When Even Standing Feels Like a Workout
If you live with POTS, exercise can feel impossible. Your heart races. Your vision fades. Your body feels like it’s betraying you. Being told to “just work out more” can feel insulting when you’re struggling just to stay upright.
But the right kind of exercise can slowly retrain your nervous system and change your baseline making you more resilient. That’s where the CHOP, Dallas and Levine Protocols come in to give structure when exercising with POTS.
This post will help you understand how medically guided exercise protocols work, why they are different from regular fitness plans, and how to approach them safely — especially if you are also hypermobile.
What These Protocols Are Actually Designed to Do
The CHOP, Dallas, and Levine protocols were created to help people with POTS rebuild cardiovascular stability. They focus on increasing blood volume, improving vascular tone, and retraining autonomic balance over time. These are not weight-loss programs or performance plans. They are medical reconditioning strategies.
They work slowly and gently. And that’s exactly why they work.
Why You Start Lying Down
Standing exercise is often intolerable in early POTS. Blood pools in the legs and abdomen, which worsens dizziness and tachycardia. These protocols begin with recumbent and seated positions to allow conditioning without triggering flares.
Common early exercises include:
- Recumbent biking
- Rowing machines
- Swimming
- Floor-based strength work
Only after your body adapts do you gradually move into upright activity.
Progress Is Slow — and That is the Point
Rebuilding your autonomic nervous system takes time. Progress is measured in months, not weeks. Trying to rush the process can make symptoms worse and trigger setbacks.
Consistency matters more than intensity.
Small steps, done regularly, lead to real change. Even a 1% improvement each day can add up in a couple months.
Hypermobility Changes the Approach
If you are one of the many people with POTS that also is dealing with EDS or other forms of hypermobility then your joints need protection while your cardiovascular system is retraining. Many hypermobile patients need slower progression, joint support with taping and bracing, and special attention to make sure that you are not over stressing your joints.
Braces, kinesiology or rock tape, and working with a physical therapist who understands hypermobility can help prevent injury and reduce flares. A good therapist can show you how to best position your body to put the least amount of strain on your joints.
What Can Improve Over Time
With consistency, these programs may lead to:
- Lower resting heart rate
- Better standing tolerance
- Fewer dizzy spells
- Improved stamina
- More stable daily energy
It’s not about perfection. It’s about building function and quality of life.
The Takeaway
Exercise doesn’t cure POTS — but structured reconditioning can shift your baseline and give your nervous system the stability it’s been missing.
You are not broken.
Your body is simply asking for a gentler path forward.
Share Your Story
Have you tried a POTS exercise program? What helped — and what felt overwhelming? Your story may help someone else feel less alone.
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Warm regards,
The Hypermobile Solutions Team
References
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What is eds?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-eds/
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Smith, C., & Wicks, D. (2017). Understanding Hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder: (previously known as Ehlers-Danlos Syndrome Hypermobility Type & Joint Hypermobility Syndrome, respectively). Redcliff-House Publications.
Cox, C. (2022). Holding it all together when you’re Hypermobile. Journey2Joy
Afrin, L. B. (2016). Never bet against Occam: Mast cell activation disease and the modern epidemics of chronic illness and medical complexity. Sisters Media, LLC.
Freeman, K., Goldstein, D. S., & Thompson, C. R. (2025). The dysautonomia project: Understanding autonomic nervous system disorders (2nd ed.). Bardolf.
Disclaimer
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