For people suffering from Orthostatic Intolerance, Postural Orthostatic Tachycardia, Mast Cell Activtation or EDS. Follow me as I document my struggle towards better health.

Going into "Maintenance Mode" with Dr. Levine's Exercise Protocol

I have now passed the three month mark of Dr. Levine's Exercise Protocol for postural orthostatic tachycardia and orthostatic intolerance.  I am feeling much better than I did at the beginning.  So what's next?

At the end of the three months I started doing the Tony Horton's P90 exercise DVDs.  I like the power yoga, plyometrics and the varied weight routines.  After two weeks of the DVDs I started to see some muscle definition.  However, I started to feel more symptomatic and my fatigue levels were going up.  WHAT A DRAG!!  In fact, I had to stop doing the DVDs and went back to the rowing and recumbent bike exercises.

Since I always wear my heart rate monitor when doing my exercises (!!!!) I noticed that during the routines my heart rate would vary between 100-165bpm whereas when I was doing the exercise protocol, my heart rate would be fairly steady within the target heart rate zones.

My Theory:  When my heart rate gets above >160, exercise intolerance sets in.

I emailed Dr. Levine's team in Texas to ask what my next steps were and they suggested I repeat month three of the protocol.  So that is what I am doing.  Recumbent cycle, rowing or swimming for the cardio portion and for the weight training, I am doing the P90 Sculpting DVD as it does not get my heart rate up too high (unlike the P90 cardio DVD).  My goal is to graduate from the P90 DVDs to the P90X Extreme. GRRrrrrrrrr I'm gonna be RIPPED!

What is HyperAdrenergic POTS?

For those of you who are new to POTS and OI, did you know there are several flavours of POTS?  Here is one:  HyperAdrenergic Postural Orthostatc Tachycardia

Symptoms appear gradually and progressively over time. Thought to be a genetic disorder.

  • increase in urine output after standing (what a nuisance!)
  • presyncope
  • fatigue
  • migraine headaches
  • palpatations
  • tremor
  • anxiety
  • cold and hands and feet

Clinical Findings:
  • orthostatic tachycardia
  • orthostatic hypertension
  • exaggerated response to isoproterenol infusions
  • significantly elevated serum catecholamine levels with serum norepinephrine levels >600 ng/mL (this was found in 29% of patients in a study)

In the hyperadrenergic form of POTS, patients often respond best to agents that block norepinephrine or its effects. One agent that is particularly helpful is clonidine HCI in either pill or patch form. We start the oral form at 0.1 mg PO 1 to 2 times a day and filtrate upward. The patch form of clonidine is quite useful because it provides a constant and continuous amount of the drug for up to 1 week at a time. The combined and β blocking drugs labetalol and carvedilol are quite useful in some patients as pure β-blockers may exacerbate symptoms (because of unopposed receptor stimulation). Methyldopa has been reported to be useful in some patients, as has phenobarbital. In addition, both the SSRIs and norepinephrine reuptake inhibitors are useful in select patients.
People who have been diagnosed with this disorder typically have other fmaily members who suffer from it too. I picture long line-ups for the toilets at family reunions.

Here is an interesting article on recent research on what genes may impact POTS...

Rowing for POTS - Is it really a better exercise?

I found this article written about rowing and why it is helpful.  Dr. Levine is quoted and his work on POTS is referenced.

Medical researchers are refining their knowledge about what keeps astronauts in space phsically fit.

Benjamin Levine: We calculated or estimated that – in order to maintain the work of the heart while you’re in spaceflight – you’d need to do about 90 minutes of cycling every day to keep the heart at its pre-spaceflight level. But that also is a lot of work. It’s a lot of exercise.

That’s Benjamin Levine, a medical researcher working with the National Space Biomedical Research Institute.

Benjamin Levine: We looked to the sporting world and asked, which athletes have the biggest hearts, the densest bones, the biggest muscles. And that was a pretty quick answer: it’s rowers.

Levine said that rowing is a very unique exercise. He said it’s like a combination of weight training and endurance training. Plus the blood pressure goes up high with each stroke, so it’s a good, solid workout for the heart.

Levine’s recent study combined rowing with nutritional support for test subjects spending 5 weeks on bed rest to simulate the effects of reduced gravity on the body. And it appears the rowing regimen does keep the hearts, bones and muscles of astronauts fit, while cutting the time spent on exercise by more than half.

Benjamin Levine: I think that all astronauts would benefit from rowing, but that doesn’t mean that all astronauts will like rowing. Honestly, as long as you maintain the work of the muscle, it will maintain its structure and function.

Levine mentioned that this research relates to what doctors call the Postural Orthostatic Tachycardia Syndrome or POTS. This ailment primary affects young women, and it means that, when these women stand up, their hearts pound, they get headaches. The disease can be incapacitating. Currently, an exercise intervention – based on rowing – similar to that studied by Dr. Levine is being tested.

Special thanks today to the National Space Biomedical Research Institute – innovations for health in space and on Earth.

Our thanks to:
Benjamin Levine
Director, Institute for Exercise and Environmental Medicine
Presbyterian Hospital of Dallas
Dallas, TX