June 20

0 comments

Orthostatic Intolerance and POTS and Exercise

By Dan

June 20, 2020

OI, POTS

How to Exercise and make yourself stronger when you have POTS and OI. 

POTS or Postural Orthostatic Tachycardia Syndrome is a marked increase in heart rate during orthostasis (a drop in Blood Pressure when standing). Orthostatic intolerance (OI) is the development of symptoms when standing upright which are relieved when reclining.

If you are in Canberra, here is an outline to get you exercising when you have POTS and or OI

1.

A structured exercise program featuring endurance (aerobic) reconditioning with some resistance (strength) training for the lower body is recommended for patients with POTS. A recumbent bike is good, with some bands to add resistance to your leg muscles.

2.
Salt loading in patients with posturally-related syncope has been shown to increase plasma volume and orthostatic tolerance. Thus, POTS patients who have normal cardiac and renal-adrenal function are recommended to gradually increase their daily salt intake by using dietary salt up to 10 g per day, if tolerated . A slow, progressive increase in daily sodium intake in/on the food and eating salty snacks are recommended. However, salt tablets should be avoided because they are very concentrated and can induce an osmotic load into the stomach which may cause nausea, vomiting and dehydration, leading to reduced rather than expanded plasma and blood volume. Patients are also encouraged to increase water intake up to 3 L per day. Increasing salt and water intake throughout the day and consuming them together are recommended, as water alone is not effective in long-term volume expansion.
3.
You are also encouraged to elevate the head of the bed off the ground 20 to 30 cm, in order to increase circulating plasma and blood volume when sleeping. Large phone books, blocks of wood, or bed risers placed under the feet at the top of the bed work best for placing the entire body at a slight angle during sleeping at night. This approach is different from sleeping on a few extra pillows under the head. The rationale behind this approach is that mild orthostatic stress induces fluid shift to the lower body and decreases central blood volume and the effective circulating blood, which activate the renin-angiotensin-aldosterone system, leading to salt-water retention and volume expansion.

 There are many types of orthostatic intolerance. OI can be a subcategory of dysautonomia, a disorder of the autonomic nervous system occurring when an individual stands up.

If you have POTS, you may be unable to stand or remain upright for prolonged periods of time because of intolerable light headedness, weakness and near syncope (temporary loss of consciousness caused by a fall in blood pressure).

Orthostatic intolerance (OI) is characterised by a drop in blood pressure of 20mmHg, while Postural Orthostatic Tachycardia Syndrome (POTS) is characterised by an increase in heart rate of 30bpm. Both of these changes happen when a person moves from lying down to standing (a postural change). 

OI/POTS is often associated with other conditions, such as chronic fatigue syndrome or myalgic encephalomyelitis, but can also be a stand-alone condition.

This disorder mostly affects pre-menopausal women. Severely affected patients are unable to work, to attend school, or to participate in recreational activities, resulting in substantial morbidity. However, the underlying mechanisms remain unknown and the effective therapy is uncertain.

Recent research has demonstrated that cardiovascular de-conditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible.

The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms.

As patients become increasingly fit, the duration and intensity of exercise should be progressively increased, and upright exercise can be gradually added as tolerated. Supervised training is preferable to maximise functional capacity.

The symptoms of OI/POTS can include:

  • Postural dizziness (from lying/sitting to standing)
  • Postural vision spots or blindness
  • Sensitivity or intolerance to the heat and/or a change in temperature
  • Nausea, over-fullness and a lack of appetite
  • Swelling in the feet after sitting or standing still for a while
  • Cold hands and feet
  • Salt cravings
  • Irregular sweating patterns
  • Fatigue from standing for a while
  • Light-headedness while in the shower or abnormal fatigue after showering
  • Intolerance to alcohol
  • Fidgeting.

What you Need To Do Now

My name is Daniel O'Sullivan and if you are finding that you cannot find a good balance in managing your POTS or OI condition, please call me, book in with me, or message me to develop a management strategy. My Clinic is located in Weetangera, Belconnen, Canberra.

The Best Resources for Postural Orthostatic Tachycardia Syndrome (POTS) Treatment in Canberra


Accelr8 Rehab

As mentioned above Accelr8 Rehab is the best place for you if you need to start exercising and managing POTS and OI. Exercise Physiology prescription along with massage is a great combination for your condition.

Active Health Clinic

Our belief in long-term self-management – to help our clients get the very best out of their life – is what underpins everything we do.

We help people overcome complex health conditions including:

  • Chronic fatigue syndrome and myalgic encephalomyelitis (CFS/ME)
  • Orthostatic intolerance and postural orthostatic tachycardia syndrome (OI/POTS)
  • Fibromyalgia and complex pain syndromes
  • Idiopathic hypersomnia and narcolepsy
  • Related anxiety and depression. 

Get in touch and we'll get back to you as soon as we can. We look forward to hearing from you!

Reception hours: 9:30 am to 4:30 pm Monday to Friday

Appointment Times:
Monday to Friday 8am - 6pm
Saturdays 9am - 1pm

Orthostatic Intolerance and POTS — Active Health Clinic

Get rid of dizziness

Years ago in our clinic, we noticed many of our clients who had fatigue or pain also had many postural symptoms, such as dizziness, visual disturbance, sensitivity to the heat and swelling in their hands and feet. This led us, in collaboration with numerous specialists in Melbourne, to investigate why people had these additional symptoms, which are known as orthostatic intolerance (OI) or postural orthostatic tachycardia syndrome (POTS). We have since developed a rehabilitation program for OI/POTS that relies on the latest research to change people's lives, and has even been successfully used by our staff.

Orthostatic intolerance and POTS

Orthostatic intolerance (OI) is characterised by a drop in blood pressure of 20mmHg, while postural orthostatic tachycardia syndrome (POTS) is characterised by an increase in heart rate of 30bpm. Both of these changes happen when a person moves from lying down to standing (a postural change). OI/POTS is often associated with other conditions, such as chronic fatigue syndrome or myalgic encephalomyelitis, but can also be a stand-alone condition.

The symptoms of OI/POTS can include:

  • Postural dizziness (from lying/sitting to standing)
  • Postural vision spots or blindness
  • Sensitivity or intolerance to the heat and/or a change in temperature
  • Nausea, over-fullness and a lack of appetite
  • Swelling in the feet after sitting or standing still for a while
  • Cold hands and feet
  • Salt cravings
  • Irregular sweating patterns
  • Fatigue from standing for a while
  • Light-headedness while in the shower or abnormal fatigue after showering
  • Intolerance to alcohol
  • Fidgeting.

Our program

Our program is designed and focused on OI/POTS rehabilitation and helps our clients make and maintain gains made, through a holistic approach. We will do a thorough assessment of your health during your first appointment. Depending on your particular situation, you may need another 4-5 individual sessions over 1-2 months, or longer if you also have a fatigue or pain syndrome.

The sessions focus on:

  • OI/POTS physiology and management, including hydration, salt intake and medications
  • Setting up a cardiovascular exercise routine
  • Strength training to promote blood flow
  • Goal setting
  • Sleep physiology and hygiene
  • Identifying triggers and developing a setback plan
  • Stress and anxiety management
  • Symptom mapping.

Our program aims to help you have a ‘normal day’ or return to work or school, without increasing your symptoms. We teach you the skills to deal with any future problems through setback planning and your personal therapy manual.

We can also refer you to a specialist near you to help you manage your health and get access to medication if appropriate.

See our Testimonials page to hear from those who have experienced our OI/POTS rehabilitation program for themselves.

Cost and questions

For program costs and rebates available, please see our Fees and Rebates page.

Do I need a referral? What if I can't get to your clinic? Please visit our FAQ page for answers to these and other questions about our programs.

What if I've already done another treatment program?

If you have had treatment for OI/POTS in the past, that's great! We take an inclusive approach and can build on and increase your understanding and progress through our program. We won't make you redo things you have already done through another program.

What causes OI/POTS?

The cause of OI/POTS is unknown, however, it's most likely caused by a range of factors.

We believe that there are two main types of OI/POTS: peripheral and central.

Peripheral OI/POTS is caused by non-neurological factors. People who have OI/POTS often also have joint hyper-elasticity. This extra stretchiness may make them more likely to have joint injuries and also have OI/POTS because of increased artery or vein elasticity. This can lead to poor blood vessel constriction and therefore poor blood pressure control.

Imagine you were trying to push water through the type of balloon clowns make animals with. When you push down in one area it bulges in another. However, if you used a garden hose instead of a balloon it would not bulge but push the water out the other end at a greater pressure. People with OI/POTS and hyper-mobility are thought to have stretchier blood vessels, which leads to poor blood vessel constriction.

Central OI/POTS is most likely caused by the sympathetic nervous system, which controls automatic body functions like blood pressure and heart rate. One reason for this may be because of an increased sympathetic load leading to a delayed or irregular response. (This can also often happen in people with chronic fatigue syndrome).

Postural Orthostatic Tachycardia Syndrome Treatment

ZebrasAus

Postural Orthostatic Tachycardia Syndrome (POTS), hyperadrenergic POTS, Orthostatic Intolerance (OI), postural tachycardia, vasovagal syncope, neurocardiogenic syncope, pre-syncope, initial orthostatic hypotension

The variety of conditions listed above possess one common debilitating feature: an inability to tolerate upright positions. In the case of POTS, a significant increase in heart rate will occur (>30bpm) along with lightheadedness, weakness and blurred vision. In initial orthostatic hypotension, a significant drop in blood pressure will be observed and in vasovagal syncope, a transient loss of consciousness will present.

These are the acute symptoms which are seen when the body is placed under stress such as being placed upright for a prolonged period of time (this may be a few minutes of sitting up in some severe cases), being in a hot, humid environment or changing postures from supine or sitting to standing.

OPENING HOURS & CONTACT

436 Burke Rd, Camberwell 3124
(At Upwell Health Collective)

POTS: Causes, Treatment, and More - Healthline

Overview

Postural orthostatic tachycardia syndrome (POTS) is a term used to describe a group of neurological conditions that have similar symptoms. People with POTS feel fatigued or dizzy when they stand up from a sitting position. Most people diagnosed with POTS experience heart palpitations or a significantly increased heart rate when they stand up.

When you have these symptoms after standing upright, it’s known as orthostatic intolerance (OI). It’s estimated that at least 500,000 peopleTrusted Source in the United States experience OI, the main symptom of POTS.

Some sources say the number of people with POTS is much higher, estimating that as many as 3 million adolescents and adults experience it. Some people have symptoms that completely disappear within 2 to 5 years, and others have symptoms that come and go over their lifetime.

People with POTS also experience different degrees of symptom severity. About 25 percent of them have symptoms that are so severe, it impairs their ability to perform household tasks or to participate in the workforce.

Keep reading to learn more about the symptoms, why POTS happens, and how to cope.

What are the symptoms?

People who don’t have POTS can switch among reclining, sitting, and standing without much thought. The autonomic nervous system (ANS) takes over and manages how gravity affects the body according to its position, including the mechanism that manages balance and blood flow. Your heart rate should adjust to be 10 or 15 beats per minute (bpm) higher when you’re standing than when you’re sitting, and your blood pressure should decrease only slightly.

If you have POTS, though, your body doesn’t send the right signals to your brain and heart when you change position. This results in an increased heart rate of up to 30 bpm higher than usual. This can make you feel like you need to sit or lie back down.

Flushing can also occur due to the activation of certain chemicals by immune cells in your body. This can result in breathlessness, headache, and feeling lightheaded. This activation can also cause nausea, vomiting and diarrhea. Blood may also pool in your lower legs and feet, giving them a swollen or purple appearance.

You may also experience:

What causes POTS and who’s at risk?

The cause of POTS isn’t always clear. That’s because the condition doesn’t trace back to one root cause for every person that has it. There is some evidence that certain genes may contribute to POTS development. ResearchTrusted Source by the Mayo Clinic suggests that in half of POTS cases, the cause might be autoimmune related.

It does seem that POTS symptoms are often triggered by life events, such as:

These events may change the way that the ANS behaves for a period of time.

Although POTS can affect anyone of any age, about 80 percent of cases are diagnosed in women ages 15 to 50 years.

Medical Professionals Directory | The Ehlers Danlos Society

The Ehlers-Danlos Society acknowledges how hard it is to find an EDS-friendly specialist across various disciplines globally, so to further our commitment to your access to management and care we have created this list that is populated by professionals submitting their information to our site.

It is important to note that The Ehlers-Danlos Society does not have any ownership or direct financial interest in any of the specific doctors or clinics listed on our EDS-friendly directory. There are no formal listing criteria, and The Ehlers-Danlos Society does not endorse, recommend, or certify any of these physicians.

If you think you have an emergency, call your doctor or emergency services immediately.

The Ehlers-Danlos Society does not guarantee or make any warranties, express or implied, as to the quality of medical advice or care given by any listed physician.

The information listed in the results are based solely upon the data entered by the medical professionals listed.

You might also like

Do You Want a Free Persistent Pain Manual? Please Click Below