Exercise for Postural Orthostatic Tachycardia Syndrome: Challenges and Opportunities to Improve скачать в хорошем качестве

Exercise for Postural Orthostatic Tachycardia Syndrome: Challenges and Opportunities to Improve

Exercise for Postural Orthostatic Tachycardia Syndrome: Challenges and Opportunities to Improve Rasnake, Erin B. PT, MS, PCS; Kouvel, Kristen PT, DPT, PCS; Cooper, Sarah PT, DPT; Greenberg, Elliot PT, DPT, PhD Purpose: Graded exercise training is widely recognized as an effective treatment for reducing symptoms and improving functional capacity associated with postural orthostatic tachycardia syndrome (POTS), a type of acquired dysautonomia. Many clinicians have encountered significant challenges with practical implementation of existing POTS exercise prescription protocols, potentially limiting overall treatment efficacy and negatively affecting outcomes. The purpose of this article is to highlight key principles of exercise treatment in POTS, summarize challenges with current protocols, and describe the newly developed CHOP AADP tools and guides to improve exercise prescription and treatment effectiveness for individuals with POTS. Methods: To address these challenges, the Children's Hospital of Philadelphia (CHOP) Acquired Autonomic Dysfunction Program (AADP) developed novel evidence-based assessment tools and treatment guides using objective data to empower physical therapists in prescribing customizable cardiovascular and strength training programs for this population. Results: The clinical presentation of POTS is complex and heterogenous; using objective measures to guide exercise prescription and customize training programs is therefore imperative to improve exercise tolerance and function. Existing POTS protocols, including the Modified CHOP Protocol, lack sufficient objectivity and customizability. Conclusions: Physical therapists should use objective measures to recommend cardiovascular training duration, position and rate of progression parameters for persons with POTS, specific to individual needs and goals. The CHOP AADP Exercise Determination Tools and Recumbent and Upright Exercise Guides provide clinicians with this objectivity and flexibility. https://journals.lww.com/cptj/abstrac...