Endurance Exercise Training in Orthostatic Intolerance

Abstract

Abstract-Orthostatic intolerance is a syndrome characterized by chronic orthostatic symptoms of light-headedness, fatigue, nausea, orthostatic tachycardia, and aggravated norepinephrine levels while standing. The aim of this study was to assess the protective effect of exercise endurance training on orthostatic symptoms and to examine its usefulness in the treatment of orthostatic intolerance. 2768 military recruits were screened for orthostatic intolerance by questionnaire. Tilt-table testing identified 36 cases of orthostatic intolerance out of the 2768 soldiers. Subsequently, 31 of these subjects with orthostatic intolerance entered a randomized, controlled trial. The patients were allocated randomly to either a "training" (3 months jogging) or a "control" group. The influence of exercise training on orthostatic intolerance was assessed by determination of questionnaire scores and tilt-table testing before and after intervention. After training, only 6 individuals of 16 still had orthostatic intolerance compared with 10 of 11 in the control group. The Fisher exact test showed a highly significant difference in diagnosis between the 2 groups (Pϭ0.008) at the end of the study. Analysis of the questionnaire-score showed significant interaction between time and group (Pϭ0.001). The trained subjects showed an improvement in the average symptom score from 1.79Ϯ0.4 to 1.04Ϯ0.4, whereas the control subjects showed no significant change in average symptom score (2.09Ϯ0.6 and 2.14Ϯ0.5, respectively). Our data demonstrate that endurance exercise training leads to an improvement of symptoms in the majority of patients with orthostatic intolerance. Therefore, we suggest that endurance training should be considered in the treatment of orthostatic intolerance patients.

Endothelial NO Synthase Polymorphisms and Postural Tachycardia Syndrome

“…Arterial BP was measured continuously with a Task Force Monitor 36 as described previously. 37 Subjects rested in a supine position for 30 minutes before being tilted to 60°C upright for 30 minutes. BP and HR measurements obtained while supine and after 3 and 5 minutes upright were used for this study.…”

Short-term Aerobic Exercise Reduces Nitroglycerin-induced Orthostatic Intolerance in Older Adults With Type 2 Diabetes

“…[8][9][10] The only study that involved both a prospective intervention and a subject population of nonathletes demonstrated a large improvement in orthostatic tolerance to upright tilting in young adult military recruits, congruent with the results of this study. 6 To our knowledge, our study is the first to show that even older adults at very high cardiovascular risk due to type 2 diabetes, and age can improve orthostatic tolerance with regular aerobic exercise.…”

“…Previous work on the effects of aerobic exercise on orthostatic tolerance has had mixed results, demonstrating positive, 6 negative, 7-9 and neutral 10 effects of training on the ability of subjects to withstand orthostatic stress. All investigations demonstrating either negative or neutral effects of aerobic exercise involved the examination of very intense training in young athletes (VO 2 max > 60 mL·kg −1 ·min −1 ) 7-10 and most involved a cross-sectional design.…”

“…Vigorous aerobic training has been shown to improve orthostatic tolerance in young normal subjects, 6 but some investigations have demonstrated a worsening [7][8][9] or no 10 effect of aerobic training on orthostatic tolerance. The impact of aerobic exercise on GTN-induced orthostatic intolerance in older adults with type 2 diabetes has not been previously examined.…”

Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope

“…These include withdrawing medications that might worsen POTS, use of compression garments and limiting gravitational deconditioning. Patients should engage in a regular, structured, graduated, supervised exercise program featuring aerobic reconditioning with some resistance training of the thighs, 23,24 starting with non-upright exercises. Exercise programs can be effective even outside of formal exercise training centres.…”