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How to Start Exercising with POTS

Updated: May 30, 2022

You’ve been encouraged to exercise, but every time you do, you have to lay in bed for a few days?

It’s estimated that about 20% of POTS patients have a diagnosis of chronic fatigue syndrome (CFS).

One of chronic fatigue syndrome hallmarks is post-exertional malaise (PEM).

What is PEM? It means that even minimal mental or physical exertion leads to a flare-up and reduced function.

This is not due to deconditioning. It involves various neurological, immunological, autonomic, and energy metabolism impairments.

What does this mean? This means that for many POTS patients, exercising makes them feel worse. A lot worse.

So, what do you do when you know that exercise is known to help POTS, but you struggle with fatigue and PEM?

Here are a few tips:

1. Start slow. And only once you are feeling more stable. Last week, I wrote about pacing. First, find a rhythm and routine that works for you. Are you at a point where you are having fewer flare-ups and can start including more activities?

2. How many minutes a day can you walk for? When you’re answering that question, you most likely thought of how much you can do on a good day. If you actively start doing that, you might have another flare-up. So, find a middle ground that encompasses what you can do on a flare-up day.

3. Don’t increase exponentially. Let’s say that you’ve been on your rowing machine for 5 minutes and feel ready to do more. Don’t jump straight to 10. Jump to 6 or 7 minutes instead. (It took years until I was able to go rowing again. So here I am, enjoying my well-deserved rest before getting up to pack the kayak.)

Exercise can be one of the toughest parts because it can be hard to find that balance.

You know about the benefits of it, but at the same time, you don’t want to do something that feels like it’s harming your body. That’s why finding that balance is so important.

Here is where having support is so important.

In my work with clients, we spend quite a bit of time discussing day-to-day activities and slowly incorporating movement.

If you’re ready to find more balance in your day-to-day activities, click here to set up a coaching session.


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