POTS: Exercise and Postural Orthostatic Tachycardia Syndrome

For most people, standing up is automatic. You don’t think about it. Your body adjusts instantly to gravity and blood continues circulating normally.

For someone with POTS, that adjustment isn’t as smooth. Standing (among other postural changes) can trigger a racing heart, dizziness, fatigue, or brain fog. These symptoms can feel confusing, especially because they can often appear in otherwise young and healthy people.

Many people assume the issue is simply poor fitness or anxiety. But POTS is actually a condition that affects how the body regulates blood flow when you move from lying or sitting to standing.

The encouraging part? The body’s circulation system is highly adaptable, and exercise can play an important role in improving how it responds.

1. The challenge isn’t just heart rate, it’s also circulation

When you stand up, gravity pulls blood toward your lower body. In a well-functioning system, your muscles, blood vessels, and nervous system work together to quickly move that blood back toward your heart and brain.

In POTS, this coordination isn’t as efficient.

This can lead to:

●      Blood pooling in the lower body

●      Less blood returning to the heart and brain

●      A rapid increase in heart rate as the body tries to compensate

Common symptoms include:

●      Lightheadedness or dizziness when standing

●      A racing or pounding heart

●      Fatigue or reduced exercise tolerance

●      Brain fog or difficulty concentrating

Think of it like this: Your body is trying to push blood uphill against gravity, but the support systems that usually help are working less effectively.

2. Symptoms can slowly change daily activity

Because symptoms are often unpredictable, people with POTS may begin to adjust their daily habits without even realising it.

They may:

●      Sit or lie down more frequently

●      Avoid long periods of standing

●      Reduce physical activity because it worsens symptoms

Over time, this can unintentionally create more challenges.

Less movement can lead to:

●      Reduced cardiovascular fitness

●      Reduced lower body strength (which helps to pump blood upward)

●      Lower overall tolerance to upright activity

This can make symptoms feel even more pronounced.

3. Exercise helps retrain the system

Exercise is a well-supported strategy for improving symptoms in people with POTS. But the key is how exercise is introduced.

Exercise can help by:

●      Strengthening muscles that help pump blood back toward the heart

●      Improving cardiovascular efficiency

●      Increasing overall blood volume over time

●      Gradually improving tolerance to upright activity

4. Progress comes from consistency, not intensity

One of the biggest misconceptions is that people with POTS just need to “push through” symptoms. In reality, too much too soon can trigger symptom flare-ups and make things more difficult.

Instead, effective exercise focuses on:

●      Gradual progression

●      Consistency over intensity

●      Building strength

●      Slowly increasing tolerance to upright activity and postural changes

With time, many people notice improvements in energy, symptom control, and confidence in movement.

The bottom line

POTS affects how the body manages blood circulation when changing postural positions, which is why symptoms often appear during everyday activities.

While it can feel frustrating and unpredictable, the body has a strong ability to adapt.

With the appropriate exercise approach, people with POTS can often:

●      Improve circulation

●      Reduce heart rate spikes when standing

●      Build physical tolerance

●      Feel more confident with daily movement

Small, consistent steps can make a meaningful difference over time.