Living with Postural Orthostatic Tachycardia Syndrome (POTS) can be challenging. Symptoms such as dizziness, light-headedness, rapid heart rate, fatigue, exercise intolerance, and brain fog can make everyday activities feel difficult.
For many people, it can seem counterintuitive that exercise is recommended when standing, walking, or physical activity may trigger symptoms. However, research increasingly shows that appropriately prescribed exercise is one of the most effective strategies for improving long-term function and symptom management in individuals with POTS.
At The Active Studio, exercise programs are tailored to help individuals gradually build tolerance, improve cardiovascular function, and increase confidence with movement.
What Is POTS?
POTS is a condition affecting the autonomic nervous system — the system responsible for regulating functions such as heart rate, blood pressure, and circulation.
A defining feature of POTS is an excessive increase in heart rate when moving from lying down to standing, often accompanied by symptoms such as:
- Dizziness or light-headedness
- Palpitations
- Fatigue
- Exercise intolerance
- Brain fog
- Reduced concentration
- Shortness of breath
While the exact causes can vary, many individuals with POTS experience challenges with blood circulation, autonomic regulation, and physical deconditioning.
The Role of Deconditioning
One of the challenges with POTS is that symptoms often lead people to reduce their physical activity.
Over time, reduced activity can contribute to:
- Decreased cardiovascular fitness
- Reduced blood volume
- Loss of muscle mass
- Reduced exercise tolerance
Unfortunately, these changes can worsen symptoms and make daily activities even more difficult.
Exercise aims to gradually reverse these adaptations and improve the body’s ability to regulate circulation more effectively.
Improving Blood Volume and Circulation
Many people with POTS have a reduced circulating blood volume, meaning less blood is available to return to the heart when standing.
Regular exercise can help improve:
- Plasma volume
- Venous return (blood flow back to the heart)
- Cardiac filling
- Overall circulatory efficiency
These adaptations can reduce the cardiovascular strain that occurs when moving into an upright position.
Improving Cardiac Function
Exercise training improves the heart’s ability to pump blood efficiently.
Over time, regular aerobic exercise can increase:
- Stroke volume (blood pumped per heartbeat)
- Cardiac output during activity
- Cardiovascular efficiency
As stroke volume improves, the heart often becomes less reliant on excessively increasing heart rate to maintain circulation.
This can contribute to improved symptom control and exercise tolerance.
Strengthening the “Muscle Pump”
The muscles of the legs play an important role in helping blood return to the heart.
When the calf, thigh, and glute muscles contract, they assist circulation by pushing blood upwards against gravity.
Strength training can improve:
- Lower limb strength
- Venous return
- Standing tolerance
- Functional capacity
This is one reason resistance training is often an important component of POTS management.
Improving Autonomic Nervous System Regulation
Regular exercise influences the autonomic nervous system itself.
Research suggests exercise may help improve:
- Parasympathetic nervous system activity (“rest and digest”)
- Heart rate regulation
- Cardiovascular responsiveness
These adaptations can help reduce the exaggerated cardiovascular responses that often occur with postural changes.
Managing Fatigue and Brain Fog
Fatigue is one of the most disabling symptoms experienced by many people with POTS.
Exercise helps improve:
- Mitochondrial function
- Oxygen delivery
- Energy production
- Physical capacity
As overall fitness improves, everyday activities often require less effort, which can help reduce feelings of fatigue and improve cognitive function.
Many individuals also report improvements in concentration and mental clarity as exercise tolerance increases.
What Type of Exercise Is Best?
Exercise for POTS should be gradual, structured, and symptom appropriate.
Initially, many people tolerate exercises performed in supported or seated positions better than upright activities.
Early-stage exercise may include:
- Recumbent cycling
- Rowing
- Swimming
- Seated resistance training
As tolerance improves, programs can gradually progress towards:
- Walking
- Upright cycling
- Functional strength exercises
- Higher-intensity aerobic exercise
The goal is to progressively expose the body to increasing cardiovascular demands without provoking excessive symptoms.
How Much Exercise Is Recommended?
There is no one-size-fits-all approach.
Most exercise programs begin with:
- Shorter duration sessions
- Lower intensities
- Frequent recovery periods
Over time, duration and intensity are gradually increased as capacity improves.
Progression is often slower than traditional exercise programs, but consistency is key.
Important Considerations
People with POTS may benefit from:
- Gradual position changes during exercise
- Adequate hydration
- Appropriate electrolyte intake
- Monitoring symptom response
- Individualised progression
Good days and bad days are common, so flexibility within the program is often important.
The goal is not to eliminate symptoms immediately, but to steadily improve physical capacity and quality of life over time.
How The Active Studio Can Help
At The Active Studio, exercise programs are tailored to support individuals living with POTS through safe, structured, and progressive exercise prescription.
We focus on:
- Building cardiovascular capacity
- Improving strength and circulation
- Managing fatigue
- Increasing confidence with movement
- Supporting long-term physical function
Exercise can be a powerful tool in helping individuals with POTS improve their tolerance to daily activities and regain confidence in their body’s capabilities.
Looking for support managing POTS through exercise?
Get in touch to discuss a personalised exercise program tailored to your symptoms and goals.
