Exercising with POTS can be challenging. But it’s not impossible. Chances are, if you have POTS, you deal–or have dealt–with exercise intolerance to some degree or another.
I know what it’s like. I’ve been there. I’ve been at the stage where my symptoms were so bad that I couldn’t run anymore and could barely tolerate upright activity without getting an exercise hangover the next day. I’d get winded just walking up the stairs or simply standing to style my hair! The thought of even attempting to run exhausted me.
But now? I’m happy to say I’m past that. And I got to where I am today by implementing a few POTS exercise strategies to make working out easier and more manageable. Keep reading to learn how to ease your way back into exercise and improve exercise intolerance.
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1. Follow A POTS Exercise Protocol
Before beginning to exercise with POTS, it’s SO important to educate yourself so that you have the best chances of success. You may choose to start in a cardiac rehab program or to work with an exercise physiologist knowledgeable on POTS. These professional resources not only create exercise plans for you and monitor your progress, but they also teach you about exercise and nutrition principles that can help improve your overall health.
You can also familiarize yourself with a POTS exercise protocol, such as the Levine Protocol or the Dallas/CHOP Protocol. These detailed exercise protocols lay out a structured exercise schedule specifically for POTS patients to help them overcome exercise intolerance and treat symptoms.
Personally, I followed the Levine Protocol for about four months. Then I eventually returned to jogging/walking intervals and other upright exercises like bodyweight cardio workouts. I loved the structure these protocols provided, and more importantly, I loved both feeling and seeing the progress I made in symptom management along the way.
2. Start Slow and Be Kind to Your Body
Spoiler alert: When exercising with POTS, it may make you feel worse in the initial stages. But don’t get discouraged–this is actually normal! Your body has to learn how to re-adapt to exercise, especially any upright exercise. Until it does, you may feel more exhausted, or you may feel like you’re heading into a POTS flare up. Your body is working hard to condition itself to activity. Be kind to yourself in the beginning exercise stages and start slow.
3. Invest in a Heart Rate Monitor
Having a smartwatch that monitors heart rate is vital when exercising with POTS. These watches allow you to monitor your pulse while exercising, which can help you know when you are pushing yourself too hard. Alternatively, if you are following an exercise protocol, then a heart rate watch can help you stay in your POTS exercise heart rate zones for maximum workout effectiveness.
I’ve worn heart rate watches for over five years. Once I was diagnosed with POTS, they became a staple for both everyday use and during exercise. Currently, I use the Fitbit Ionic Smart Watch. However, I also use a Polar H10 Heart Rate Sensor for high-intensity exercises like running, as chest straps are considered the gold standard for precise, real-time heart rate data.
4. Stock Up on Electrolyte Drinks
Drinking plenty of fluids and staying hydrated is a top priority for POTS patients. Exercising and excess sweating can lead to dehydration, which intensifies POTS symptoms. Stock up on your favorite electrolyte drinks, like Liquid I.V. or Pedialyte, and keep them nearby during exercise sessions. Make sure to keep drinking fluids even after finishing a workout.
Side note: Has anyone tried any of the new Liquid I.V. flavors?! My go-to has always been lemon-lime, but the new guava flavor sounds amazing!
5. Wear Compression For POTS Exercise
Compression can help with pain and other POTS symptoms that occur while upright and exercising. How? Simply put, because compression aids circulation. That means it lessens the blood pooling people with POTS experience, which can reduce pain in the lower extremities, lightheadedness, and tachycardia.
My favorite compression sock brand, by far, is VIM & VIGR. I absolutely adore this compression sock brand because they provide stylish patterns while delivering varying levels of compression. (See my honest review of their socks here!)
I also own super tight Lululemon leggings that provide compression. They are on the pricier side, but in my experience, it’s worth the investment for a pair. This may sound weird, but I feel more “held in” while I exercise in them, and my legs, hips, and lower back hurt less while I exercise. Once, putting on a pair while I was experiencing sciatica pain nipped it right in the bud. They literally saved me from three days of excruciating pain. Ugh. Gotta hate sciatic pain. But I sure love these leggings.
Bottom line, if you experience muscle or joint pain or POTS symptoms due to inadequate circulation during exercise, compression garments can help!
6. Incorporate Recumbent Cardio Exercise
Upright cardio exercise can be difficult for POTS patients, especially those new to an exercise program or those with severe POTS exercise intolerance. Performing recumbent exercises to build cardiovascular endurance can help exercise intolerance, improve POTS symptoms, and get your body in better shape.
Try incorporating swimming, recumbent biking, cycling, rowing, and recumbent stepping into your exercise routine. I love biking outside, and rowing is an excellent exercise for strengthening the heart!
7. Focus on Strengthening Your Lower Body
Your legs hold some pretty powerful muscles. I’m talking about the calves, quads, and hamstrings here. While standing, these muscles serve as “pumps” that push blood back up to the heart. A research review found that strengthening these muscles with resistance training at least two days per week, along with consistent endurance training, caused 71% of POTS participants to go “into remission” after three months of training. (Meaning, they no longer met the criteria for a POTS diagnosis.)
So it’s not just all about getting your cardio in. It’s about incorporating both cardio and resistance training into your exercise regime and sticking to it long-term.
8. Break Up Exercise Throughout The Day
Do you struggle to complete workouts? Yeah, I’ve been there, too! So try this tip: Instead of attempting to complete a long exercise session all at once, break up your exercise into shorter segments throughout the day.
For example, say you need thirty minutes of cardio to crush your scheduled workout of the day. But let’s also say that you’re in the initial months of an exercise protocol and exercise feels more difficult. Try completing ten minutes of exercise at three different times in your day, say, before breakfast, lunch, and dinner.
It’s not uncommon for me to break my exercise up into chunks throughout my day, even though I’m feeling significantly better with my POTS. For example, on weekends I’ll often go for a walk in the morning or afternoon and then crank through some strength training before dinner.
I really think this approach helps to not overwhelm and exhaust your body all at once, especially if you are a newbie to exercising with POTS. Breaking your exercise up into smaller chunks gives your body the chance to recover and grow stronger. And it also gives you the confidence to not give up on your exercise journey because you’re creating small, attainable goals for yourself!
9. Try Floor Workouts For POTS Exercise
Pilates workouts and any other workouts that can be done on a yoga mat have become my best friends. These kinds of workouts are great for anyone, but they’re exceptionally great for POTS patients. Instead of doing resistance training with free weights while standing and making yourself lightheaded, take your moves down onto the floor! There are plenty of exercises you can safely do either seated or on the floor to strengthen your muscles.
My beginner lower body workout with resistance bands can be completed on the floor–all you need is a yoga mat and some resistance bands! You can also try my seated beginner upper body workout with exercises to improve strength and posture.
10. Modify Workouts As Needed
There’s no need to try to complete workouts as is. If there’s a move that your body just isn’t up for, then modify it! You can even omit the move altogether and replace it with something easier for your body to successfully do. For example, whenever a trainer in an exercise video does burpees, I’ll do a static plank instead. If I feel up to it, I’ll do a modified burpee without jumping.
If a routine suggests more reps or resistance than your body can handle, don’t be afraid to lower either component, too. Or, if you’re trying a new workout video and the trainer is performing moves that would cause you symptoms, then modify it. Don’t jump! Don’t do explosive movements! Go slower! You can often replace jumps with a step-touch. Also, if you notice your heart rate is spiking and you feel POTS symptoms coming on strong, hit pause on your workout. Take a minute or two to recover. You are the master of your workouts. Listen to your body and modify accordingly.
[P.S. For anyone looking for fantastic workouts that are the most mindful of exercise modifications of any workout app I’ve ever used, check out FitOn. I’m not affiliated with them in any way, but this app has seriously changed my life. I love the pilates workouts with Cassey and the variety of low-impact cardio routines. Seriously, check it out–it’s free and amazing!!!]
11. Avoid Exercising in The Heat
If you’ve read my other posts, like how to survive the heat with POTS, you know that hot temperatures are bad news for POTS patients. Yes, it’s true, heat often worsens POTS symptoms because it encourages blood pooling and causes us to become dehydrated. And if this is your first time hearing it, then listen up! Heat is a major POTS trigger!!!
So, with that being said, can you imagine how difficult it can be to combine heat and exercise? You are fast-tracking your way to dehydration with that combination, and I don’t want that for you. So please, please, please avoid exercising in the heat. Work out in an air-conditioned gym or room if possible, or save your summer outdoor exercise sessions for early morning or evening when it’s cooler. Have your Liquid I.V. ready on standby (cuz you’re probably gonna need it!).
12. Prioritize Rest Days
And finally, don’t skip your rest days, friends. Prioritize them. Anybody who exercises needs a rest day or two at a minimum per week to allow their bodies the time to heal and recover. If you push yourself too hard and don’t give yourself adequate time to rest, you could set yourself up for a POTS flare, the dreaded exercise hangover (as I call it), or an injury. I like to give myself at least two rest days per week, but follow whatever instructions your medical professional or exercise protocol gives you.
POTS Exercise Tips Takeaway
Exercising with POTS remains one of the best ways to treat the syndrome naturally. While it takes patience, persistence, and dedication, cardio and resistance training will condition your cardiovascular system and strengthen your body. POTS exercise intolerance can make working out a struggle, but these tips can help make exercise a little easier. I want all my fellow POTSies to have the best chances for success in improving symptoms through exercise! I hope these tips help. 🙂
Comment below if you have any questions or additional tips!