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Breathing & recovery

PoTS exercises: a lying and seated starter session

Upright exercise often sets off the symptoms of postural tachycardia syndrome (PoTS), so the programmes that help start seated or lying down and move upright over months. This session follows week 1 of the Children's Hospital of Philadelphia (CHOP) programme, adapted from the Levine protocol: two 3-minute blocks at an easy pace with a warm-up and cool-down, then the lying leg strength moves CHOP gives for home. We split the cardio between a bike and a rowing machine, which CHOP allows; you can do it all on one. Drink two glasses of water first, wait an hour after eating, keep the room cool, and wear compression tights if you use them. It's for people whose PoTS has been diagnosed and who don't get post-exertional malaise.

30 minBeginner8 movesCardio machine · Other / check instructions · A wallQuads · Glutes · Hip abductors · Adductors · Hamstrings
Follow along: a timer, a cue and the next move, one step at a time.

Bike: warm-up and first easy-pace block

  1. Stationary cycling5 min
    Beginner · Quads, Glutes, Hamstrings · 3D demoWarm up very easily, with little or no resistance. A recumbent bike, the kind with a backrest, suits best if you have one; any seated exercise bike worksHarder: Air bike intervals
  2. Stationary cycling3 min
    Beginner · Quads, Glutes, Hamstrings · 3D demoEasy pace: about 2 to 4 out of 10 for effort, or the heart rate zone your clinic gave youHarder: Air bike intervals
  3. Stationary cycling2 min
    Beginner · Quads, Glutes, Hamstrings · 3D demoRecovery: slow right down and have a drink, but keep pedalling gently, about 0 to 2 out of 10Harder: Air bike intervals

Rowing machine: second easy-pace block and cool-down

  1. Indoor Rowing (Rowing Machine)3 min
    Beginner · Quads, Biceps, Calves · 3D demoMove across slowly: sit on the bike for a moment first, and sit straight back down if you feel light-headed. Then row at the same easy pace. No rowing machine? Stay on the bikeHarder: Rucking (loaded walking)
  2. Indoor Rowing (Rowing Machine)5 min
    Beginner · Quads, Biceps, Calves · 3D demoCool down: row lighter and slower until your breathing settles. Slow down gradually rather than stopping suddenlyHarder: Rucking (loaded walking)

Lying leg strength

  1. Glute bridge8 to 10, holding each up to 10 s
    Beginner · Glutes, Hamstrings, Abs · 3D demoSqueeze your buttocks and lift slowly without arching your back. Count out loud so you keep breathingEasier: Pelvic tilt into bridgeHarder: Glute kickback (quadruped hip extension)
  2. Straight-leg raise8 to 10 each leg
    Beginner · Quads, Hip flexors, Abs · 3D demoTighten your thigh to straighten the knee, lift the leg to the height of the other knee, hold for a second and lower slowlyEasier: Quad set (static quads)Harder: Leg extension
  3. Side-lying leg raise8 to 10 each side
    Beginner · Hip abductors, Glutes · 3D demoKeep the top leg in line with your body or slightly behind it, never in frontEasier: Lateral band walkHarder: Lateral band walk, band at the feet
  4. Lying adductor ball squeeze8 to 10, holding each 5 s
    Beginner · Adductors, Abs · 3D demoWith a pillow or soft ball between your thighs, squeeze while you count out loud, then let goHarder: Copenhagen plank
  5. Clamshell8 to 10 each side
    Beginner · Hip abductors, Glutes · 3D demoKeep your ankles together and your hips still as the top knee liftsHarder: Lateral band walk

Finish

  1. Legs up the wall (Viparita Karani)2 to 3 min
    Beginner · Hamstrings, Calves · 3D demoOr lie with your legs raised on cushions. Then sit for a minute before you stand up slowlyHarder: Plow pose (Halasana)

Tips

  • This is adapted from week 1 of the CHOP programme. CHOP sets heart rate zones for each person after an exercise test; we use perceived effort instead (our editorial change). If you take a beta blocker, CHOP also goes by effort rather than heart rate.
  • Check with your doctor or PoTS team before you start. Skip this session if you get post-exertional malaise, where your symptoms flare up a day or two after effort: no trial of these programmes checked for it, so pace as our ME/CFS guide describes and talk to your specialist.
  • If you feel faint, stop, lie down and raise your legs until you feel better. If you can't lie down, cross your legs and squeeze your buttock and tummy muscles. If you faint while exercising, call 999 (911 in the US).
  • Do the session 3 times a week, with the strength block on 2 of those days and a day between them, as CHOP does. Each week, if your symptoms are no worse, add about a minute to each easy-pace block, and build the strength moves towards CHOP's 3 sets of 8 to 10. Stay seated or lying for about the first 3 months. This build-up is our editorial reading of CHOP's calendar.
  • Feeling more tired in the first weeks is common, CHOP says: repeat a week rather than pushing on. PoTS UK says it can take 6 to 12 weeks to notice a change.
  • Keep cool, because CHOP doesn't recommend exercise in the heat. Cool down gradually rather than stopping, and stand up slowly at the end.

The doses are suggested starting points, not a prescription. Choose a range you can control and stop for sharp or increasing pain, numbness or tingling. Get individual advice after an injury or surgery, or if you are pregnant or managing a health condition.

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Questions people ask

How long does the pots exercises: a lying and seated starter session take?

About 30 minutes, including any warm-up and cool-down listed. Shorten it by doing fewer rounds; lengthen it by adding one.

What equipment do I need?

You need: Cardio machine, Other / check instructions, A wall. Each move links to its guide, where you can find an alternative if you are missing something.

Is it suitable for beginners?

It is written for beginners. 3 of its 8 moves have an easier option listed beside them if you need one.

How do I make it easier or harder?

Use the easier or harder option listed under each move, change the number of rounds, or adjust the rest. Progress one change at a time.