Physical activity and exercise training in Postural orthostatic tachycardia syndrome - physiological mechanisms and clinical implications - a narrative review
DOI:
https://doi.org/10.12775/QS.2026.79.76822Keywords
postural orthostatic tachycardia syndrome, physical activity, exercise training, exercise intolerance, quality of life, rehabilitationAbstract
Background: Postural orthostatic tachycardia syndrome (POTS) is a disorder of autonomic cardiovascular regulation associated with orthostatic intolerance, fatigue, and reduced exercise tolerance, substantially affecting daily functioning and quality of life. Although exercise training is considered an important component of non-pharmacological management, optimal exercise prescription remains insufficiently established.
Aim: To examine exercise mechanisms, clinical outcomes and practical implications in POTS.
Material and methods: Material and methods: PubMed was the principal database used to identify publications from 2017–2026, including interventional and observational studies, systematic reviews, narrative reviews, and clinical recommendations. Evidence concerning exercise capacity, cardiovascular responses, symptom severity, quality of life, and exercise prescription was narratively synthesized.
Results: Training improved aerobic capacity in some studies, whereas effects on symptoms, quality of life and daily activity were inconsistent. A recent trial in post-COVID-19 POTS found no quality-of-life advantage and reduced upright time relative to standard care.
Recumbent exercise, resistance training and symptom-guided progression are commonly proposed. Small samples, attrition, co-interventions and limited follow-up restrict interpretation. Proposed rehabilitation models should be distinguished from tested interventions.
Conclusions: Exercise may benefit selected patients with POTS, but improved fitness does not establish improved daily functioning. Prescription should account for orthostatic tolerance and delayed symptom exacerbation. Trials should assess sustained function, adherence and adverse events alongside physiological outcomes.
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Copyright (c) 2026 Julia Duszejko, Jarosław Kucharski, Zuzanna Zofia Cecot, Maciej Mariusz Lesiczka, Filip Lenartowicz, Oliwia Gałczyńska, Dawid Oskar Mazurek, Katarzyna Kuklińska, Anna Magdalena Maciaszczyk, Alicja Martyna Lewczuk
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