Skip to main content
SpringerLink
Log in

POTS versus deconditioning: the same or different?

  • REVIEW ARTICLE
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

The 2007 Streeten Lecture focused on the idea that physical deconditioning plays a key role in the symptomology and pathophysiology of POTS. Parallels were drawn between the physiological responses to orthostatic stress seen in POTS patients and the physiological responses seen in “normal” humans after prolonged periods of bedrest, deconditioning, or space flight. Additionally, the idea that endurance exercise training might ameliorate some of these symptoms was also advanced. Finally, potential parallels between POTS, chronic fatigue syndrome, and fibromyalgia were also drawn and the potential role of exercise training as a “therapeutic intervention” in all three conditions was raised. The conceptual model for the lecture was that after some “initiating event” chronic deconditioning plays a significant role in the pathophysiology of these conditions, and these physiological changes in conjunction with “somatic hypervigilence” explain many of the complaints that this diverse group of patients have. Additionally, the idea that systematic endurance exercise training might be helpful was advanced, and data supportive of this idea was reviewed. The main conclusion is that the medical community must retain their empathy for patients with unusual conditions but at the same time send a firm but empowering message about physical activity. As always, we must also ask what do the ideas about physical activity and inactivity and the conditions mentioned above not explain?

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Benrud-Larson LM, Dewar MS, Sandroni P, Rummans TA, Haythornthwaite JA, Low PA (2002) Quality of life in patients with postural tachycardia syndrome. Mayo Clin Proc 77:531–537.

    Article  PubMed  Google Scholar 

  2. Benrud-Larson LM, Sandroni P, Haythornthwaite JA, Rummans TA, Low PA (2003) Correlates of functional disability in patients with postural tachycardia syndrome: preliminary cross-sectional findings. Health Psychol 22:643–648.

    Article  PubMed  Google Scholar 

  3. Bonyhay I, Freeman R (2004) Sympathetic nerve activity in response to hypotensive stress in the postural tachycardia syndrome. Circulation 110:3193–3198.

    Article  PubMed  Google Scholar 

  4. Dorfman TA, Levine BD, Tillery T, Peshock RM, Hastings JL, Schneider SM, Macias BR, Biolo G, Hargens AR (2007) Cardiac atrophy in women following bed rest. J Appl Physiol 103:8–16.

    Article  PubMed  Google Scholar 

  5. Fu Q, Shook RP, Okazaki K, Hastings JL, Shibata S, Conner CL, Palmer MD, Levine BD (2006) Vasomotor sympathetic neural control is maintained during sustained upright posture in humans. J Physiol 577:679–687.

    Article  PubMed  CAS  Google Scholar 

  6. Fu Q, Shook RP, Shibata S, Hastings JL, Okazaki K, Conner CL, Palmer MD, Levine BD (2007) Vasomotor sympathetic and hemodynamic responses during upright tilt in postural orthostatic tachycardia syndrome. FASEB J 21:A879.

    Google Scholar 

  7. Fu Q, Shook RP, Shibata S, Okazaki K, Hastings JL, Dorfman T, Conner CL, Palmer MD, Jacob G, Levine BD (2006) Cardiac size: a potential mechanism for gender differences in orthostatic intolerance and POTS? Clin Auton Res 16:321.

    Google Scholar 

  8. Halliwill JR, Lawler LA, Eickhoff TJ, Joyner MJ, Mulvagh SL (1998) Reflex responses to regional venous pooling during lower body negative pressure in humans. J Appl Physiol 84:454–458.

    PubMed  CAS  Google Scholar 

  9. Levine BD (2006) The Grinch syndrome: a new name for orthostatic hypotension and syncope. In: 2006 ACSM annual meeting named lectures [DVD]. American College of Sports Medicine, Monterey, healthy learning.

  10. Levine BD, Pawelczyk JA, Ertl AC, Cox JF, Zuckerman JH, Diedrich A, Biaggioni I, Ray CA, Smith ML, Iwase S, Saito M, Sugyama Y, Mano T, Zhang R, Iwasaki K, Lane LD, Buckey JC Jr, Cooke WH, Baisch FJ, Eckberg DL, Blomqvist CG (2002) Human muscle sympathetic neural and haemodynamic responses to tilt following spaceflight. J Physiol 538:331–340.

    Article  PubMed  CAS  Google Scholar 

  11. Levine BD, Zuckerman JH, Pawelczyk JA (1997) Cardiac atrophy after bed-rest deconditioning: a nonneural mechanism for orthostatic intolerance. Circulation 96:517–525.

    PubMed  CAS  Google Scholar 

  12. Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, Suarez GA, Rummans TA (1995) Postural tachycardia syndrome (POTS). Neurology 45:S19–S25.

    Article  PubMed  CAS  Google Scholar 

  13. Masuki S, Eisenach JH, Johnson C, Dietz NM, Benrud-Larson L, Schrage WG, Curry TB, Sandroni P, Low PA, Joyner MJ (2006) Excessive heart rate response to orthostatic stress in postural tachycardia syndrome is not caused by anxiety. J Appl Physiol 102:896–903.

    Article  PubMed  Google Scholar 

  14. Masuki S, Eisenach JH, Schrage WG, Dietz NM, Johnson CP, Wilkins BW, Dierkhising RA, Sandroni P, Low PA, Joyner MJ (2007) Arterial baroreflex control of heart rate during exercise in postural tachycardia syndrome. J Appl Physiol 103:1136–1142.

    Article  PubMed  Google Scholar 

  15. Masuki S, Eisenach JH, Schrage WG, Johnson CP, Dietz NM, Wilkins BW, Sandroni P, Low PA, Joyner MJ (2007) Reduced stroke volume during exercise in postural tachycardia syndrome. J Appl Physiol 103:1128–1135.

    Article  PubMed  Google Scholar 

  16. McCully KK, Smith S, Rajaei S, Leigh JS Jr, Natelson BH (2004) Muscle metabolism with blood flow restriction in chronic fatigue syndrome. J Appl Physiol 96:871–878.

    Article  PubMed  Google Scholar 

  17. Muenter Swift N, Charkoudian N, Dotson RM, Suarez GA, Low PA (2005) Baroreflex control of muscle sympathetic nerve activity in postural orthostatic tachycardia syndrome. Am J Physiol Heart Circ Physiol 289:H1226–H1233.

    Article  PubMed  CAS  Google Scholar 

  18. Perhonen MA, Franco F, Lane LD, Buckey JC, Blomqvist CG, Zerwekh JE, Peshock RM, Weatherall PT, Levine BD (2001) Cardiac atrophy after bed rest and spaceflight. J Appl Physiol 91:645–653.

    PubMed  CAS  Google Scholar 

  19. Richards SC, Scott DL (2002) Prescribed exercise in people with fibromyalgia: parallel group randomized controlled trial. Br Med J 325:185.

    Article  Google Scholar 

  20. Streeten DH, Anderson GH Jr, Richardson R, Thomas FD (1988) Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling. J Lab Clin Med 111:326–335.

    PubMed  CAS  Google Scholar 

  21. Streeten DH, Scullard TF (1996) Excessive gravitational blood pooling caused by impaired venous tone is the predominant non-cardiac mechanism of orthostatic intolerance. Clin Sci (Lond) 90:277–285.

    CAS  Google Scholar 

  22. Wallman KE, Morton AR, Goodman C, Grove R (2004) Physiological responses during a submaximal cycle test in chronic fatigue syndrome. Med Sci Sports Exerc 36:1682–1688.

    Article  PubMed  Google Scholar 

  23. Wallman KE, Morton AR, Goodman C, Grove R, Guilfoyle AM (2004) Randomised controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust 180:444–448.

    PubMed  Google Scholar 

  24. Winker R, Barth A, Bidmon D, Ponocny, Weber M, Mayr O, Robertson D, Diedrich A, Maier R, Pilger A, Haber P, Rudiger HW (2005) Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Hypertension 45:391–398.

Download references

Acknowledgments

The author’s work on this topic was supported by NS 32352. The author would also like to thank his many collaborators over the years, and especially Dr. Phillip A. Low, who first suggested that he conduct physiological studies on patients with orthostatic intolerance.

Author information

Authors and Affiliations

  1. Dept. of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Michael J. Joyner MD

  2. Dept. of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan

    Shizue Masuki PhD

Authors
  1. Michael J. Joyner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shizue Masuki PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael J. Joyner MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Joyner, M.J., Masuki, S. POTS versus deconditioning: the same or different?. Clin Auton Res 18, 300–307 (2008). https://doi.org/10.1007/s10286-008-0487-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-008-0487-7

Keywords

Search

Navigation