The Orthostatic Intolerance (OI) Center
Move Into Health
No Walking, Running or Exercising While You Are Standing Up....
If you have orthostatic intolerance and your symptoms are not under control, the first thing to say is -- STOP -- don't try to increase your strength or health by running, walking with weights on your ankles or doing exercises standing up!
This is one of the most important things to know about recovering and moving into health. It is the reason so many exercise programs have failed to work. It is why people continue to be tired and feel worse after they exercise or exert themselves even going up stairs.
There is a very good, logical reason that it doesn't work.
Why Exercising Standing Up Makes Things Worse
The basic problem with orthostatic intolerance is that your body cannot adjust so that you get blood to your head and top of your body. If you exercise standing up, your body is still not getting blood up to the head PLUS now your legs need more blood to do the exercise. It's more than your body can do. You get tired because the blood is going to the legs and not enough is getting to the other muscles in your body.
The material on how your body works will explain more about what happens to your blood when you stand up.
The Missing Piece
In all the research published more recently,2,3,5-7 there are 2 things that people with orthostatic intolerance need to remember:
• The body has less volume volume (amount) of blood than it had before. There's not as much blood getting back to the
heart when you stand up.
• The heart is weaker and parts of the heart muscle have gotten smaller - so it pumps out less blood every time it pumps.
This information is the piece of the puzzle on that has been missing. It answers the question - how can you get exercise to get better when exercising makes you feel worse?
What Your Body Needs First - Before It Can Run or Even Walk
• Volume - it needs salt and fluids. If that isn't enough for you, it needs fludrocortisone.
• To retrain the pressure receptors so that lying down is NOT normal anymore - the head of the bed
needs to be raised.
• To exercise your heart and get it stronger - before it can handle exercising the rest of your body.
Plan on it taking about 8 weeks to build up to all this. You might not notice a change right away but you will start to notice.
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The research shows that bedrest has more of an effect on exercising standing up than is does on exercising done lying down (supine)
- When you stand up and exercise: Your heart rate is faster. The stroke volume (amount of blood the heart pumps out) is lower than when you exercise lying down (supine exercise).
- After bed rest, the ability to do aerobic activities (like running, walking) decreased 2 – 2.5 times more during upright exercise compared to supine exercise.
- In one study, after 10 days of bed rest, ability to do running/biking (aerobic capacity) decreased by 15% in the upright posture, but it only went down 6% when people were exercised lying down.
What this means The body can tolerate exercise lying down better it can standing up. It is less stressful for the body to exercise lying down - the heart rate doesn't go up as much and the heart can pump out more blood.
The opposite is true: It is harder on the body to exercise standing up. It makes the heart rate go higher. The amount of blood pumped out of the heart is lower. This can make more orthostatic symptoms.
References
- Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306. Abstract. Article PDF.
- Fu Q, Vangundy TB, Galbreath MM, Shibata S, Jain M, Hastings JL, Bhella PS, Levine BD. Cardiac origins of the postural orthostatic tachycardia syndrome. J Am Coll Cardiol. 2010 Jun 22;55(25):2858-68. Abstract. Article PDF
- Shibata S, Perhonen M, Levine BD. Supine cycling plus volume loading prevent cardiovascular deconditioning during bed rest .J Appl Physiol. 2010 May;108(5):1177-86. Epub 2010 Mar 11. Article pdf
- Mtinangi BL, Hainsworth R. Effects of moderate exercise training on plasma volume, baroreceptor sensitivity and orthostatic tolerance in healthy subjects. Exp Physiol. 1999 Jan;84(1):121-30. Abstract. Article pdf
- Fu Q, VanGundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD. Menstrual cycle affects renal-adrenal and hemodynamic responses during prolonged standing in the postural orthostatic tachycardia syndrome. Hypertension 56(1): 82-90, 2010.
- Fu Q, Vangundy TB, Galbreath MM, Shibata S, Jain M, Hastings JL, Bhella PS, Levine BD. Cardiac origins of the postural orthostatic tachycardia syndrome. J Am Coll Cardiol. 2010 Jun 22;55(25):2858-68. Abstract. Article PDF
- Fu Q, VanGundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension 58(2); 167-75, 2011.
- Galbreath MM, Shibata S, VanGundy TB, Okazaki K, Fu Q, Levine BD. Effects of exercise training on arterial-cardiac baroreflex function in POTS. Clinical Autonomic Research 21(2):73-80, 2011.
- Belavý DL, Bock O, Börst H, Armbrecht G, Gast U, Degner C, Beller G, Soll H, Salanova M, Habazettl H, Heer M, de Haan A, Stegeman DF, Cerretelli P, Blottner D, Rittweger J, Gelfi C, Kornak U, Felsenberg D.The 2nd Berlin BedRest Study: protocol and implementation. J Musculoskelet Neuronal Interact. 2010 Sep;10(3):207-19. Abstract. Article PDF.
Author: Kay E. Jewell, MD
Page Last Updated: August 28, 2012
