Exercise rehabilitation for people with postural tachycardia syndrome at two secondary care centres in the UK: the PULSE feasibility... 2025 McGregor+

Full title: Exercise rehabilitation for people with postural tachycardia syndrome at two secondary care centres in the UK: the PULSE feasibility randomised controlled trial

Abstract

Objectives
The aim of the study was to assess the feasibility of conducting a definitive multicentre randomised controlled trial (RCT) testing an online exercise rehabilitation and behavioural/motivational support intervention for people with postural tachycardia syndrome (PoTS).

Design
Feasibility RCT.

Setting
Two secondary care centres.

Participants
Adults aged 18 to 60 years with PoTS. Exclusions were serious mental health/cognitive problem preventing safe participation; currently undertaking physical activity equivalent to the Chief Medical Officer guidelines; pregnancy.

Interventions
Participants were randomly assigned (1:1) to best-practice usual care (a single 1:1 session of advice) or the ‘postural tachycardia syndrome exercise’ (PULSE) intervention: (1) individual online consultation, (2) 12 weeks of supervised online group exercise and behavioural/motivational support, and (3) home exercise programme with recumbent exercise bike.

Outcomes
The primary outcome was feasibility: (1) patients screened, eligible, recruited, randomised, withdrawn; (2) adherence; (3) physiological, clinical and patient-reported outcomes (4 and 7 months); and (4) embedded qualitative study to evaluate acceptability.

Results
209 patients screened between 5 May 2021 and 1 December 2022, 44 (female 98%; age 29.9 SD, 7.5) were randomised to usual care (n=21) or PULSE (n=23) (71% of target). Follow-up at 4 months was n=12 and n=17 respectively (66% of target). Median live exercise/support session attendance was 15 (IQR 12 to 17) of 18 sessions. Home exercise bike usage was highly variable. There were two serious adverse events in each treatment arm, both unrelated to the trial. Exercise rehabilitation was considered important by participants, and trial procedures, outcomes and interventions were acceptable.

Conclusions
The PULSE trial procedures and interventions were acceptable, and important design considerations were identified. A definitive RCT testing a remotely supervised exercise rehabilitation and behavioural/motivational support intervention for people with PoTS is feasible in the UK National Health Service.

Open access

 

Previously, Co-creation of complex, multicomponent rehabilitation intervention & feasibility trial protocol for the PostUraL tachycardia Syndrome Exercise (PULSE)

 

Ok to they only interviewed for acceptability:

- 5 patients who had the intervention at 4months

- 3 patients who had the intervention at 8months

there were more that they interviewed at baseline but that’s academic isn’t it given what everyone knows about questions asking people to predict their behaviour nevermind their own acceptability of that are as unreliable as they come and to be avoided

and of course apart from those in those two bullets then they are asking people who haven’t done the intervention by that point

so I guess the whole paper (or should I say the main outcome that they mention in the abstract) is based on 3-5 interviews ?


They also report exercise capacity on the bike in mins (intervention vs std care) but there are brackets after the minutes like 8 (2.4) vs 7 (3.2) so I assume it isn’t ‘N’ as isn’t whole numbers and am not fully sure how many completed these tests?