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This is another post in my series on Postural Orthostatic Tachycardia Syndrome.

Working out with POTS is interesting, and is completely different than exercising without it. Exercise is a critical component of the treatment of POTS, but while we’re asked to exercise, it’s pretty much the last thing that our bodies actually want to do. People with POTS are often labeled as “exercise intolerant”, as it’s difficult for the body to handle the stress that occurs when the body exercises. Exercise is helpful as it strengthens the leg muscles, a crucial aspect of treating pots. However, exercise also exacerbates symptoms afterwards, at least for a day or two.

So, you can see the problem. With POTS, it’s the best thing for you and the thing that is the most difficult to do. I wrote an entire post on “how POTS changed my exercise“, and that will give you some information about what changed for me. Picture someone with a resting heart rate of 120, dizzy regularly throughout the day, loses vision almost every time she stands up being told she needs to start working out. Crazy, right?

Starting to work out was a LONG and SLOW process for me, and one that I would never embark without talking to a physician. Here are some of the steps that I took in working out with pots:

  1. TALK TO YOUR DOCTOR. Never start an exercise regimen without talking to your doctor first if you have POTS. With POTS there are so many variables that we have to do with, and it’s important to have a doctor be a part of your journey.
  2. I got on a Beta Blocker. With my resting heart rate at 120, I could hardly start to move much without getting dizzy, with my heart pounding, and being very short of breath. Getting on a beta blocker allowed my resting heart rate to go down to about 80 beats a minute, which gave me a wider gap in which to workout in. However, a beta blocker also means that it’s not safe for me to run much faster than a 10:00 minute mile, so it comes with some constraints.
  3. Start to walk… slowly. Over the course of about 4 months I started to walk more frequently and with more intensity. I picked up my pace through more days until I was walking around 20 miles a week (and felt good through most of them). This took some patience, lots of hours with friends laughing and talking, and a nutrition plan.
  4. With POTS you need more salt and water than the average person, and it took a bit of time for me to figure out how that looked for me personally. I realized what I needed to do not only the day that I worked out, but also the day before I worked out.
  5. I went on my first run, and collapsed in a yard close to passing out at mile 0.75. You can read all about that run here. It would’ve been really easy to quit here, but I was determined.
  6. I came up with a new running plan, and started to do a “run/walk” pattern, slowly increasing my amount of run time and decreasing the amount of walk time. I started running for abut 20 seconds at a time, and then increased to 30-40 seconds, and kept increasing from there. You can read all about that progress here.
  7. I found ways to cross train that would strengthen other leg muscles. Biking, swimming, and pilates were all part of this strategy.
  8. There are things that I avoid. Running in the heat almost never turns out well, and if I do it, I very much limit my time/miles. Also- STAY AWAY FROM HOT YOGA. Or, as my doctor said “RUN AS FAR AWAY FROM HOT YOGA AS YOU CAN. IT’S TOO DANGEROUS FOR YOU.” Since heat further exacerbates symptoms of POTS, hot yoga can become too dangerous far too quickly for someone with POTS. If you do yoga, stick to normal temperatures.
  9. I came up with a permanent walk run strategy by using the Galloway Method. Because I consistently walk for 1 minute after running for 3 minutes, I had a chance to regularly bring my heart rate down. This become highly important as I started racing, particularly during my half marathons.
  10. BE PATIENT! Some days POTS symptoms are overwhelming, some days they are more manageable. Some days might be ideal schedule or weather wise to work out, but your body might just not be ale to do it that day; that’s ok- be patient. Build your strength slowly, and don’t try to push too hard or too fast. Building up a good base without POTS can be tough, but building it up with POTS takes far more work. Be patient with yourself.

Like I said above, this is just what I did. Everyone’s journey to working out while managing POTS looks different. The best you can do is avoid comparison, be patient with yourself, and move slowly as you start gradually exercising. Be smart, be wise, and enjoy what you can do!

Disclaimer: I am not a doctor, and this post shouldn’t be taken as advice on what you should do. I am simply sharing what I personally did as I started to work out after my POTS diagnosis. Always consult a doctor before beginning a workout regime. 

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