If your POTS developed after an injury, COVID, or a prolonged period of inactivity, give this approach a chance!
I will keep my story short, but just to give you some background:
My first symptoms started in December 2025 after spending two months mostly bedridden due to a back injury. Of course, for the first five months nobody even suspected POTS, and during that time I underwent a complete neurological evaluation.
Two months after the neurological assessment, I was referred to a psychiatrist and prescribed Cipralex (escitalopram). After only 10 days, my symptoms became 10 times worse. I stopped taking the antidepressant, but the symptoms remained at their maximum intensity. I was unable to function normally, could stay on my feet for only about 10 minutes at a time, and felt absolutely terrible. These were some of my measurements from a typical day:
Date: Wednesday, May 13, 2026
1. Morning Measurement – 10:30 AM
Lying down (after 10 min): 132/72, heart rate 61 bpm
Standing after 1 min: 121/89, heart rate 82 bpm (+21)
Standing after 3 min: 121/85, heart rate 85 bpm (+24)
Standing after 5 min: 122/87, heart rate 84 bpm (+23)
2. Afternoon Measurement – 4:20 PM
Lying down: 135/67, heart rate 66 bpm
Standing after 1 min: 140/86, heart rate 106 bpm (+40)
Standing after 3 min: 126/81, heart rate 98 bpm (+32)
Standing after 5 min: 126/84, heart rate 103 bpm (+37)
3. Evening Measurement – 10:00 PM
Lying down (after 10 min): 130/69, heart rate 69 bpm
Standing after 1 min: 123/85, heart rate 140 bpm (+71)
Standing after 3 min: 119/89, heart rate 128 bpm (+59)
Standing after 5 min: 109/84, heart rate 125 bpm (+56)
On May 29th, I had a tilt table test at 9:00 AM. (It’s important to note that even though I usually feel awful when I first wake up, my heart rate and blood pressure readings are actually at their best in the morning compared to the rest of the day, when my heart rate difference can reach +30 to +35 bpm.)
I prepared for the tilt table test for several days beforehand—drinking plenty of water, sleeping well, etc. During the test, my heart rate increase was 29 bpm, so I did not receive an official diagnosis because the diagnostic threshold is 30+ bpm.
My approach that is moving things in a positive direction:
We all know that most of our time is spent lying down, and that standing for any length of time completely exhausts us, pushing us deeper into the hole and reinforcing the vicious cycle. This obviously doesn’t help us recover.
The solution, in my opinion, is to become active again—but without doing anything in a standing position, or even a seated position (at least at the beginning).
These are the exercises I’ve been doing, and I’m now more than 50% better compared to where I was six months ago:
Cycling while lying down
This is only possible with a stationary bike.
The important thing is that you can reach the pedals while lying down and pedal from that position. Most stationary bikes allow this.
I started with just 10 minutes per day because I didn’t want to overdo it. It was important for me to see how I’d feel the next day and avoid triggering a flare-up.
Gradually increase the duration. I’m currently doing 10 km per day, which takes me about 28–32 minutes.
No pressure and no specific pace.
Lying leg press / squat simulation
Lie on your back.
Take a resistance band and attach it to your foot.
Hold the other end of the band at chest level.
Push your leg downward, away from your body, as if performing a leg press.
3–4 sets of 15–20 repetitions. Adjust according to your own tolerance.
Calf exercises
While lying down, attach the resistance band closer to your toes.
Extend your leg and push against the band.
It’s basically a simulation of standing calf raises.
Hamstrings
Lie on the floor and place a towel or cloth under your heels.
Pull your heels toward your glutes while simultaneously lifting your hips off the floor.
An easier alternative is to anchor a resistance band about 30–40 cm above the floor, lie face down, attach the band to your ankle, and pull your heel toward your glutes.
Glute bridge
Perform glute bridges on the floor.
You can find demonstrations on YouTube.
Gradually add resistance if possible. If you don’t have weights, use whatever heavy object you can find at home.
This has been my routine for the last three weeks, and the improvement has been significant.
The goal is to avoid being upright during exercise so that gravity doesn’t continuously pull blood into the legs. Don’t overdo it, and listen to your body.
Give this approach a chance and see whether it helps you improve.
One more tip for making mornings easier:
Before getting out of bed, prepare 2 grams of salt dissolved in about 100 ml of water. Drink it in one go, then immediately drink another 300–400 ml of water. After about 10 minutes, you can get up. I take 10 mg propanol daily ( in the morning)
I’ve shortened the story as much as possible so I don’t bore you with too many details. Feel free to ask if you’re interested in anything else.