POTSWhat do garments and training do?
GUESS FIRST
Which garment coverage lowered heart rate on tilt the most?
Garment coverage during a 10-minute tilt
Bourne 2021: randomized crossover in 30 adults with POTS. Pick a garment to dress the body and see that arm of the trial.
With no garment, heart rate on tilt averaged 109 bpm.
The body is an illustration; the bars show the trial. Bourne 2026 tested an abdominal garment on and off in a small single-day study: the effect reversed when the garment came off. Single-session effects only. No blinding is possible and no long-term outcome data exist. Comfort and heat limit wear for some people.
Exercise builds over months
Programs start lying down or seated, then move upright as tolerance grows.
MONTH 1
Lying and seated: rowing, recumbent bike, swimming
MONTH 2
Longer seated sessions, some upright
MONTH 3
Upright exercise
Bar heights only show the shape of a ramp. They are illustrations.
A community exercise program
George 2016: an uncontrolled registry. Of 251 people who enrolled, 103 finished.
Among the 103 who finished, 71% no longer met POTS criteria afterward, and their rise on standing fell from 46 to 23 bpm.
This registry had no comparison group, and salt and water were part of the program, so exercise cannot be separated from them. Results describe the people who finished.
Fu 2011: three months of training lowered standing heart rate and raised physical functioning scores (33 to 50) in 19 people with POTS compared with 15 controls. Propranolol did not improve quality of life.
Cortez 2025: a systematic review of 7 studies found heart rate improved in all seven. Risk of bias was moderate to high in most.
Limits: Small studies, large dropout in the registry, and salt and water were part of the program, so exercise cannot be isolated. Many people feel worse before they feel better, so pace the ramp-up with a clinician.
Read the trials: Bourne 2021, Bourne 2026, Fu 2011, George 2016, Cortez 2025.