You read it all of the time. Gradually return to exercise. The Postural Orthostatic Tachycardia Syndrome (POTS) community is told to start slow, and have patience. But, where are they starting? What do they do? By default, patients search for programs or a qualified professional who will help them achieve their desired health goals with POTS. Patients know that the structure and incentive POTS programs offer are appealing and needed. However, what patients don’t realize is many programs are a disservice to the population entirely, lacking the ability to personalize to the individual’s specific real-time needs.
Starting Point
Common questions I get:
- Should I do floor exercises before 1o minute of cardio?
- What modalities are best?
- I want to join a gym, but the idea of it scares me. Should I?
- What days should I lift?
- Does my smart watch work to track my HR?
- I feel “x, y & z” before, during, and after my exercise, is this normal?
- My doctor encouraged me to hire a personal trainer, how do I find the right fit?
- What should I eat before my workout?
- I don’t understand the prescribed exercise. Can you educate me?
The above questions can’t be answered in a general program.
Therefore confusion begins, confidence decreases and success rates decline.
Let’s paint a common picture in the POTS world to better understand the importance of individuality and specificity.
Pretend you are a POTS patient who feels frustrated, tired, and severely deconditioned. You have just been told by your physician that exercise will be a part of your treatment. You are offered a PDF or told to google the Levine Protocol and gradually implement exercise into your days. This news excites you and also feels challenging. You leave your appointment feeling hopeful.
After viewing the protocol, you soon realize that this science-based globally recognized protocol is specific and measurable. The prescribed target heart rate zones your physician calculated for you coincide with the recommended daily training. You notice cardio modality options for your Month 1 starting point. Your training calendar shows the prescribed workout length, training pace, the number of days a week you exercise and looking further you note the intensity increases progressively. It’s all cut and dry. So, you begin.
After several days pass, you realize questions flood your brain. Outside of your doctor’s appointment, you start to feel a lack of support. You are inspired to hire a certified personal trainer, but you are unsure if they will know what POTS is or understand how to help. You decide to gradually incorporate exercise alone. Thinking, it’s a matter of gradually introducing exercise. How difficult can this be?
I see a few problems here.
Problem #1
Being told to exercise, when you feel ill is a big task.
Patients can effectively gradually return to exercise if they have a program that meets their specific needs. The needs of a POTS patient are far more than physical, it’s mental too. Offering the necessary support to begin gradual exercise is vital. By understanding the patient’s motives and fears in combination with symptom response and routine behavior gradual exercise can be effectively introduced with appropriate interventions and needed education for overall program success.
Problem #2
Real-time questions need to be answered.
Patient success rates increase by having their needs met. Waiting for a scheduled appointment to answer the questions you have right now, freezes your progress. Having access to personal support when needed is invaluable. As the days and months pass, so will your treatment plan. Feeling understood and having access to needed resources increases program compliance.
Problem #3
Gradual exercise must be of appropriate overload.
Patients can effectively gradually return to exercise if they are participating in appropriate, specific, and individualized exercise routines. No POTS journey is the same, nor should it ever be treated that way. In the exercise world, overload is a principle used to challenge the body safely. Through stimuli, the human body adapts. Intensity is key. Too much or not enough overload can cause regression.
Key to Your Success
When it comes to exercise, what truly makes a program effective is the ability to individualize and meet your specific needs. The Postural Orthostatic Tachycardia Syndrome Community does not benefit from a group or general program approach. Program guidelines and incentives are beneficial, but what encourages success are the principles of individuality and specificity. A certified personal trainer knows that progressive overload is key to achieving goals. A certified personal trainer who is educated with POTS knows how to look beyond commonly used principles and prioritize individuality and specificity. This allows the client to safely and successfully gradually return to exercise.
POTS Strong™ Training Defined
Working with clients, I look for improvements in well-being, volume, intensity, movement quality and efficiency, endurance, and recovery. The principle of specificity dictates that the overload method(s) chosen should be specific to the desired adaptation (1). Only if the client is ready would we: For example, if a client or athlete is training to improve orthostatic intolerance, they could gradually exercise in upright positions. If they prefer to increase strength, they could gradually add heavier loads or perform more repetitions with the same load.
It is important to note that exercises are progressed on an individual basis rather than a pre-determined schedule.
Resistance
Adding additional stress to your muscles allows them to break down, rebuild, and get stronger. One way to do this is to ensure the weight you choose to lift is of adequate weight. A general rule that can be used is the last 2-3 reps of a set should be challenging. Allow 1 -2 days of rest before training the same muscle group again.
Duration
Every week to two weeks to increase cardiovascular endurance, you need to increase the length of your workouts. Dependent on session frequency an increase of 5 minutes- 10 total minutes per week may suffice. (***Active recovery days are recommended after an increase in cardio)
Tempo
The intensity of your exercise sessions increases strength and fitness. If your function level permits interval, HIIT, AMRAP or circuit styles of training, this quicker pace may be enjoyable for you. Your trainer may prescribe light weights as part of this routine due to the demand in workload.
Exposure
Training conditions that are supportive of your current function are key. Noise, light, temperature, weather, and terrain are all variables that can affect your training capacity. Dependant on function level, one session per month may be beneficial to be scheduled in a monitored field setting.
Resources
1. Sheppard, JM, and Triplett, NT. Program design for resistance training. In: Haff, GG, and Triplett, NT (Eds.), NSCA’s Essentials of Strength Training and Conditioning. (4th ed.) Champaign, IL: Human Kinetics; 439-469, 2016.
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