Exercising with POTS: gentle movements and tips for managing flares

When you have POTS, exercise usually takes a bit more planning — but it can still be a powerful tool to help you feel and function better. You might notice that even light activity sometimes leaves you feeling wiped out, dizzy, or short of breath, which can be discouraging at first. But with the right plan and pacing, many people with POTS find ways to move more comfortably and gradually build up what their body can handle.

Postural orthostatic tachycardia syndrome (POTS) affects how your body manages blood flow when you’re upright. When you stand, blood can pool in your legs instead of returning quickly to your heart, so your heart and nervous system have to work harder to keep blood moving to your brain. That’s why even activities that might feel simple for other people — like taking a walk, climbing stairs, or standing for a workout — can leave you feeling dizzy, lightheaded, short of breath, or wiped out, a pattern often called exercise intolerance.

At the same time, research suggests that aerobic exercise can improve fitness, overall resilience, and certain POTS symptoms over time. The key is recognizing that people with POTS often do best with a different plan than traditional “push harder” exercise advice. Many people feel better starting slowly, choosing the right types of movement, and building tolerance step by step.

“Everyone has a different level of exercise tolerance,” says Julia Guseva, PT, DPT, a physical therapist at Hinge Health who has POTS. “A lot of people with POTS need a personalized approach because their experience of POTS symptoms may be very different from someone else’s.”

Read on to learn more about how exercise can support POTS, plus simple, targeted exercises recommended by Hinge Health physical therapists that you can aim to do daily.

Why POTS makes exercise feel so hard

Some people with this condition say that exercise can feel almost impossible because of exercise intolerance. This is unrelated to being out of shape or unmotivated — it’s about how your nervous system and blood vessels respond to changes in position and movement.

Normally, when you stand up, your body automatically adjusts by slightly increasing your heart rate and tightening blood vessels to keep blood flowing to your brain. In people with POTS, that process doesn’t always work as efficiently. “Blood can pool in the extremities, so your heart and nervous system have to work differently to keep things moving,” says Dr. Guseva.

That’s why you may experience symptoms such as:

• Dizziness or lightheadedness

• Rapid heart rate

• Fatigue

• Brain fog

• Shortness of breath

• Feeling faint

Many people with POTS also have other conditions, such as hypermobility syndromes (such as Ehlers-Danlos syndrome), chronic pain, or digestive issues, which can make exercise feel more complicated.

Even though exercise can feel harder with POTS at first, the right plan can help your body adapt, support circulation, and make movement feel more manageable over time. The bottom line is that if you have POTS, exercise is still good for you — you just may need to ease into exercise routines more gradually and thoughtfully.

How exercise can help manage POTS

If you often feel dizzy after doing a sit-to-stand maneuver, working out may feel counterintuitive. Still, exercise — especially lower-body movements — is one of the most effective non-medication tools to help manage POTS symptoms. 

Dr. Guseva emphasizes the importance of strengthening key muscle groups in your legs, including your thighs and calves, because they act as a “pump” that helps push blood back toward your heart and brain. “As you contract those muscles, it helps support the valves in your veins to pump fluid back up to your heart and your brain,” she explains. “Over time, strengthening that muscle pump can help reduce POTS symptoms because it can work more efficiently.”

Research also shows that exercise training can increase blood volume, improve cardiovascular fitness, and help your body regulate heart rate responses more effectively over time.

Best types of exercise for POTS

Not all exercise affects POTS symptoms in the same way. In general, activities that minimize the effects of gravity and blood pooling tend to be easier to tolerate. Since POTS can make it harder for your body to move blood back to your heart and brain when you’re upright, exercises performed in a seated, reclined, or horizontal position often feel more manageable.

Here are the best types of exercises for POTS, according to Hinge Health physical therapists.

• Recumbent exercises. Exercises performed lying down or seated are often the best place to start, especially if you’re new to exercise or were recently diagnosed with POTS. “I really like recumbent exercises because they’re a way to build strength while minimizing flare-ups of symptoms,” says Dr. Guseva. Examples include recumbent biking, rowing, floor exercises, and mat-based strength training.

• Swimming and water exercises. Many people with POTS feel better exercising in water, as it creates gentle pressure around your body, helping to support circulation and reduce blood pooling in the legs. Swimming also places your body in a more horizontal position, making gravity less of a factor. “The water helps support that muscle pump,” says Dr. Guseva. “And when you’re swimming, you’re horizontal, so you’re not fighting gravity.”

• Leg and core strengthening. Strengthening your calves, thighs, glutes (butt muscles), and core muscles can help improve circulation and reduce symptoms over time. Because these larger muscle groups help pump blood back toward the heart, they play a particularly important role in managing and preventing POTS symptoms.

• Gentle stretching and mobility. Stretching and mobility exercises can support recovery, improve flexibility, and help calm the nervous system. “Prolonged stretching can actually help decrease heart rate and engage the rest-and-digest state,” says Dr. Guseva. “That’s why a cool-down stretching routine can be really helpful.”

These exercises focus on the areas most important for managing POTS symptoms: the calves, thighs, glutes, and core. Calf raises, quad sets, and glute sets help strengthen the muscle pump that supports circulation. Legs up the wall uses gravity to help blood return toward your heart and brain, while diaphragmatic breathing and abdominal bracing help improve nervous system regulation and core stability.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Exercises to approach with caution

There aren’t specific exercises that everyone with POTS must avoid. However, some activities may be more likely to stir up symptoms, especially if you’re early in your exercise journey or experiencing a flare. Starting slowly and gradually increasing the intensity and duration of exercise can help your body adapt more comfortably.

• Upright exercise. Activities like running, using an elliptical, or doing strength training movements while standing may bring on symptoms early in your exercise journey. Many POTS exercise programs recommend starting with recumbent exercise and progressing gradually.

• Exercises with rapid position changes. Movements like burpees or jumping from the floor to standing can bring on dizziness and lightheadedness.

• High-intensity workouts. HIIT workouts and vigorous cardio may be too much too soon for some people. Building tolerance gradually is usually more effective than pushing through symptoms.

• Exercising in heat. Heat can worsen symptoms because it causes blood vessels to dilate. “Typically, we recommend an air-conditioned, temperature-controlled environment for exercise,” says Dr. Guseva.

When it comes to exercise and POTS, a gradual, personalized plan usually works better than trying to follow a one-size-fits-all routine. Some people tolerate yoga well, while others find that frequent position changes during sun salutations stir up symptoms. Pay attention to how your body responds and work with your care team to find what works best for you.

How to build exercise tolerance with POTS

Building exercise tolerance takes time. The most successful approach is usually gradual, consistent, and personalized.

• Start recumbent and progress to upright. Begin with exercises done lying down, reclined, or seated, such as leg lifts, bridges, or recumbent cycling. As your tolerance improves, you can gradually introduce more upright activities. “When symptoms are severe, even sitting upright for a workout may be challenging,” says Dr. Guseva. “Starting in positions that reduce the effects of gravity can help you move more comfortably and build confidence.”

• Start low and go slow. With POTS, consistency matters more than intensity. Even three to five minutes of movement is a great starting point. Rather than pushing through symptoms or making dramatic jumps, try adding one to two minutes per week as you can tolerate. “People often feel like they need to do more to make progress, but with POTS, slower is usually better,” says Dr. Guseva. “Your body needs time to adapt.”

• Monitor your heart rate. Some people find it helpful to use a heart rate monitor to better understand how their body responds to activity. If you’re taking medications such as beta blockers, however, perceived exertion may be a better guide than heart rate alone. “Pay attention to how you feel, not just what the numbers say,” says Dr. Guseva. “Your symptoms can provide important information about whether you’re working at the right level.”

• Hydrate and ask your doctor about salt intake. Drinking fluids throughout the day can help support blood volume and circulation. Some people may also benefit from increasing their salt intake, but this should always be discussed with a healthcare provider first. “Exercise is just one piece of the puzzle,” says Dr. Guseva. “Hydration, nutrition, sleep, and recovery all play an important role in how you feel.”

• Time your workouts wisely. Many people with POTS find that symptoms are more manageable later in the day. If mornings tend to be your most symptomatic time, consider scheduling exercise for the afternoon or evening when your body feels more prepared for activity. “It’s okay to work with your body instead of against it,” says Dr. Guseva.

• Wear compression garments. Compression socks, stockings, or leggings may help reduce blood pooling in your legs during and after exercise. Ask your healthcare provider whether compression garments are appropriate for you and what level of compression they recommend.

• Cool down properly. Try not to stop suddenly after exercise. Instead, gradually decrease your intensity and continue moving for a few minutes before resting. “Giving your body time to transition out of exercise can help minimize symptom flare-ups afterward,” says Dr. Guseva.

Managing exercise during POTS flares

Even with a well-designed exercise plan, flare days happen. Symptoms can be unpredictable, and it’s normal to have times when your routine feels harder than it usually does. “On flare days, it’s okay to modify your exercises,” says Dr. Guseva. “It’s important to keep moving, but it’s okay to do those exercises lying down.”

• Listen to your body. Some days, your usual workout may simply be too much. That’s not a sign you’re losing progress. “A flare doesn’t mean you’ve failed or that exercise isn’t working,” says Dr. Guseva. “It just means your body needs something different that day.” Scaling back, shortening your workout, or choosing gentler movements can help you stay active without worsening symptoms.

• Have a flare-day routine. Keep a backup plan ready for days when your symptoms are more intense. Gentle, floor-based movements such as diaphragmatic breathing, legs-up-the-wall, glute sets, or quad sets can help you maintain mobility and circulation without putting too much demand on your cardiovascular system.

• Prioritize recovery. Some people with POTS experience a symptom flare or “crash” after activity, where fatigue, dizziness, or other symptoms worsen hours or even days later. If this happens, give yourself permission to rest and recover. “Recovery is part of the process,” says Dr. Guseva. “Your body may need extra time before it’s ready for the next step.”

• Return gradually. After a flare, it can be tempting to jump back to where you left off. Instead, reduce the duration or intensity of your workouts and build back up slowly. Taking a step back temporarily can help prevent another setback.

• Track patterns. Keeping a simple journal of your symptoms, activity levels, sleep, hydration, and stress can help you identify what affects your symptoms. Over time, you may notice patterns that help you find your movement sweet spot for exercise and better manage future flares.

When to see a doctor

POTS is a condition that’s best managed with support from a healthcare provider experienced in treating it, often a cardiologist or neurologist, alongside lifestyle approaches like exercise.

If your symptoms are severe, getting worse, or significantly affecting your daily life, see a healthcare provider. It’s also a good idea to get care from a specialist if you experience:

• Fainting or near-fainting episodes

• Chest pain during exercise

• Severe shortness of breath

• New or worsening symptoms that don’t improve with rest

• Difficulty managing symptoms despite trying recommended strategies

PT Tip: Meet your body where it is today

Many people with POTS were active before their symptoms started, which can make it frustrating when your body no longer tolerates the same level of activity it once did. “It’s hard to make peace with where you’re at now versus what you used to be able to do,” says Dr. Guseva. “You have to have a long-term relationship with your body. You have to be kind to it and meet it where it’s at today.”

Instead of comparing yourself to what you could do in the past, focus on what feels manageable right now. Progress may be slower than you’d like, but small, consistent steps often lead to meaningful improvements over time.

How Hinge Health can help you

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Fu, Q., & Levine, B. D. (2015). Exercise in the Postural Orthostatic Tachycardia Syndrome. Autonomic Neuroscience: Basic & Clinical, 188, 86–89. doi:10.1016/j.autneu.2014.11.008

2. Gonçalves, P., C Mahony Reategui-Rivera, & Finkelstein, J. (2024). Exercise Interventions in the Management of Postural Orthostatic Tachycardia Syndrome: A Scoping Review. Journal of Multidisciplinary Healthcare, Volume 17, 5867–5885. doi:10.2147/jmdh.s495088

3. Cortez, M. M., Aikins, K., Arnold, A. C., Boris, J. R., Davenport, T. E., Johnson, K., Kattaya, H. S., Kinsella, L., McFarland, M. M., Pelo, R., Powers, C. D., Schiltz, K., Stiles, L. E., Ziaks, L., Chung, T. H., & Dal Molin, C. (2025). Impact of exercise to treat postural orthostatic tachycardia syndrome: a systematic review. Frontiers in Neurology, 16. doi:10.3389/fneur.2025.1567708

4. Peebles, K. C., Jacobs, C., Makaroff, L., & Pacey, V. (2024). The use and effectiveness of exercise for managing postural orthostatic tachycardia syndrome in young adults with joint hypermobility and related conditions: A scoping review. Autonomic Neuroscience: Basic & Clinical, 252, 103156. doi:10.1016/j.autneu.2024.103156

5. Lau, D. H., Artur Fedorowski, Raj, S. R., Schild, C., Pace, L. A., Blitshteyn, S., Raj, V., Boris, J. R., Kavi, L., Seeley, M.-C., & Gallagher, C. (2026). Postural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review. Heart, Lung and Circulation. doi:10.1016/j.hlc.2025.09.004