Exercise, POTS, and the Art of Doing Hard Things: A No-B.S. Guide to Moving Forward
Let’s get real for a minute: if you’re living with Postural Orthostatic Tachycardia Syndrome (POTS), exercise can feel like the cruelest joke.
It’s supposed to help you feel better, right?
So why does it sometimes make you feel like you’ve been hit by a truck?
And why does every rehab plan out there seem like it was designed for someone with a completely different body?
This isn’t just frustrating—it’s one of the greatest challenges of your recovery journey.
The problem?
Most exercise protocols for POTS are rigid, cookie-cutter, and completely out of touch with the messy, unpredictable reality of how your body responds.
But here’s the thing: you’re not broken.
Your body isn’t a failure.
It’s just stuck in a loop it hasn’t yet learned how to break.
And today, we’re talking about how to change that—without toxic positivity, fluff, or empty promises.
Let’s dive into the real science, the struggles, and why hope isn’t just a cliché when it comes to your recovery.
Why Exercise Can Feel Like Your Worst Enemy
First, let’s validate what you’ve been through. If you’ve tried to follow a traditional exercise program and felt worse, it’s not because you didn’t try hard enough. It’s because most rehab plans don’t account for what’s really happening in a body with POTS.
The Science of “Why Do I Feel Worse After Exercise?”
When your body is “unconditioned”—which is common if you’ve had to limit activity due to POTS—exercise can actually cause inflammation.
Here’s why:
Inflammatory Storm: Your muscles release chemicals (cytokines) that irritate nerves and trigger pain. It’s like your body’s alarm system is on overdrive
Hyperactive Pain Signals: Your nervous system hasn’t learned how to regulate itself yet, so it amplifies every signal—making soreness, fatigue, and dizziness feel 10 times worse
Emotional Fallout: Let’s not ignore this. When exercise leaves you bedridden or flaring, it’s not just physical—it’s emotionally crushing. You start to wonder, “What’s wrong with me? Am I ever going to feel normal again?”
But here’s the thing: this isn’t permanent.
Your body can learn to respond to exercise differently.
You just need a smarter, more compassionate approach.
Moving Beyond Rigid Rehab: A Smarter, Science-Backed Way Forward
The old way of exercising for POTS goes something like this: start slow, progress in fixed stages, and hope for the best.
Sounds harmless, right?
Wrong.
For many people, these programs feel like a one-way ticket to symptom flare-ups.
It’s time to move on from one-size-fits-all.
Here’s how we make exercise work for you, not against you:
1. Start Horizontal—Seriously
Forget about jumping straight into standing exercises. Your body needs to build tolerance without gravity messing things up. Supine or recumbent exercises, like cycling or leg lifts, are the best place to start.
“Programs should begin with horizontal exercises to minimize orthostatic stress while building tolerance.” (Ziaks et al., 2024)
2. Understand the Transition to Anti-Inflammatory Exercise
When you stick with gentle, regular movement, something magical happens: your body adapts.
Over time:
Your muscles start producing anti-inflammatory chemicals that calm pain sensors.
Your nervous system learns to stop amplifying pain signals and starts calming down instead.
Your immune system shifts from a “fight” mode (inflammatory cytokines) to a “heal” mode (anti-inflammatory cytokines).
This is why exercise feels hard at first but gets easier the more conditioned you become.
Reference: Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation
This diagram shows how your muscles, immune cells (called macrophages), and pain sensors (nociceptors) interact.
When your body is under stress or inactive for long periods, more macrophages take on the “M1” role.
These M1 macrophages release chemicals that cause inflammation, which makes your pain sensors more active and leads to pain.
However, when you do regular, gentle exercise, your immune system starts shifting.
More macrophages become “M2” instead, which release anti-inflammatory chemicals.
These chemicals calm down your pain sensors, reducing pain and helping your body feel better.
The takeaway?
Over time, consistent movement can teach your body to create more M2 macrophages, reducing inflammation and improving how your body handles stress and pain.
3. Go at Your Own Pace—No Timelines
Progression isn’t about rigid timelines. It’s about listening to your body. You’re ready to move to seated or standing exercises when you can handle 20 minutes of horizontal movement without flaring up. Not before.
4. Use Interval Training for Recovery
If steady-state exercise feels overwhelming, try intervals: short bursts of effort followed by rest. For example, 30 seconds of light movement and 1–2 minutes of rest. It’s a gentle way to build endurance without overloading your system.
The Philosophical Side of Doing Hard Things
Here’s the tough truth: recovery is hard.
Exercise with POTS forces you to face both physical and emotional challenges head-on.
It’s uncomfortable, messy, and often feels like two steps forward, one step back.
But what if the struggle is the point?
Every time you listen to your body and adjust instead of pushing through, you’re practicing self-compassion. Every time you show up, even when you’re scared of flaring, you’re building resilience. And resilience isn’t just physical—it’s emotional, too.
By focusing on small, consistent actions instead of fearing the big picture, you’re taking back control.
Hope, Without the Fluff
Let’s get one thing straight: this isn’t about toxic positivity. Hope doesn’t mean pretending everything is fine when it’s not. Hope is understanding that your body isn’t your enemy—it’s just trying to protect you in ways that aren’t helpful right now.
With the right approach, exercise can go from being a trigger to being a tool. It can become something that strengthens you—physically, emotionally, and even spiritually.
So, start small. Stay consistent. And remember: every step forward, no matter how tiny, is progress.
You’ve got this. One rep, one breath, one day at a time.
References:
Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation