Review Exercise in Postural Orthostatic Tachycardia Syndrome: Focus on Individualized Exercise Approach 2024 Blitshteyn et al

[Andy]

Abstract

Exercise is a vital component of health and is commonly utilized as a non-pharmacologic therapy for many disorders, including postural orthostatic tachycardia syndrome (POTS). However, exercise intolerance is a key feature of POTS and other autonomic disorders and, therefore, presents a major barrier for many patients. Despite exercise being uniformly recommended as a therapeutic intervention, a majority of patients with POTS, especially those with severe orthostatic intolerance and fatigue, are unable to complete or sustain rigorous exercise programs or successfully integrate them into their daily routine.

In this narrative review, we discuss the current literature on exercise and POTS and our clinical experience with a home-based exercise approach developed at the Dysautonomia Clinic. We conclude that individualized exercise programs that are delivered remotely by a certified physical therapist may be convenient, easily accessible, and safe for patients with POTS, especially those with severe symptoms who may be home- or bedbound. Future randomized controlled studies are needed to quantify and characterize the benefits of home-based exercise programs delivered remotely compared to standard therapy.

Open access, https://www.mdpi.com/2077-0383/13/22/6747

 

[Turtle]

Authors with knowledge and common sense, how wonderful.

 

[ME/CFS Skeptic]

This is the paper that contains 'helpful facts' for which they author received a lot of criticism on social media (seems that she has now deleted that post)

https://twitter.com/user/status/1857854003347951744

 

[Jonathan Edwards]

That list is simply a string of un-evidenced or meaningless statements presented as expert advice.

The paper is presumably just a bid to justify a profitable practice by people with nothing to offer.

 

[rvallee]

I still haven't seen evidence that exercise provides any meaningful benefits in POTS without PEM. It's all generic "exercise is good for you", which is true in most cases, but something being good doesn't treat specific problems. Not drinking water will always lead to problems, and yet drinking enough water will only ever fix problems of a deficit in body water. Same with exercise here, as they state POTS is not related to deconditioning, therefore how could conditioning fix anything? It makes zero sense.

After seeing it enough times, I now interpret individualized programs as meaning arbitrary. That's it, that's what it means: wing it. Standardization is not bad. And even with standardized treatments, there is usually a dosage relative to body weight. Although the language of dosage is used here, it doesn't apply, so the whole thing is irrelevant. There are no reliable answers, obviously the solution is not to arbitrary try unreliable things that have shown no efficacy.

Pacing is not a technique, and is not that either:

Pacing, a highly beneficial technique to conserve energy and mitigate PEM, involves activity alternating with rest and can be beneficial in patients with POTS, especially in those with severe symptoms and/or comorbid ME/CFS

Activity is the wrong term here. Washing my dishes in 2-3 bouts is not an activity. There are so many basic vocabulary and language issues in medicine, and so-called evidence-based is basically the art of abusing those issues.

Everyone seems to confuse the goal being about exercising. This isn't the issue. My problems in life have nothing to do with not being able to exercise. I would love to be able to exercise, I always enjoyed it, but it's not in the top 100 of my problems. Any solution that makes the goal in itself to be all about exercise completely misses the mark.

As stated above, existing exercise protocols have a low success rate for individuals with POTS, especially when accompanied by severe symptoms and comorbidities. Therefore, the focus of our program is on treating the entire body and functional impairments in an individualized and targeted exercise approach—not the one-size-fits-all model commonly used in existing structured exercise programs

Again the problem is not with a one-size-fits-all model. It's that the entire objective here is wrong and misunderstands the nature of the problem.

And again with this crap:

Extensive patient education is provided on how the ANS works in controlling the body’s automatic functions in order to empower the patient to engage in their own exercise program and ensure compliance

I'm getting on going with a simple "fuck you" at all things that involve crap like this, teaching us about things that are easy to understand and, again, have literally nothing to do with the problem.

Education and knowledge of why symptoms occur are key components in learning to manage them

They don't know that either. How can anyone think they can teach things they don't even understand and how it relates to problems they also don't understand? Good grief this is ridiculous.

When you literally have no idea what PEM is and completely miss the point:

Increasing the duration of these positions and activities gradually is the key to reducing severe orthostatic symptoms and PEM

Just complete backwards-ass.

I remain mostly convinced that literally none of this is of any relevance in POTS, just as it is with ME/CFS. POTS seems to have higher rates of remissions and natural recoveries, which I assume is why some have convinced themselves of it. After all it is tradition in this industry to take credit for things that go right, regardless of any cause-and-effect, and to attribute to other factors anything that doesn't work.

Not as bad as most garbage out there. Still garbage.

 

[Mij]

Discussion about Blitshteyn here regarding PEM and GET. She doesn't get it.