Everything POTS, Lifestyle

How to Calculate Your Levine Protocol Training Paces

If you’re using the Levine Protocol to improve exercise tolerance and build cardiovascular fitness with POTS, then you’ll need to know how to calculate your target heart rates for each training pace in the program. Sound daunting? That’s why I’m here! In this post, I’ll take you through all the math in a step-by-step process to show you exactly how to calculate your Levine Protocol training paces tailored to your age and fitness level. All you need is a pencil, paper, and a calculator.  

Disclaimer: I am not a medical doctor or a certified personal trainer. All advice I give in this blog is based on my personal experience with the Levine Protocol and research. Consult your doctor before starting this or any new exercise program.

This blog post contains affiliate links, and I may earn from qualifying purchases at no extra cost to you. Full disclaimer here.

Before I begin, as per the Levine Protocol guidelines, if you are on a beta-blocker for your POTS, then you will NOT be able to follow these calculated heart rate ranges. Ask your doctor how you should gauge exercise intensity on these medications.

I detail the different training paces in my post about the Levine Protocol and the CHOP Modified Protocol. In summary, there are five different training paces that you’ll need to calculate heart rate ranges for. They include recovery pace, base pace, mid-maximal steady state (MSS) pace, race pace, and interval pace. By following the step-by-step process below, you’ll be able to calculate your personal heart rate ranges for each Levine Protocol training pace. 

If you are new to the Levine Protocol, have just been diagnosed with POTS, or your doctor has recommended the Levine Protocol, I would suggest going to either a cardiac rehab program or an exercise physiologist first. They’ll help you calculate your target heart rates to get started with the program and monitor your progress through the initial stages.

I went to cardiac rehab for several weeks after my POTS diagnosis for guidance on starting to exercise with this condition. Plus, I also saw an exercise physiologist at Cleveland Clinic whose knowledge from just one appointment has been invaluable throughout my exercise journey.

Once you’re ready to exercise on your own, either at home or at a gym, it’s important to calculate and recalculate your training paces as your fitness level improves. Your supine (or laying) resting heart rate is a simple way to gauge your fitness level. A lower resting heart rate generally indicates better cardiovascular fitness. Since resting heart rate is a factor in determining the values for your training paces, any drastic change in it will consequently change your target heart rates for each pace. Make sense so far? 

So, as you get in better shape and become more fit, you’ll need to recalculate your training paces. On the opposite end of the spectrum, if you take too long of a break from exercise and become less fit, you’ll also have to recalculate these values. That’s why monitoring your resting heart rate is so valuable!

You should find your supine resting heart rate first thing in the morning before getting out of bed. You can do this manually by placing two fingers on the carotid artery in your neck or the radial artery on your wrist. Count your heartbeats for 30 seconds and multiply that number by 2. Or, if you have a smartwatch (like the Fitbit Sense), just check there! Easy! Do this for a few days and take the average as your resting heart rate.

Now, you may be asking, how often should I recalculate my heart rate ranges for the Levine Protocol? To this, I will say there is no definitive answer I can give you, as everyone responds to exercise differently. My rule of thumb? I’ll recalculate my values when I turn a year older, or if my supine resting heart rate has consistently changed by 3 or more bpm for at least a week. Of course, you can recalculate your values whenever you want, but your ranges probably won’t change too much with a change in resting heart rate of only 1-2 bpm.

How to Calculate Your Levine Protocol Training Paces in 9 Easy Steps:

Now that you know why you should calculate (and recalculate!) your Levine Protocol heart rate paces, let’s get down to business calculating them! I’ve taken these steps directly from the Levine Protocol guidelines. You can view the instructions yourself and refer to my example below as a guide. Reminder: The following example is based on my data, so make sure to fill in your own! 

*The order of each pace in ascending order of intensity is: recovery pace, base pace, MSS pace, race pace, and interval pace. 

Step 1: Find your Max Heart Rate (MaxHR): 220 – your age

Example: MaxHR = 220 – 25 = 195 bpm

Step 2: Find Heart Rate Reserve (HRR): MaxHR – supine resting HR

Example: HRR = 195 bpm – 65 bpm = 130 bpm

Step 3: Multiple HRR by .75 (75% of HRR)

Example: 130 bpm x .75 = 97.5 bpm (round up to 98 bpm) 

Step 4: Find Mid-Maximal Steady State (MSS) HR: 75% of HRR + Resting HR

Example: 98 bpm + 65 bpm = 163 bpm

Step 5: Find MSS pace: 5 bpm +/- MSS HR

Example: 163 bpm +/- 5 = 158-168 bpm 

*So, my MSS pace is between 158-168 bpm.

Step 6: Find base pace: Subtract 20 bpm from low end of MSS pace range

Example: 158 bpm – 20 bpm = 138 bpm

*So, my base pace is between 138-157 bpm.

Step 7: Find recovery pace: Less than your lowest base pace HR

Example: 138 – 157 bpm is my base pace range

*So, my recovery pace is < 138 bpm.

Step 8: Find race pace: Multiply .95 by MaxHR

Example: .95 x 195 bpm = 185.25 (round down to 185 bpm); 168 is upper limit of MSS pace 

*So, my race pace is between 169-185 bpm.

Step 9: Find Interval Pace: Anything higher than your greatest race pace value (but not more than your MaxHR!).

Example: My greatest race pace value is 185 bpm; my max HR is 195 bpm

*So, my interval pace is 186 bpm – 195 bpm.

Summary of My Levine Protocol Training Paces:

Recovery Pace = less than 138 bpm

Base pace = 138 – 157 bpm

MSS pace = 158 – 168 bpm

Race pace = 169 – 185 bpm

Interval pace = 186 – 195 bpm

There you have it! Now you know how to calculate your five Levine Protocol training paces! At this point, I’ll usually write up a nice summary of my heart rate ranges for each training pace (like above) and take a picture of it on my phone. This way, I’ll have a reminder with me when I’m exercising so I know: 1. How hard to work, 2. What kind of exercise session to do, and 3. Where to keep my heart rate during exercise.

This may seem like a no-brainer now, but wearing a heart rate monitor is a necessity when exercising with POTS. If you went to cardiac rehab, they’d strap you up to monitors so they can tell if you’re pushing yourself too hard, or not enough. The same logic applies to exercise at home or at a gym. You need to have some way to monitor your heart rate during exercise on the Levine Protocol! It’s crucial to not over- or under-train, which can contribute to rebound symptoms or lack of progress, respectively. 

I’ve used Fitbit products for years, not just for exercise, but also for everyday monitoring. I recently got a new Fitbit Sense smartwatch and love all the new features, like stress management and exercise readiness scores.

For running and higher intensity training, I now also use a Polar H10 Heart Rate Sensor as chest straps are known for their precision accuracy. High-intensity exercise is when I can easily overdo it, so this was completely worth the investment for me.

I depend on both of these products, and while having two monitors is a personal choice, I highly recommend having at least one. I’ve never gone wrong with Fitbit or Polar products! 

The Levine Protocol has changed my life with POTS and has been instrumental in helping my body heal. I know I would not be at the point I am today without using this detailed, step-by-step program. Calculating my heart rates for each training pace has been another detail that’s made all the difference, especially in the beginning months when my supine resting heart rate decreased more. 

Exercising with POTS is hard, but stick with it! The first three months of the Levine Protocol were the most difficult, but it began to get a lot easier after that. Be patient with yourself, listen to what your body needs, and keep pushing forward! Your body will adapt to the demands of exercise and grow stronger and more conditioned. It just takes time, consistency, and perseverance. But don’t worry–you got this! 

If you have any questions about any of the above steps or need clarification, let me know! If you are unsure about your calculated training paces or how you should gauge exercise intensity with your own POTS case, please ask your doctor for assistance!

Happy training!

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14 thoughts on “How to Calculate Your Levine Protocol Training Paces

  1. I’m finding it impossible to check my supine resting heart rate. My ‘sleeping’ rate can be anywhere from 65 – 75, but the second I roll over in bed, or lift my arm to check my heart rate manually it can jump up to 80-90 bpm. When ‘resting’ in bed it can vary from 70 – 90 which is a considerable amount! Any thoughts?

    1. Hi Rachel! Thanks for reading. 🙂 I’d suggest trying to lie still once you’ve lifted your arm to manually check your heart rate. If it typically spikes from movement, maybe if you wait a minute or two it will stabilize and you can get a better reading. I am the same way–when I roll over in bed my heart rate goes higher than my normal resting rate. So try keeping your fingers on your wrist or neck (wherever you manually take your pulse from) and wait 1-2 minutes before counting your pulse. Hope that helps!

  2. Hey!
    I’ve been on beta blockers for few years because of migraine. I don’t have POTS diagnosis but I’m probably having that or something similar as a part of long covid-19 since March. I was wondering whether I can use heart rate as a guide while exercising? I know you’re not a medical professional but I would still like to hear your thoughts. Thank you for your informative posts!

    1. Hey, Tuija! Thank you for reading. 🙂 I am sorry to hear that you are struggling with long term effects from covid. I hope better days are ahead for you!

      To answer your questions, I don’t personally have any experience with beta-blockers. However, I know that some people are prescribed them to help POTS and tachycardia. If you are still on beta-blockers now I would say you need to ask your doctor how to approach exercise or see an exercise physiologist (especially post-covid!). There is still so much unknown with covid, like you said, so I wouldn’t start any new exercise program unless you run it by your doctor.

      The Levine Protocol (which I’ve linked to in this post) states that those on beta-blockers can’t use heart rate as a gauge for exercise intensity. Instead, you need to use an RPE, or Rate of Perceived Exertion scale. Heart rate won’t be an accurate gauge of exercise intensity because the beta-blockers keep your heart rate from getting too high, so you may never reach your target heart rate while exercising. I think consulting with your primary care physician or an exercise physiologist would be really useful and informative, as they can help you learn how to monitor exercise intensity on beta-blockers!

  3. Adding to my previous post: I’d like to hear your thoughts about beta blockers in my case assuming that I have POTS. I don’t expect that you can tell me whether I should be exercising in general because no one knows, lol. Covid is still no new.

  4. Thank you for this! My own doctors couldn’t figure out how to calculate these numbers for the protocol for me. Question – and i realize this is purely an opinion of a fellow potsie and not medical professional opinion – my RHR actually fluctuates by 15 beats from start to end of my menstrual cycle. With such a large range of rhr, would you adjust your protocol zones to reflect this monthly?

  5. Hello,

    Thank you for sharing this information! I was wondering, do you always round down for heart rates even if its above .5 decimal points? I just wanted to make sure, thank you!

  6. I am an RN. Yes you can exercise. Your HR will increase some, even if your on beta blockers. You can also tell your to be tolerence by your respiratory rate and BP and general feeling of exertion.

  7. Thank you so much for this. I self-diagnosed when I read an article about POTS and did a poor mans tilt test a few times at home. Also did one at my GP ( who never even heard of POTS). A cardiologist confirmed but couldnt offer me more than betablockers and salt. Unfortunately the BB lowered my BP too much and made my resting HR dip into the 30s. So now unmedicated and trying if I can improve my symptoms with exercise and supplements.

    I came across the Levine protocol on a blog about POTS but couldnt figure out how to calculate. This explains it perfectly! Thank you!

  8. The information you are providing here, particularly the Levine Protocol and how to calculate your training pace, is invaluable. Thank you, Laurie! I just started following you on IG too. I hope you keep writing because you’re excellent at it!! I actually believe I can tolerate exercise too, lust like you. Heading to do 10 mins on my recumbent bike right now 😀

    1. Hi Sharon! Thank you so much for reading and for those kind words! It means a lot to me to get that feedback. I hope to write more often again, but having a full-time job now has really cut into my blogging time. Rest assured, I will keep writing! 🙂 Wishing you all the best!

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