POTS stands for Postural Orthostatic Tachycardia Syndrome, a condition that affects the autonomic nervous system (ANS). The ANS controls involuntary bodily functions like heart rate, blood pressure, digestion, temperature regulation, and breathing without conscious effort.
When a person without POTS moves from a lying to sitting or standing position, the body quickly adjusts to keep the blood flowing to the brain and balances the heart rate accordingly. The ANS essentially tells the blood vessels in the lower body to constrict to keep the blood from pooling in the legs. This response makes sure that the brain always has enough blood flow to continue to work well.
However, for a person who suffers from POTS, the ANS doesn’t respond this way and these positional changes don’t happen quite so smoothly. Blood tends to pool in the lower body as the person stands up, which reduces blood return to the heart. To compensate, the heart beats faster and the person may feel symptoms such as light-headedness, which could potentially lead them to pass out.
Who gets POTS ?
POTS most commonly affects younger women aged 15–50, but it can occur in men and people of any age.
Figuring out why someone might have POTS can be difficult as there are many possible underlying reasons. While the exact cause of POTS is not always known, there are certain environmental triggers such as viral infections, significant illness, pregnancy, and chronic fatigue that can onset symptoms. People with connective tissue disorders including Ehlers-Danlos Syndrome also appear to be more predisposed to developing POTS.
Some people have a genetic predisposition, while others may develop POTS without a clear trigger. Despite these differences, the symptoms are often similar — and early recognition and management can make a real difference in daily life.
Common symptoms of POTS
POTS isn’t a disease, it’s a group of symptoms that are often seen together, which present differently from person to person. Some of the most common symptoms include:
- A rapid increase in heart rate when standing
- Dizziness or light-headedness
- Fatigue or low energy
- “Brain fog” or difficulty concentrating
- Nausea or gastrointestinal discomfort
- Temperature regulation issues
- Fainting or feeling close to fainting
These symptoms can fluctuate from day to day and are often worsened by heat, dehydration, or standing for long periods.
How to manage the symptoms of POTS
While there’s no one-size-fits-all approach, POTS can often be managed effectively through a combination of education, lifestyle changes, medical support, and structured exercise. Everyone is going to have different strategies that work for them but a few key ones include:
Hydration and electrolyte intake to support blood volume
Increased salt intake to manage blood pressure
Compression garments to help regulate blood flow and prevent pooling in the legs
Pacing strategies to reduce symptom flare ups
Gradual reconditioning to build strength and cardiovascular endurance
How exercise helps manage the symptoms of POTS
Exercise is one of the most effective long-term management tools for POTS, but it needs to be carefully graded and individualised to ensure results. The goal isn’t to push through symptoms, it is to retrain the body, in particular the cardiovascular system, to tolerate upright movement again.
The aim of exercise is to improve blood flow and circulation back up to the heart and brain. Strengthening the legs and core muscles assist with this action which is known as “venous return”. Graded exercise also helps reduce symptoms of fatigue and improves overall function, as well as improving general strength and stability.
In the early stages, exercises are often performed in a lying, sitting or semi-reclined position – think rowing, cycling, Pilates. This allows the body to move and strengthen without stressing the body in an upright position that triggers symptoms. As time goes on and tolerances improve, the shift focuses towards exercises in standing positions.
This process takes time and you are not going to see changes within one or two weeks. Most people need to commit to a structured and guided exercise program for at least 8-12 weeks before they notice meaningful changes in symptoms like fatigue, dizziness or exercise tolerance.
When living with POTS, it’s important to remember that your body is adapting to a new way of regulating your blood flow and heart rate responses. Unlike general fitness outcomes, improvements with POTS can feel slow and unpredictable. The key is to progress slowly, stay consistent, and listen to your body.
The takeaway ?
Living with POTS can be challenging but improvement through regular exercise is absolutely possible with the right guidance and support. Through education, gradual reconditioning and a compassionate approach, exercise can become a powerful tool in managing symptoms and improving overall quality of life.
Kirsty is an Exercise Physiologist who helps support people with POTS, hypermobility spectrums disorders (HDSs), and Ehlers Danlos Syndrome (EDS), by providing and supervising tailored, and individualised exercise programs. If you’d like to make a booking to see Kirsty, you can do so by calling (03) 97522368, or you can BOOK ONINE.