain strength without injury to the body, or causing an increase in symptoms.

While you’re increasing your endurance, it is vital to stay below the trigger point threshold. And mind you, this will take patience but is a crucial part of recovery!

Here are the 4 steps you can take to properly build endurance and manage your POTS symptoms…

1) Establish Your Base Endurance Level

Learning where and how to start can be one of the most intimidating parts of the process. It’s important to start low so as not to increase symptoms. It’s much easier to add reps in the following days than it is to deal with the increase in symptoms or pain from overdoing it. Remember, even if you have the surrounding strength, you are only as strong as your weakest muscle so you must start slowly.

Recognize that any movement is beneficial
Start with exercises you can perform lying down or seated
Focus on consistency rather than intensity

Begin with 5-10 reps at light to no resistance for two days. If symptoms or pain have not increased, begin to increase the reps by one each day until you feel that the exercises are challenging but manageable. The goal is to match the level of release with the proper muscle endurance required to maintain the muscle release.

POTS Exercise Tips: Light weights and increased reps can build endurance — *Using light weights can clearly determine your base endurance level. Steadily increasing the number of reps with those same weights can build your endurance.*

2) Build Endurance

The process of building endurance can seem tedious and confusing, but it doesn’t have to be. Focus on the following:

Gradually increase duration and intensity
Listen to your body and adjust accordingly
Celebrate small victories and improvements

We like to follow the “3 by 3 rule.” Every 3rd day, you want to increase the number of reps by up to 3. This will allow ample time for the body to get used to the new endurance without feeling stagnant, and not shock the muscles so that they retighten and cause an increase in pain or symptoms. This progression should feel comfortable and will be consistent.

Resistance bands for POTS endurance — *Using resistance bands can be an alternative to weights - and a great way to build endurance.*

3) Manage Symptoms

It’s very common for symptoms to arise here and there throughout recovery. If you feel you have overdone your exercise, lightly stretching the affected area and applying gentle heat will help to counteract it. Instead of continuing to increase reps at this point, decrease slightly and stay at that level for a few days until pain and/or symptoms subside. Once pain and/or symptoms have decreased, then continue to gently increase endurance beginning from that point again.

It's normal to experience setbacks in your exercise journey. Remember:

Progress isn't linear
Adjustments to your plan are normal and expected
Rest when needed, but try to maintain some form of movement
Focus on long-term progress rather than day-to-day fluctuations

4) Remember Not to Overdo It

As symptoms fade and your endurance grows, remember not to overdo it. There are factors that are unfortunately out of your control, such as environmental stressors and barometric pressure changes, that will affect your body.

In these situations, you might experience symptoms or pain come up as you complete your typical strength program. Give yourself grace, and remember it’s important to meet your body exactly where it is at, not where you think it should be. If you push your body too far, you can cause a further increase in symptoms and/or pain and feel like you hit a wall or have taken steps backwards. At any point during your strength/endurance training you feel pain and/or symptoms come up, stop and stretch gently. Do not continue and push through it and put yourself at risk of injury.

Examples of Exercise

There is no need to overcomplicate exercise, start with what you have and go from there. Here are a few easy options to start:

Go for a walk: Find a time of day that you feel the best (and isn't overly hot outside) and walk for 5 minutes. You can gradually increase the distance based on how you feel after
Arm and leg movements laying down: You can start with simple shoulder and leg movements in a comfortable lying position within a pain free range of motion. Gradually build up your repetitions and potentially add weight
Ride an exercise bike: You can choose to start with a bike that incorporates more back support or begin with an upright bike. Be sure to pick a speed, resistance and length of time that is within your comfort zone and build from there.

While the path may seem challenging, maintaining daily movement is indeed a key component in your recovery process. By approaching exercise thoughtfully and consistently, you can:

Gradually improve your symptoms
Build confidence in your physical abilities
Work towards returning to activities you love
Enhance your overall quality of life

Remember, the goal isn't to return to high-intensity exercise immediately, but to build a sustainable, adaptable approach to physical activity that supports your health and well-being.

Moore Myoworx is an expert in treating your POTS symptoms. Learn more from our blog: Understanding POTS Syndrome

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