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Exercise Stress Test for POTS: What It’s Like

Exercise stress test for POTS

Hi, friends! I recently had an exercise stress test for POTS and want to share what my experience was like in case you or a loved one is about to get one, too. If you’ve followed my blog for the past year, you might know that my POTS suddenly got worse over last winter. One of my most frustrating relapses was an intolerance to running, as well as getting frequent palpitations during upright exercise. When I saw my new cardiologist in August (it took that long to get a new patient appointment), she told me to stop running until I had a stress test done. (It took until December to get that scheduled! Ugh!) 

Keep reading to learn what’s involved in an exercise stress test, specifically a treadmill stress test, and what my experience was like. 

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What’s an Exercise Stress Test?

An exercise stress test, also known as a cardiac stress test, commonly involves doing progressively harder exercise on a treadmill. While you exercise, nurses or doctors monitor your heart’s response to exercise (in other words, when it’s working really hard) via ECG readings, as well as by checking your vitals. The nurse or doctor will tell you to try and push yourself and exercise for as long as you can or until you experience symptoms that call for ending the test. An exercise stress test can help doctors see how POTS affects your heart function during exercise, as well as check for other cardiac issues.

If you’re wondering if an exercise stress test is hard, then I’ll tell you that at least for me, it felt physically hard because I was pushing myself to exercise as long as I could. However, the test itself is relatively straightforward. The actual exercising part doesn’t take too long — mine lasted less than 15 minutes — and you’ll be monitored for the entire test.

My Experience With a Treadmill Exercise Stress Test

So what was my experience like doing a treadmill exercise stress test for POTS? Let’s get into it, step-by-step.

When I entered the testing room, the nurse first asked me some questions, like if I’d ever done an exercise stress test before and what kind of symptoms I was having that prompted the test. Then, she took a blood pressure reading when I was sitting and then another when standing to get baseline readings. After that, she put on my ECG leads by sticking small square pads on my chest and upper ribcage area and connecting them to the monitor wires. Then my heart rate rhythm was live on the computer screen! 

Before starting the test, the nurse explained every step involved in it. Then, another medical professional came into the room and said he’d monitor my ECG in real time while I exercised. He’d also mark anything worth noting for the doctor. They told me to let them know if I felt any symptoms while performing the exercise stress test, like shortness of breath, palpitations, or chest pain.

For the exercise stress test, I did the Bruce Protocol. This protocol includes stages of progressively harder exercise on a treadmill, starting with a very slow walk at a low incline. Each stage lasts for three minutes. When you progress to the next stage, the incline gets steeper and the treadmill belt moves faster. 

Because I had mentioned that I was a runner before my latest onset of palpitations, I did an “accelerated” version of the test. That meant I only did stages one and two for one minute each before progressing to the next stage. Stage three was the first stage I exercised the full three minutes.

The nurse took my blood pressure at regular intervals throughout the test to monitor its response to exercise. This part felt a little challenging because I had to give her my arm, which meant I could only hold on to the treadmill with one hand. Luckily, my uncoordinated tendencies didn’t make any appearances!  

For me, the hardest part about the test wasn’t the speed of the treadmill, it was the incline. Power walking at a steep incline, and then jogging at a steep incline in stage four was hard. I felt it in my calves a ton, so prepare for that if you do a treadmill exercise stress test! (You can also do a stationary bike exercise stress test, depending on the resources available at your medical facility.) 

I almost made it to stage five of the Bruce Protocol. But I used up all my juice and asked to end the test. My heart rate got up to 196 bpm! I’d never let it get that high while running on my own. And to be honest, I was a little surprised they didn’t stop me. (My cardiologist later told me that it’s OK for my heart rate to get that high during exercise at my age, which did give me a lot of peace of mind.) 

But I was frustrated and relieved by my cardiac stress test experience. The reason? I didn’t feel any of the scary palpitations that made me seek a cardiologist in the first place. So, I was frustrated because if it didn’t happen, then they couldn’t document it, which meant I couldn’t get a straight answer for what was happening whenever I felt that. But it was also relieving because I thought, hey, maybe I’m getting better and these palpitations won’t happen as often when I’m exercising upright. I guess time and more exercise will tell.

Once I finished the exercising portion of the test, I sat in recovery for about five minutes so they could monitor my heart rate and blood pressure response. Then, the nurse removed my ECG leads and the little sticky pads (ouch!—literally like ripping off band-aids). After that, I was free to go! I went back to the waiting room where my husband was waiting for me, and I chugged my huge water tumbler of Liquid IV electrolytes. I was only a little sweaty and red-faced.

My Exercise Stress Test Recovery

While that pretty much makes up what happened during my exercise stress test, I also want to share how I felt after the test.

Because I didn’t feel good. At all. 

For the rest of the day, and even an entire day after, I felt like I was in the biggest POTS flare I’d been in since my pre-diagnosis days. My heart rate stayed elevated (high 90s to low 100s when sitting; around 120 while standing). I felt SO. EXHAUSTED. Anything I did felt like I was doing cardio, even if I was just walking to the bathroom or bending over to pick something up. It was terrible. By the end of the second day, my whole body hurt with exhaustion just from standing to do normal daily tasks. And my heart rate still refused to calm down. 

That’s when I thought maybe activating my parasympathetic nervous system would help. So, I tried some things to stimulate my vagus nerve, including icing the back of my head/neck area, doing box breathing (breathe in for 4 seconds, hold for 4, breathe out for 4), and humming. It took some time, but this actually started to work! I felt so relieved that I got my heart rate down to the upper 70s.

All in all, don’t be surprised if you need some extended recovery time after an exercise stress test for POTS like I did. 

How to Prepare for a Cardiac Stress Test:

Here are some tips that can help you or your loved one prepare for your exercise stress test:

  • Wear comfortable clothing and a loose top like a tee-shirt (so the medical staff can more easily get your ECG leads hooked up). Don’t forget to wear sneakers! 
  • Ask your doctor if you can take medications as usual on the day of your test.
  • Ask your doctor if you can eat and drink normally before the test.
  • Bring a big water bottle with your favorite electrolytes, like Liquid IV, to drink after the test.
  • Ask someone to drive you to and from your exercise stress test, if possible, because you’ll likely be tired afterward. And if you’re a little nervous, having someone there for moral support can help!
  • Plan to do some calming and low-energy activities afterward to help your body recover. You might not be up for cooking a big dinner or going out with friends. Kick your feet up and watch some TV or read a good book!
  • It’s not a bad idea to put on compression socks or garments after the test, if you have them. I put on my Vim & Vigr socks and watched tv in bed!   
  • If your skin is irritated by the ECG stickers, put some healing lotion on the affected areas. An option I use and love is Curel Ultra Healing lotion

An exercise stress test can help your doctors see how well your heart works during times of intense activity. It can be a helpful measure to see how POTS affects your body during exercise. It can also determine if any other cardiac issues worth further investigation are present.

Exercise stress test for POTS

If you have any other questions about my experience or want to share what your experience was like, please share in the comments!

Until next time!


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