Written By: Julie B. Barnett, PT, DPT, MTC


Postural Tachycardia Syndrome (POTS) is a form of orthostatic dysautonomia and is a complication after Covid-19. Vitals are measured in 10 minute increments in supine and standing to monitor POTS.

Criteria for POTS include:

  • HR Increase of at least 30 bpm from supine to standing for adults
  • HR Increase of at least 40 bpm from supine to standing for pediatric patients
  • Blood pressure may be stable or fluctuating

Prevention interventions could include:

  • Adequate hydration/electrolytes
  • Compression stockings
  • Increased dietary or supplemental salt
  • Slow and careful transfers to upright positioning
  • An exercise program that begins with supine or reclining activity and gradually progresses to more upright conditioning
  • Multiple muscle group Isometrics 3 sec with normal breathing
  • Resisted breathing exercise/use of a straw

Other interventions for orthostatic symptoms:

  • Crossing of legs with isometric pillow squeeze or knee squeezes 3 sec
  • Heel raises or ankle pumps 30-50 reps
  • Sitting: timed
  • Deep squatting: hold onto chair/counter for safety
  • Slow deep breathing to engage respiratory muscles; 3 times. Do not hyperventilate

Breathing interventions:

  • Inhaling
    • Breathing in through a straw
    • Incentive spirometer
  • Exhaling
    • Blow up a balloon
    • Blow a plastic pinwheel
    • Blow through a straw to blow a cotton ball across table
    • Pursed lip blowing a Kleenex in front of them
    • Blow as if to fog up a mirror
    • Hands on lower ribs and feel ribs expand
    • Place Kleenex box on stomach and watch it rise and fall with breathing

Therapists should assess for fall risk and ensure safe environments around the individual. Supported exercises in supine initially for safety. Low level cardiovascular exercises with pulleys, seated pedals, and slow walking with support. Pulse oximeters, wearable technology and smart watches can be used to assist in monitoring and progress.  


Review of how to use


  • Key points
    • Simple and great benefits
    • Highest portion of lungs receives most air
    • Lowest portion of lungs receives most blood
    • Gravity helps dislodge mucus and triggers healthy cough
  • Tips
    • 4 postures: R and L side lying, bridging and down-ward dog
    • 2 deep breathes in each posture
    • Pillows or props can be used
Interested in learning more from this instructor? Check out Julie Barnett’s upcoming webinar, ACSM Guidelines for Exercise for Special Populations during our CE Acceleration Virtual Conference.
Interested in learning more on this topic? Check out Catherine Lewan’s upcoming webinar, Post-COVID-19 Syndrome: Rehabilitation Considerations for Patients with Long-Term Symptoms.
Explore even more with our upcoming CE Acceleration Virtual Conference, offering six distinct tracks across three days to support your setting and patient population. 
Visit summit-education.com for more information.
Angelo Carfì, MD; Roberto Bernabei, MD; Francesco Landi, MD, PhD; et al. Persistent Symptoms in Patients After Acute COVID-19 JAMA. 2020;324(6):603-605. doi:10.1001/jama.2020.12603
Rebecca Martin, PT, DPT, PhD, APTA podcast Dr.
Catherine Lewan, PT DPT Summit Instructor