Cardiovascular exercise as a treatment for postural orthostatic tachycardia syndrome: a pragmatic treatment trial

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of orthostatic intolerance with few proven treatments.

OBJECTIVE: To determine the efficacy of an unsupervised at-home training regimen for the treatment of POTS.

METHODS: We reviewed the medical records including autonomic function testing, symptom scores and activities of daily living in individuals with POTS that were invited to participate in a 6-month outpatient cardiovascular exercise program.

RESULTS: Seventy-seven individuals were invited (Invited group), 48/77 participated (treated group) and 43/77 of those completed. Twenty-nine (of 77) did not participate (control group). After 6 months, 11/48 individuals in the treated group met heart rate criteria for POTS compared to 27/29 in the control group (P<0.0001, χ2 ). Supine heart rate (68±8 vs. 77±10; P<0.001) and standing heart rate (95±11 vs. 115±10; P<0.001 decreased in the treated group compared to the control group. The frequency of syncope decreased in the treated group (P<0.001). An improvement in the EuroQol perceived quality of life scale was detected in the treated group (61±15 vs. 71±12 after 6 months, P<0.001) compared to the control group (64±9 vs. 66±8 after 6 months, P=NS).

CONCLUSIONS: In this study, we report a successful pragmatic clinical trial of an outpatient exercise protocol in a tertiary care referral population that significantly improved cardiovascular function and quality of life for patients with POTS.