Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome.
5 affiliations
- 1Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Unit Allied Health Professional, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden. Electronic address: [email protected].
- 2Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Unit Allied Health Professional, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden.
- 3Medical Unit Allied Health Professional, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
- 4Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
- 5Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical Unit Allied Health Professional, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden. Electronic address: https://twitter.com/MalinNB.
Abstract
Background
Postural orthostatic tachycardia syndrome (POTS) is common in post-COVID-19 condition and is associated with high symptom burden and reduced quality of life. Although physical exercise is recommended for POTS, evidence of its effectiveness remains limited.Objectives
The objectives of the study was to evaluate the effectiveness of tailored exercise on health-related quality of life (HRQoL), upright time, physical function, and symptom burden in individuals with COVID-19-induced POTS.Methods
Adults with COVID-19-induced POTS were randomized to standard care or standard care plus tailored exercise with weekly supervision. Assessments were conducted at baseline and 16 weeks. Primary outcomes were HRQoL and upright time. Secondary outcomes included daily steps, sedentary time, orthostatic autonomic response, muscle strength, physical capacity, patient-reported activity limitations, mental health, and symptom burden. Analyses used mixed models.Results
Data were analyzed from sixty participants (85% females, mean age 37 years). No time-by-group interaction effects were observed for HRQoL. Upright time was reduced in the intervention group compared with controls, with an estimated between-group difference of -31 min/day, (95% CI -57 to -6). For secondary outcomes, daily steps were reduced in the intervention group, whereas both groups improved in POTS symptoms, activity limitations, and physical capacity, with a trend toward reduced postexertional malaise. No other secondary outcomes showed significant effects.Conclusions
Tailored exercise did not outperform standard care in HRQoL and was associated with reduced upright time, whereas improvements in several secondary outcomes were observed in both groups. Heterogeneity supports an individualized approach to exercise, integrated with pharmacological and multimodal management strategies.
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BibTeX
@article{svensson2026effectiveness,
title = {{Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome.}},
author = {Annie M Svensson and Anna Um Svensson-Raskh and Anna C Törnberg and Carl E Hallberg and Linda Holmström and Artur Fedorowski and Malin C Nygren-Bonnier},
journal = {JACC. Advances},
year = {2026},
month = sep,
doi = {10.1016/j.jacadv.2026.103328},
url = {https://europepmc.org/article/MED/42868961},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome.
AU - Annie M Svensson
AU - Anna Um Svensson-Raskh
AU - Anna C Törnberg
AU - Carl E Hallberg
AU - Linda Holmström
AU - Artur Fedorowski
AU - Malin C Nygren-Bonnier
PY - 2026
DA - 2026/09/22
JO - JACC. Advances
DO - 10.1016/j.jacadv.2026.103328
UR - https://europepmc.org/article/MED/42868961
AB - Background Postural orthostatic tachycardia syndrome (POTS) is common in post-COVID-19 condition and is associated with high symptom burden and reduced quality of life. Although physical exercise is recommended for POTS, evidence of its effectiveness remains limited.Objectives The objectives of the study was to evaluate the effectiveness of tailored exercise on health-related quality of life (HRQoL), upright time, physical function, and symptom burden in individuals with COVID-19-induced POTS.Methods Adults with COVID-19-induced POTS were randomized to standard care or standard care plus tailored exercise with weekly supervision. Assessments were conducted at baseline and 16 weeks. Primary outcomes were HRQoL and upright time. Secondary outcomes included daily steps, sedentary time, orthostatic autonomic response, muscle strength, physical capacity, patient-reported activity limitations, mental health, and symptom burden. Analyses used mixed models.Results Data were analyzed from sixty participants (85% females, mean age 37 years). No time-by-group interaction effects were observed for HRQoL. Upright time was reduced in the intervention group compared with controls, with an estimated between-group difference of -31 min/day, (95% CI -57 to -6). For secondary outcomes, daily steps were reduced in the intervention group, whereas both groups improved in POTS symptoms, activity limitations, and physical capacity, with a trend toward reduced postexertional malaise. No other secondary outcomes showed significant effects.Conclusions Tailored exercise did not outperform standard care in HRQoL and was associated with reduced upright time, whereas improvements in several secondary outcomes were observed in both groups. Heterogeneity supports an individualized approach to exercise, integrated with pharmacological and multimodal management strategies.
SN - 2772-963X
ER -