How we treat POTS at Move Sports Physiotherapy Geelong
- Joseph Smith
- 18 hours ago
- 5 min read
Joseph Smith - Move Sports Physiotherapy & Pilates Geelong
If you’ve been experiencing symptoms such as brain fog, lightheadedness, and persistent fatigue, you are not alone. These symptoms are commonly reported in individuals with Postural Orthostatic Tachycardia Syndrome (POTS), a condition affecting the autonomic nervous system. POTS is characterised by an excessive increase in heart rate upon standing, along with a range of associated symptoms that can significantly impact daily function.
At Move Sports Physiotherapy in Geelong, our team of Physiotherapists and Exercise Physiologists work collaboratively to support individuals with POTS. We focus on graded, individualised exercise and education to help improve tolerance to upright positions, restore functional capacity, and enhance overall quality of life.
Understanding POTS
POTS can present with a wide spectrum of symptoms, including lightheadedness, fatigue, palpitations, and symptoms of autonomic dysregulation such as anxiety-like sensations. The presentation is highly individual, with symptom severity and triggers varying significantly between patients, which highlights the importance of a tailored, patient-centred approach to assessment and management.
Increasingly, greater awareness of POTS within both the medical community and the public has helped improve recognition of the condition and support more timely diagnosis and intervention.
Our Treatment Approach: Your Path to Recovery
Initial Assessment and Quick Wins
The journey begins with a comprehensive assessment where we identify trends in your symptoms. This includes recognising potential triggers, such as anxiety and postural changes.
Here’s how we kick-start your treatment:
Symptom Tracking and Baseline Measures
We utilise tools like fatigue scales to establish a baseline and monitor your symptoms closely.
Quick Wins
Our goal is to find manageable strategies early in your treatment to boost your confidence. This might include physical counter-maneuvers such as squeezing a rubber ball, crossing your legs while tensing muscles, or squatting to help maintain blood pressure.
Key Quick Wins
Compression Garments: Wearing compression clothing can help reduce blood pooling in your legs, supporting circulation during movement. Check out options here.
Sodium and Fluid Intake: Staying hydrated with added sodium is crucial for boosting blood volume, which is vital for managing POTS symptoms. Make sure to follow your healthcare provider’s guidance on this - High sodium formulated electrolyte supplements can be really helpful.
Medications: We can collaborate with your GP for pharmacological interventions, such as:
Ivabradine: Helps reduce heart rate without impacting blood pressure.
Propranolol: A beta-blocker that manages sympathetic effects on heart rate and blood pressure.
Fludrocortisone: Increases sodium and water retention to expand plasma volume.
Midodrine and Phenylephrine: Medications that constrict blood vessels to raise blood pressure.
Acute Management
Fatigue Management
We educate you on energy conservation and pacing techniques. Think of it as a “cup of marbles” strategy, where each activity you do uses a marble from your cup. You need to rest, before you completely run out.
Symptom and Anxiety Management
We’ll help you address anxiety related to your symptoms with gentle exercise initiation, focusing on breath control and relaxation techniques. Studies show that breathing retraining can significantly improve symptoms for POTS patients.
Movement tolerance management
To avoid overexertion, we might use digital tools like PIXELS for patient-guided pacing outside the clinic. This helps with gradually building confidence in movement. We also recommend regular clinic visits (twice a week) to keep you engaged and motivated.
Progressive Exercise Program
Our structured program is designed to improve your load tolerance, functional capacity and overall endurance over 12 weeks:
Starting with Supine Exercises
We begin with supine strength and endurance exercises, with an emphasise on breathing mechanics and body awareness. You’ll learn to connect with your body, enhancing both physical and mental strength.
Endurance Training
Engage in lower-intensity horizontal exercises, such as using a recumbent bike or
swimming, to build cardiovascular conditioning without triggering symptoms.
We’ll monitor your heart rate to ensure you are exercising safely within your zones, and gradually increasing intensity as you adapt.
Resistance Training
We focus on strengthening your lower body and core, essential for supporting your body during upright activities. Your program might include:
Lower Body Exercises: Seated leg press, leg curl, calf raises—starting with manageable sets/reps and progressing as tolerated.
Upper Body and Core Work: Chest presses, seated rows, and core stability exercises like side planks to enhance your overall strength.
Weeks 1-4: Supine and Seated Strength Training
In these first few weeks, we’ll focus on supine (lying down) and seated exercises to prevent any risk of dizziness or fainting while building strength and endurance.
Reformer Pilates
This is a key strategy for supine work. Reformer Pilates provides controlled, low-impact movement that strengthens the core and lower body while supporting your joints. This method is great for improving muscular endurance and stability without overloading your cardiovascular system.
Seated Resistance Exercises:
Leg press (seated)
Leg curl (seated)
Leg extension
Seated chest press
Seated row
Calf raises
These exercises will be performed in 2 sets of 10-12 reps. As your strength builds, we’ll adjust the resistance and the complexity of the exercises.
Weeks 5-8: Horizontal endurance & cardiovascular conditioning
In this phase, we’ll integrate more endurance-based work with low-impact cardiovascular activities.
Swimming / water-based exercises: This is an excellent option because it alleviates strain on the body while improving overall cardiovascular fitness.
Recumbent Cycling / Rowing Machines: These are low-impact ways to increase heart rate without putting stress on your joints or increasing symptoms. Start with 20-30 minutes, 3-4 times per week, and aim to increase your duration gradually.
Weeks 9-12: Upright functional movements
As you build strength and endurance, we’ll transition to more upright, weight-bearing exercises. This is crucial for improving your ability to function in everyday life without triggering symptoms.
Reformer Pilates (Upright Exercises): We’ll begin to incorporate upright movements on the reformer to simulate more functional positions, gradually increasing the intensity and duration.
Treadmill Walking: A low-impact way to begin reintroducing upright movement.
Standing Strength Exercises: These may include squats, lunges, or standing calf raises, tailored to your ability.
During this phase, the goal is to increase your total exercise time to 40-45 minutes per session, progressing from 3 days a week to daily activity. We'll emphasize breathing and hydration throughout, with ongoing adjustments to avoid overexertion.
Maintenance and long-term progress
After the first 12 weeks, we’ll move into a maintenance phase, where you’ll continue structured exercise, with progressive resistance and cardiovascular conditioning for the next 6-12 months.
We may also begin integrating more dynamic, functional exercises, including:
Pilates-based core strengthening: to stabilise the spine and pelvis.
Higher-intensity walking or cycling: if your tolerance allows.
Yoga or Tai Chi: to work on flexibility, balance, and relaxation, which can help manage anxiety and improve circulation.
The goal is to keep progressing slowly, adding more challenging exercises only when you feel confident and capable.
Advanced Rehabilitation
Once you’ve built a solid foundation, it’s time to set your sights higher! Our advanced rehabilitation phase is excellent for those with high-level goals such as preparing for running, high intensity training and competition. This may involve multidisciplinary support - including; nutrition, massage therapy and hot or cold exposure therapy.
Sample 12-Week Exercise Plan
Weeks 1-4: Supine & Seated Resistance Training
Reformer Pilates (Supine/Seated): 2-3 sessions per week
Seated Leg Press: 2 sets of 10 reps
Seated Row: 2 sets of 10 reps
Leg Extension: 2 sets of 10 reps
Calf Raises: 2 sets of 10 reps
Weeks 5-8: Endurance and Cardiovascular Conditioning
Swimming/Water Aerobics: 2-3 sessions per week (20-30 minutes)
Recumbent Bike/Rowing: 3-4 sessions per week (20-30 minutes)
Weeks 9-12: Weight-Bearing & Functional Movements
Reformer Pilates (Upright): 2-3 sessions per week
Treadmill Walking: 3-4 sessions per week (25-35 minutes)
Standing Leg Squats: 2 sets of 10-12 reps
Standing Calf Raises: 2 sets of 10-12 reps
Beyond 12 Weeks: Maintenance and Progression
Increase duration of walking, cycling, or swimming to 40-60 minutes, 4-5 times per week.
Add higher-intensity cardio as tolerated.
Integrate functional activities and higher resistance in Pilates.
Key Takeaway
POTS is a challenging condition that requires a slow and structured plan for longterm results.
At Move we’re dedicated to helping you manage POTS and reclaim your life.
Our comprehensive treatment combines hands-on care, tailored exercise programs, and ongoing support to help you thrive.
References
For further reading and support, check out these links:
