I Want to Ride My Bicycle. I Want to Ride My Bike.

Life with POTS is all about being paradoxical.  I'm overheated, but my feet are ice cold... My heart rate sky rockets, while my blood pressure plummets... I'm beyond exhausted, but I can't sleep.  Then comes the real kicker... you are too dizzy to stand or even sit up most days, but your doctor wants you to exercise.  According to a heartwire article about research done by Dr. Benjamin Levine, exercise helps to improve "upright hemodynamics, normalizing renal-adrenal responsiveness, and improving quality of life in patients with postural orthostatic tachycardia syndrome (POTS)".*

I understand fitness, and my workouts pre-POTS consisted of hitting the park or the treadmill for a 3-mile run.  POTS is a game-changer though.  My body and heart no longer work or respond the same, so just pushing through a standard workout isn't the answer.

I was referred to the cardiac rehab program at Cleveland Clinic.  The head doctor and the exercise physiologists in the rehab department are great!  You can certainly do your exercise training at home if insurance, money or location/transportation doesn't allow you to work with a professional.  However, I would highly recommend at least consulting with a cardiac rehab program if you can.  They helped me plan a course of action and determine my optimal heart rate targets for my current condition.

8 Tips for Working Out with POTS:

1. Start slow! Obviously there is a certain amount of mind over matter in all of life's challenges, but the typical athletic mantras of "just do it" or "no pain, no gain" aren't applicable to reconditioning with POTS. Don't try to do too much too fast.  Even if you can only do a few minutes at first, that's ok.  Just build from there at a pace you can handle.

My HRM even knows to wish me Happy
Birthday!

2. Use a Heart Rate Monitor. There are various heart rate monitors on the market from basic to those with more advanced functions.  My exercise physiologist told me the Polar brand with a chest strap was reliable and accurate so I bought a Polar FT4 from Amazon.  I love it!  Not only can I make sure I am not pushing myself out of my prescribed heart rate target, it is nice to see when a certain exercise intensity and duration is becoming too easy.  This helps me gauge when it is time to move to the next level.

3. Monitor Blood Pressure.  During cardiac rehab they would take my blood pressure reading before and after my workout and once during.  This isn't as easy to do on your own, but if you buy an at-home blood pressure cuff, you can at least check it before and after.  Keep track of these numbers along with your heart rate readings so you can monitor progress.  Remember if you are suffering from low blood pressure after your workout, elevate your feet while you recover and get some salt in your system.

4. Hydrate. Back in my running days, I would workout for 30 minutes or so and not even think of drinking water until I was done.  Not any more.  It is really important to drink water before, during and after your workout.  It helps me fight off my heat intolerance, dizziness and unstable BP while working out.  We just simply need more fluids as POTS patients, and it doesn't change during our workouts.  If you use electrolyte drinks, definitely include them during your workout routine, or at least add a little sea salt with your water.

5. Wear Your Compression Socks.  I am not always good about wearing my compression socks around the house, but I will not workout without them.  You want to keep your blood from pooling during your exercise as much as possible to help support you from losing to your orthostatic intolerance.

6. Keep Cool.  If you suffer from heat intolerance like me, heating up during exercise can induce lightheadedness and wear you out fast.  Make sure you are wearing cool, breathable workout gear.  I advise sticking to shorts and tees or tanks.  When it comes to my exercise clothes these days, sweatpants and long-sleeved shirts need not apply.  I also make sure to use a fan and even a cooling neck wrap if necessary.

7. Exercise Recumbent-Style or Seated.  We already know that standing is tough on our vitals and causes increased blood pooling.  This means working out on a recumbent bike, rowing machine or on the floor is perfect for POTSies.  In cardiac rehab, I rode a recumbent bike before moving to the upright bike, and then finally I was walking on a treadmill.  If you don't have access to a recumbent bike, doing stretching and strengthening exercises seated or on the floor is a great at-home alternative.  I downloaded a 20-minute workout from Exercise TV on iTunes.  It is called Gentle Pilates and is a floor workout.  Some of the warm-up is done standing so I either skip it or try to modify it while sitting on the floor.

8. Be Patient and Don't Get Discouraged.  You are not going to get stronger overnight.  Even though I was able to build up to walking on a treadmill at a healthy clip for 45 minutes, it took months for me to reach that point.  There were lots of hurdles and setbacks along the way.  Nothing about it was easy.  There were days I had to stop early or leave rehab in a wheelchair.  If at first you don't succeed, try, try again.


Some closing motivation by Queen... 

* Taken from http://www.theheart.org/article/1241927.do