The Treatment of Postural Orthostatic Tachycardia Syndrome, Post-Covid-19 Using Aerobic and Resistance Training

ABSTRACT

BACKGROUND AND PURPOSE: Twenty-five to 50% of individuals who contract COVID-19 develop postural orthostatic tachycardia syndrome (POTS).3 The underlying etiology remains undetermined, yet there is research to support several root causes. Mechanisms such as dysautonomia, hypovolemia and prolonged bed rest leading to cardiac atrophy provide some indications.2,3,4 Recent research suggests that a structured and supervised training program that includes both aerobic and resistance components, was found to improve oxygen uptake, increase cardiac size, and increase blood volume.1,5 The purpose of this case study is to describe the successful treatment of a 13-year-old female diagnosed with POTS following COVID-19 using aerobic and resistance training. CASE DESCRIPTION A 13-year-old female student who was being treated for hypermobility, contracted COVID-19 during her plan of care. During this time, she developed symptoms of lightheadedness, headaches, fainting episodes, dizziness and heart palpitations. Her rheumatologist performed an active head up tilt test that was negative for orthostatic hypotension but positive for tachycardia, which indicated a diagnosis of POTS. She was prescribed fluidicortisone with a dose of 1mg twice per day and returned to physical therapy. The interventions included 40 minutes of zone 2 aerobic training with a heart rate range of 151 to 171 beats per minute (BPM) on a recumbent bike and 20 minutes of resistance training of the lower extremities at rate of perceived exertion (RPE) of 7 to 8. The intensity of the aerobic training progressed to zone 3 and greater aerobic training with a heart rate of at least 171 BPM when the resting heart rate was stabilized. OUTCOME(S) The patient completed 26 visits over 4 months. Following the completion of the program, the resting heart rate of the patient returned to 76 BPM from a starting rate of 127 BPM. Heart rate response to exercise was congruent with the subjective RPE reported by the patient without any reoccurring symptoms previously experienced. An active head up tilt test was performed in the clinic without a tachycardic response indicating she was no longer positive for POTS. The patient was able to resume her previous extracurricular activities, including soccer, without symptom provocation. DISCUSSION: The physiological rationale supporting this conclusion consists of a decreased compensatory tachycardic response to upright positions, improved oxygen uptake, increased blood volume and increased cardiac size. Although there was a successful outcome to this case, there are some limitations. Psychological components should be monitored as well as a greater importance of RPE due to due to the inability to accurately detect heart intensity in the diagnosis of POTS.4,1.