Using an exercise program to improve activity tolerance in a female with postural orthostatic tachycardia syndrome: A case report

The incidence of postural orthostatic tachycardia syndrome (POTS) is estimated to be at least 500,000 in the United States and is most commonly found in premenopausal females. This syndrome shares clinical features with orthostatic hypotension (OH); however, the inclusion criteria and clinical features for POTS are not well known. The purposes of this case report are to: 1) describe the common clinical features of POTS and highlight the differences to orthostatic hypotension and 2) discuss physical therapy management of patients with POTS using exercise. A 34-year-old female with a POTS exacerbation completed a 4-week physical therapy endurance and strengthening ‘reconditioning’ program. Initial symptoms included the following: dyspnea with mild exertion, light-headedness, fatigue, leg “heaviness,” and the inability to perform normal work duties. One-mile track walk test (1-MWT) estimated VO_2max improved from the 45–50th percentile to the 65–70th percentile at 8 weeks post-discharge. She returned to work full-time and resumed all previous fitness activities. The patient demonstrated clinically meaningful improvements in estimated VO_2max after the “reconditioning” training. Physical therapists should be able to recognize the clinical features and inclusion criteria for POTS as part of a differential diagnosing process for patients complaining of orthostatic symptoms.