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


If you suffer from orthostatic intolerance or postural orthostatic tachycardia then you understand what it means to be "exercise intolerant".

Here is a uncited definition of Exercise Intolerance from Wikipedia:
Exercise intolerance is a condition where the patient is unable to do physical exercise at the level or for the duration that would be expected of someone in his or her general physical condition, or experiences unusually severe post-exercise painfatigue, or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but a symptom.
From a practical point of view what does this mean to patients suffering from postural orthostatic tachycardia or orthostatic intolerance? Walking upstairs can be exhausting.  Grocery shopping can require a 2 hour post-expedition nap.  Exercise programs to get back into shape can have the OPPOSITE, deleterious effect.

Based on what I have learned so far from my own experiences and from Dr. Levine's protocol,when you have Postural Orthostatic Tachycardia or Orthostatic Intolerance, your body's cardiovascular system is in a fragile state.
  1. If you overtax your system you will be set back in your recovery.  
  2. Standing up while exercising, getting your heart rate up too high are ways to overtax your body.
  3. If you focus on gradual, incremental progress your body can adapt and improve.  
  4. Strengthening your core muscles help your body's ability to respond to the cardio exercises and can help regulate blood pressure.  
Fighter pilots use their abdominal core muscles to help control their blood pressure to prevent themselves from passing out when their airplanes are in a steep dive.
Exercise Advice
Understand what you're heart rate levels are for exercising. This is important as you must understand what your limits are to prevent triggering an exercise intolerance reaction. You can use this heart rate calculator as it gives our heart rate maximums and minimums based on your resting heart rate, sex and age.
  • get a heart rate monitor and watch to ensure you are working within your target heart rate zones
  • do all exercises sitting down!!  whether you feel dizzie or not.
  • 3 times per week - do cardio for 30 minutes and monitor your heart rate- keep your heart rate within Level One or 50%-60% of maximum heart rate
  • do a cardio warm-up for 10 minutes and a cool down for 10 minutes below Level One maximum heart rate (See heart rate calculator here
  • 3 times per week - do strength training such as sit ups, leg raises, sitting squats, chest pulls/press, calf raises
  • do your exercises regularly - you can miss a day or two but don't miss three days
  • alternate days doing cardio and weight training
  • rowing is one of the best exercises for cardio (from a researcher working with Dr. Levine)
  • focus on large muscle and core muscle groups when weight training
  • Remember - do everything sitting down!
The above is not the prescriptive treatment protocol by Levine but it WILL help you start conditioning.  Exercise, is one of the most important activities you can undertake to help improve your "orthostatic health"; your body's ability to cope with the POTS and OI.  But unless you can learn the fundamentals of working out while exercise intolerant you will be very frustrated at your lack of progress.

Exercising when you feel crappy is VERY DIFFICULT but well worth the effort as studies have now proven this works to reduce or eliminate symptoms!

This is NOT about mind over matter which is a typical athlete or competitive mentality.  You cannot PUSH IT and get better!  That is a lesson that I've learned, forgotten and have relearned a few times.

Remember - Take it real slow but keep at it!

Soldier on!