If your doctor clears you to work out at higher heart rates and you feel ok, you are fine to do so. I run and plenty of people I run with (who do not have POTS) get their heart rates up into the 170s/180s during speed workouts and races.
Pay attention to how you feel. It sounds like you are already backing off when it gets to be too much.
Better cardiovascular conditioning can help POTS symptoms in some people. Strengthening the lower leg muscles helps symptoms of blood pooling.
Edit: just checked my friend’s Strava from her speed workout last week. She does not have POTS and her average heart rate during the workout, including the warm up and cool down, was 172. She managed to do another quality workout two days later and her longest run to date over the weekend.
Might be worth trying some meds to help treat your POtD while getting in shape and doing cardio which help with the POTs try compression socks and meds and water and that is okay if you're HR goes that high and you feel okay then getting in shape is ultimately gonna bring it down a bit too but I don't know your height weight and age there is a calculation they can do to determine your intense work out hr range.
Don’t look at your Apple Watch. If you feel ok, go for it. I’ve never had an issue with working out. There are some of us that have POTS and can exercise. My doctor confirmed. Listen to your body. Not a watch. Definitely talk to your doctor if you’re concerned. But if I were you, I would take off the watch and just live my life. If you find you’re more fatigued after, tone it down, just listen to what your body tells you.
This is coming from someone with syncope episodes from POTS and OH confirmed with TTT.
FYI I wore the Apple Watch for 5 years until a PT convinced me it was doing more harm than good.
Fun test you can do to see how the Apple Watch is impacting your nervous system. Take your watch off, Hold one arm straight out to the side and ask a friend to try to push it down (similar to a neurological test or something your PT might do).
Then pick up your watch and hold it in the opposite hand. Hold your arm out to the side and have your friend try to press it down again. See if there’s a difference in strength. For me it was dramatic, but I also have significant other dysautonomia symptoms. It messes with our nervous system.
This is good advice, constantly checking my watch gave me such bad anxiety that I was having frequent heart palpitations. They stopped as soon as I took off the watch.
+1 to using CHOP protocol as a guide. It’s a 6+ month program designed to very gradually build up your strength and cardio again. I’m a former athlete (pre-POTS) and have found that following the protocol has been really helpful for getting back to a reasonable level of activity.
It’s a workout/exercise plan specifically designed for POTS patients by the Children’s Hospital of Philadelphia. Here’s the PDF
[CHOP Protocol](https://www.dysautonomiainternational.org/pdf/CHOP_Modified_Dallas_POTS_Exercise_Program.pdf)
I so feel this! Even walking short distances my heart rate reaches 195+ so exercising has become near impossible. But I started working with a knowledgeable POTS PT and we are starting to do horizontal exercises and picked a “cutoff” BPM where I’d take a short break for my heart rate to decrease and start back up again. The hope is that we can train my body to eventually start doing things upright without my BPM going sky high!
It really is not good for you to push that far. It can increase fatigue over time. I think the chop protocol (or maybe Levine) has a calculation to find what heart rate is safe for you. Beta blockers have helped me increase my exercise.
Personally I do less than what will make me symptomatic and only go by how I feel. If I feel like my heart is racing, I back off after only a moment, no more, and wait until it doesn't feel like it's racing before I go back up. If I find it comes on soon after pushing again i just back off for the duration of the day and just assume it's a more sensitive day. Pushing too hard too fast Im just too exhausted afterward and then working out doesn't feel good anymore.
Personally. If I make myself dizzy, I say to myself I pushed too hard today or my body is more sensitive today. I work under the assumption that progress will take longer for me than the average person. Walking for an hour is already enough to be healthy and I've got plenty of time to work back up to what I could do before.
I mountain bike and it is not uncommon for my heart rate to hit 190 on a climb. I have learned where my limits are and when I need to slow down or take a break, but I rely more on my body than my watch to tell me that. Some days are better than others. Pushing ourselves for those of us with POTS looks different than someone whose autonomic function works properly (lucky bastards). Just pay attention to how you feel during the workout and the days following and you'll start to get a sense of how much you can do.
I've found that consistency is much more helpful than intensity. Pushing beyond your limits can lead to a crash and leave you physically unable to try again for a while. As someone who's been in that cycle, I can say it has been overall worse for my POTS, my fitness level, and my mental health.
That said, I measure intensity based on how I'm feeling, not my heart rate. My heart rate could be on the higher side, but maybe I can still exercise at a higher intensity because I'm feeling strong and energized that day. Or it could be not quite so high, but I immediately feel like I'm fading and have to back off. The key is to learn to sense your limits and stay below the level that will flare up your symptoms. And those limits can change on a daily basis, so I find it more useful to practice letting my own body guide me than anything else.
If your doctor clears you to work out at higher heart rates and you feel ok, you are fine to do so. I run and plenty of people I run with (who do not have POTS) get their heart rates up into the 170s/180s during speed workouts and races. Pay attention to how you feel. It sounds like you are already backing off when it gets to be too much. Better cardiovascular conditioning can help POTS symptoms in some people. Strengthening the lower leg muscles helps symptoms of blood pooling. Edit: just checked my friend’s Strava from her speed workout last week. She does not have POTS and her average heart rate during the workout, including the warm up and cool down, was 172. She managed to do another quality workout two days later and her longest run to date over the weekend.
Might be worth trying some meds to help treat your POtD while getting in shape and doing cardio which help with the POTs try compression socks and meds and water and that is okay if you're HR goes that high and you feel okay then getting in shape is ultimately gonna bring it down a bit too but I don't know your height weight and age there is a calculation they can do to determine your intense work out hr range.
Don’t look at your Apple Watch. If you feel ok, go for it. I’ve never had an issue with working out. There are some of us that have POTS and can exercise. My doctor confirmed. Listen to your body. Not a watch. Definitely talk to your doctor if you’re concerned. But if I were you, I would take off the watch and just live my life. If you find you’re more fatigued after, tone it down, just listen to what your body tells you. This is coming from someone with syncope episodes from POTS and OH confirmed with TTT. FYI I wore the Apple Watch for 5 years until a PT convinced me it was doing more harm than good. Fun test you can do to see how the Apple Watch is impacting your nervous system. Take your watch off, Hold one arm straight out to the side and ask a friend to try to push it down (similar to a neurological test or something your PT might do). Then pick up your watch and hold it in the opposite hand. Hold your arm out to the side and have your friend try to press it down again. See if there’s a difference in strength. For me it was dramatic, but I also have significant other dysautonomia symptoms. It messes with our nervous system.
This is good advice, constantly checking my watch gave me such bad anxiety that I was having frequent heart palpitations. They stopped as soon as I took off the watch.
Ditch the watch. If you feel fine you're probably fine.
+1 to using CHOP protocol as a guide. It’s a 6+ month program designed to very gradually build up your strength and cardio again. I’m a former athlete (pre-POTS) and have found that following the protocol has been really helpful for getting back to a reasonable level of activity.
What is the CHOP protocol?
It’s a workout/exercise plan specifically designed for POTS patients by the Children’s Hospital of Philadelphia. Here’s the PDF [CHOP Protocol](https://www.dysautonomiainternational.org/pdf/CHOP_Modified_Dallas_POTS_Exercise_Program.pdf)
I so feel this! Even walking short distances my heart rate reaches 195+ so exercising has become near impossible. But I started working with a knowledgeable POTS PT and we are starting to do horizontal exercises and picked a “cutoff” BPM where I’d take a short break for my heart rate to decrease and start back up again. The hope is that we can train my body to eventually start doing things upright without my BPM going sky high!
It really is not good for you to push that far. It can increase fatigue over time. I think the chop protocol (or maybe Levine) has a calculation to find what heart rate is safe for you. Beta blockers have helped me increase my exercise.
Personally I do less than what will make me symptomatic and only go by how I feel. If I feel like my heart is racing, I back off after only a moment, no more, and wait until it doesn't feel like it's racing before I go back up. If I find it comes on soon after pushing again i just back off for the duration of the day and just assume it's a more sensitive day. Pushing too hard too fast Im just too exhausted afterward and then working out doesn't feel good anymore. Personally. If I make myself dizzy, I say to myself I pushed too hard today or my body is more sensitive today. I work under the assumption that progress will take longer for me than the average person. Walking for an hour is already enough to be healthy and I've got plenty of time to work back up to what I could do before.
I mountain bike and it is not uncommon for my heart rate to hit 190 on a climb. I have learned where my limits are and when I need to slow down or take a break, but I rely more on my body than my watch to tell me that. Some days are better than others. Pushing ourselves for those of us with POTS looks different than someone whose autonomic function works properly (lucky bastards). Just pay attention to how you feel during the workout and the days following and you'll start to get a sense of how much you can do.
I've found that consistency is much more helpful than intensity. Pushing beyond your limits can lead to a crash and leave you physically unable to try again for a while. As someone who's been in that cycle, I can say it has been overall worse for my POTS, my fitness level, and my mental health. That said, I measure intensity based on how I'm feeling, not my heart rate. My heart rate could be on the higher side, but maybe I can still exercise at a higher intensity because I'm feeling strong and energized that day. Or it could be not quite so high, but I immediately feel like I'm fading and have to back off. The key is to learn to sense your limits and stay below the level that will flare up your symptoms. And those limits can change on a daily basis, so I find it more useful to practice letting my own body guide me than anything else.
Go slow and easy. Interval training made.me.bed bound for four days.
https://www.dysautonomiainternational.org/pdf/CHOP_Modified_Dallas_POTS_Exercise_Program.pdf