Review Impact of Exercise to Treat Postural Orthostatic Tachycardia Syndrome: A Systematic Review, 2025, Cortez et al

forestglip

forestglip

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Impact of Exercise to Treat Postural Orthostatic Tachycardia Syndrome: A Systematic Review

Melissa M Cortez, Kayla Aikins, Amy C Arnold, Jeffrey R Boris, Todd E Davenport, Katie Johnson, Hagar S Kattaya, Laurence Kinsella, Mary M McFarland, Ryan Pelo, Clayton D Powers, Kelsi Schiltz, Lauren E. Stiles, Lauren Ziaks, Tae Hwan Chung, Claudia DalMolin

Background
Postural orthostatic tachycardia syndrome (POTS) is a chronic condition associated with a high symptom burden and decreased quality of life (QOL). Exercise is currently considered to be a first line non-pharmacological treatment for POTS. The purpose of this systematic review was to evaluate the impact of exercise on cardiovascular and patient-centered outcomes in patients with POTS.

Purpose
To evaluate whether exercise benefits patients with POTS by synthesizing data from published clinical studies.

Methods
Electronic databases, including Medline, Embase, CINAHL Complete, Cochrane CENTRAL, and others were searched and results were exported on May 2, 2023. Study inclusion: those that utilized an exercise program as an intervention for POTS and were conducted as experimental or quasi-experimental design.

Exclusions
Non-English language papers and opinion-based/theoretical/non-empirical studies/case reports. Data extraction was based on Cochrane Handbook guidance and summarized according to Synthesis Without Meta-analysis (SWiM) guidelines; methodological quality and risk of bias was evaluated using the JBI Critical Appraisal tools. Standardized effects were calculated and summarized based on the direction of effect.

Results
Seven studies included in the final review are described in the data summary and synthesis. Improvements in heart rate were reported across all studies reviewed, while stroke volume and QOL improvements were also found. Notably, not all studies reported on the latter two outcomes. Methodological variability across studies precluded meta-analysis, and risk of bias was considered moderate-high in all but a single study.

Link (Frontiers in Neurology) [Provisionally accepted, only abstract right now)
 
The review said:
conducted as experimental or quasi-experimental design
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Very strong feel of Theranos 'showing' that their machines work by testing behind closed doors and bringing you the results. You can trust them. Why would they just fake them? Other than having promised for literally decades that this works.

Are the exams to work in this industry open book and time-unlimited, too? Done in teams with the answer sheet? Then self-graded? Why even bother with this process when you can simply report an opinion as fact? Just skip all the theater, then.
 
Results: Seven studies included in the final review are described in the data summary and synthesis. Improvements in heart rate were reported across all studies reviewed, while stroke volume and QOL improvements were also found. Notably, not all studies reported on the latter two outcomes. Methodological variability across studies precluded meta-analysis, and risk of bias was considered moderate-high in all but a single study.

Conclusion: While currently available evidence supports exercise as beneficial to QOL and cardiovascular features of POTS, we identified a major need for additional studies assessing the effect of exercise on symptom burden and daily function, including studies that consider patients with specific comorbidities that impact exercise tolerability and/or dosing.
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I struggle to understand how this sentence is supported by the evidence. If pretty much all of the studies have a substantial risk of bias they do not support anything. The evidence is inconclusive.
 
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nearly all studies (except one) suffered from moderate to high risk of bias and study design limitations. In particular, those with comorbid conditions that impact exercise tolerability remain severely understudied. Such factors also contribute to a key limitation of this review, including rendering the data inappropriate for meta-analysis.
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Finally, it is estimated that a fair proportion of patients with POTS also meet the current diagnostic criteria for ME/CFS , which is also characterized by multisystemic symptomatology including autonomic dysfunction, and is exemplified by moderate to severe PEM. PEM is, by definition, precipitated by exertion (e.g., mental, emotional, or physical), and can result in a worsening of a constellation of symptoms, leading to extreme fatigue, cognitive impairment and flu-like symptoms within hours or days after exertion lasting days to weeks.
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Notably, none of the studies characterized (or considered) the participants prior experiences with exercise, which may influence an individual’s decision to participate in an exercise study. Since exercise is commonly recommended as a treatment for POTS, it is likely that most have tried some type of exercise prior to encountering an opportunity to enroll in a study. Those who have seen no benefit from exercise, or in some cases may feel worse after exercise (such as those with significant PEM), may be inherently less likely to volunteer for exercise studies, whereas patients who have seen some benefit from exercise are more likely to volunteer for exercise studies. This may itself, lead to further [self-]selection bias.
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Sean said:
after exertion lasting days to weeks.

More like as little as minutes.
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I think «lasting» is connected to the symptoms earlier in the sentence and not the exertion. They could have used a comma or two to make it clearer.
PEM is, by definition, precipitated by exertion (e.g., mental, emotional, or physical), and can result in a worsening of a constellation of symptoms, leading to extreme fatigue, cognitive impairment and flu-like symptoms within hours or days after exertion lasting days to weeks.
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I have heard accounts from people with POTS (not seeming to have known comorbidities) that increasing exercise did help them but it was a long process. From what I understood from them was they also increased other things too such as salt intake and some took medications to help in that area.
 
Utsikt said:
I think «lasting» is connected to the symptoms earlier in the sentence and not the exertion. They could have used a comma or two to make it clearer.
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Adding a comma makes a lot more sense.

...and can result in a worsening of a constellation of symptoms, leading to extreme fatigue, cognitive impairment and flu-like symptoms within hours or days after exertion, lasting days to weeks.​
 
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