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

OI, POTS and Exercising - Procrastinating...?

I was planning on writing a pots on the exciting Midrodine story: the drama of the FDA vs Patients but elected to write about the POTS and exercise debate instead.  I personally believe this matter to be so important to the health of so many POTS sufferers I thought I would weigh in again.

POTS or OI can be caused by a number of different conditions but can ALSO BE CAUSED or MADE WORSE by deconditioning.  This is a fact.  By embarking upon an exercise program which helps overcome exercise intolerance it can (not in all cases) greatly assist with managing symptoms.  In some people it can be a CURE for POTS. (cure meaning the patients no longer met the criteria for POTS)  This is also a fact.

People who have OI may also have received a diagnosis for POTS (and vice versa).  Regardless of whether you have been diagnosed with POTS and/or OI you may still benefit from a managed exercise routine.

What is the difference between Orthostatic Intolerance and Postural Orthostatic Tachycardia?
Here is how Vanderbillt describes Orthostatic Intolerance and Postural Orthostatic Tachycardia:
When orthostatic symptoms occur in patients, but blood pressure does not fall as much as 20/10 mmHg on assumption of upright posture, the patient has orthostatic intolerance (OI). Additional criteria used for the diagnosis of OI at Vanderbilt’s Autonomic Dysfunction Center include an increase in heart rate of at least 30 beats per minute with standing, and a standing plasma norepinephrine level of at least 600 pg/ml. Because upright heart rate is usually greatly increased, the term Postural Tachycardia Syndrome (POTS) is also used.
Did you know Orthostatic Intolerance can be induced in otherwise healthy subjects?
Yes, that is correct.  Evil scientists can inflict this dreadful condition on subjects by enforcing bed rest, particularly if the bed rest includes a head down tilt posture.  There is a report by Waters et al which compiles the results from 16 studies from 10 different researchers on enforced bed rest and its consequences.  Each of these studies look at the MECHANISMS of orthostatic hypotension such as cardiac atrophy (aka "Grinch Heart)", sympathetic dysfunction, arterial and venous alteration.  It appears that a decrease in stroke volume is the nastiest culprit in promoting symtpoms of OI.

If I tie my husband to the bed for 2 weeks will he get POTS?
It seems that some otherwise healthy people are pre-disposed to getting POTS under certain circumstances and others are not.  In studies I have read up to 80% of healthy subjects can exhibit symptoms of OI after 2 weeks of bed rest.  My suggestion is to tie your husband down for two weeks if he appears unsympathetic to your symptoms.



  1. How you are with dr Levine´s protocol at this moment? What your progress?

  2. I developed POTS after being on 14 weeks of strict bedrest while pregnant with my twins. HA! :)