Effectiveness of Individualized Physical Exercise in COVID-19–Induced Postural Orthostatic Tachycardia Syndrome

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is common in post-COVID-19 condition and is associated with high symptom burden and reduced quality of life. Although physical exercise is recommended for POTS, evidence of its effectiveness remains limited. OBJECTIVES: The objectives of the study was to evaluate the effectiveness of tailored exercise on health-related quality of life (HRQoL), upright time, physical function, and symptom burden in individuals with COVID-19-induced POTS. METHODS: Adults with COVID-19-induced POTS were randomized to standard care or standard care plus tailored exercise with weekly supervision. Assessments were conducted at baseline and 16 weeks. Primary outcomes were HRQoL and upright time. Secondary outcomes included daily steps, sedentary time, orthostatic autonomic response, muscle strength, physical capacity, patient-reported activity limitations, mental health, and symptom burden. Analyses used mixed models. RESULTS: Data were analyzed from sixty participants (85% females, mean age 37 years). No time-by-group interaction effects were observed for HRQoL. Upright time was reduced in the intervention group compared with controls, with an estimated between-group difference of -31 min/day, (95% CI -57 to -6). For secondary outcomes, daily steps were reduced in the intervention group, whereas both groups improved in POTS symptoms, activity limitations, and physical capacity, with a trend toward reduced postexertional malaise. No other secondary outcomes showed significant effects. CONCLUSIONS: Tailored exercise did not outperform standard care in HRQoL and was associated with reduced upright time, whereas improvements in several secondary outcomes were observed in both groups. Heterogeneity supports an individualized approach to exercise, integrated with pharmacological and multimodal management strategies.