Review Exercise Interventions in the Management of Postural Orthostatic Tachycardia Syndrome: A Scoping Review 2024 Gonçalves Leite Rocco et al

Objective: This review aims to identify the exercise rehabilitation approaches used for patients with POTS (Postural Orthostatic Tachycardia Syndrome).

Methods: An electronic literature search was conducted using the PubMed database, covering January 2005 to October 2023. Studies were included if they reported an exercise rehabilitation intervention for POTS patients and resulting clinical outcomes. Eligible study designs included randomized and non-randomized clinical trials and case reports.

Results: Initially, 34 publications were identified, but only 14 met the criteria for inclusion. After a thorough analysis, 7 studies were included in this scoping review. The majority of the studies stated aerobic exercise training significantly improves symptoms in most of the patients with orthostatic intolerance, reduces the frequency of syncope, enhances patient quality of life, and improves autonomic balance as assessed by heart rate variability analysis and cardiorespiratory endurance. Short-term exercise training was found to boost physical fitness and cardiorespiratory responses in patients with POTS. Therefore, exercise training can serve as an effective non-pharmacological therapy for managing POTS.

Conclusion: This scoping review identified different approaches used for exercise rehabilitation in POTS patients. However, more research is needed to identify the optimal exercise rehabilitation program for this patient population.

Open access, https://www.dovepress.com/exercise-...tic-tachy-peer-reviewed-fulltext-article-JMDH

 

The authors note
"Additionally, alcohol or metal poisoning, and chronic fatigue syndrome may lead to POTS.7"

and in discussion say
"Similarly to our study, Peebles et al emphasize the necessity for careful adaptation of exercise routines due to challenges such as fatigue and post-exertional malaise. Their review advocates for a gradual, progressive approach that begins with recumbent exercises before advancing to upright activities.35 This strategy accommodates the unique needs of young adult patients experiencing joint hypermobility, chronic pain, or fatigue. Such a nuanced approach supports the present review’s recommendation for supervised, adaptable, and individualized exercise regimens, particularly for POTS patients with additional comorbidities, where early intervention can lead to symptom reduction and improved cardiovascular responses."

But then in the conclusion say
"Based on this scoping review, previous articles found that a specialized set of exercises prescribed for patients with POTS can be beneficial and feasible. However, methodological limitations such as small sample size, quasi-experimental design, and short-term follow-up limited the generalizability of these studies. Additional research is essential to determine the optimal methodologies, protocols, and strategies to enhance clinical practice for treating POTS patients using exercise interventions."

 

Sounds like they're using 'post-exertional malaise' in general terms. Perhaps some pwPOTS benefit from some kind of carefully managed form of exercise.

 

This is all a terrible experiment in "what if we made an entire discipline out of the worst possible studies?" Not that we needed to know how bad it would be.

No one can even come up with a coherent explanation for why various types of exercise would even matter here. The claims of improvements can't be trusted as we know they are massively exaggerated as a standard. And it remains that POTS has nothing to do with lack of fitness or muscle strength, therefore anything addressing physical fitness or muscle training makes as much sense here as it would against loss of smell.

We are so long past the point at which in a reasonable world there would be restraining orders against this nonsense. But of course we are not in a reasonable world.

Those sentences don't even make sense combined this way. Those have nothing to do with one another as it has nothing to do with the problems found in POTS. Just pure nonsense.

 

Still haven't seen any evidence of this that isn't in the form of cherry-picking from the worst possible studies or just trusting the word of unreliable people who overhype their claims and couldn't even tell the difference if their life depended on it anyway.

And reviews like this only make it all that clearer. They got nothing, but "imagine a world"-based medicine is just that: imagine the potential, then send them money.