Exercise training was superior to propranolol in POTS patients, significantly improving physical functioning quality of life scores (50 vs 33 baseline; P<0.01) while propranolol did not (P=0.63).
RCT (n=34)
Double-blind
Does exercise training improve symptoms, hemodynamics, and renal-adrenal responses compared to propranolol in patients with postural orthostatic tachycardia syndrome?
Exercise training appears superior to propranolol for improving upright hemodynamics, normalizing renal-adrenal responsiveness, and enhancing quality of life in patients with POTS.
p-value: p=<0.01
We have found recently that exercise training is effective in the treatment of the postural orthostatic tachycardia syndrome (POTS). Whether this nondrug treatment is superior to "standard" drug therapies, such as β-blockade, is unknown. We tested the hypothesis that exercise training but not β-blockade treatment improves symptoms, hemodynamics, and renal-adrenal responses in POTS patients. Nineteen patients (18 women and 1 man) completed a double-blind drug trial (propranolol or placebo) for 4 weeks, followed by 3 months of exercise training. Fifteen age-matched healthy individuals (14 women and 1 man) served as controls. A 2-hour standing test was performed before and after drug treatment and training. Hemodynamics, catecholamines, plasma renin activity, and aldosterone were measured supine and during 2-hour standing. We found that both propranolol and training significantly lowered standing heart rate. Standing cardiac output was lowered after propranolol treatment (P=0.01) but was minimally changed after training. The aldosterone:renin ratio during 2-hour standing remained unchanged after propranolol treatment (4.1±1.7 SD before versus 3.9±2.0 after; P=0.46) but modestly increased after training (5.2±2.9 versus 6.5±3.0; P=0.05). Plasma catecholamines were not affected by propranolol or training. Patient quality of life, assessed using the 36-item Short-Form Health Survey, was improved after training (physical functioning score 33±10 before versus 50±9 after; social functioning score 37±9 versus 48±6; both P<0.01) but not after propranolol treatment (34±10 versus 36±11, P=0.63; 39±7 versus 39±5, P=0.73). These results suggest that, for patients with POTS, exercise training is superior to propranolol at restoring upright hemodynamics, normalizing renal-adrenal responsiveness, and improving quality of life.
Fu et al. (Tue,) conducted a rct in Postural Orthostatic Tachycardia Syndrome (POTS) (n=34). Exercise training vs. Propranolol or placebo was evaluated on Patient quality of life (physical functioning score) (p=<0.01). Exercise training was superior to propranolol in POTS patients, significantly improving physical functioning quality of life scores (50 vs 33 baseline; P<0.01) while propranolol did not (P=0.63).