# Patient perspectives on exercise among adults with postural orthostatic tachycardia syndrome: a mixed methods study

## TL;DR

This study explores how adults with POTS experience and perceive exercise, identifying barriers and facilitators to help improve treatment recommendations.

## Contribution

The study is the first to investigate patient perspectives on exercise in POTS using mixed methods, offering insights to optimize exercise interventions.

## Key findings

- Participants reported lower exercise engagement after developing POTS symptoms.
- Symptom burden was identified as the most significant barrier to exercise.
- Patients expressed a belief in the importance of exercise for managing POTS.

## Abstract

Despite the central role of exercise in treating postural orthostatic tachycardia syndrome (POTS) there have been no studies on the subjective experience of exercise interventions and/or recommendations among this patient population. The purpose of this mixed-methods study was to provide greater understanding of the perceived barriers, preferences, perceptions of exercise, and experiences implementing exercise recommendations for adults with POTS in order to optimize treatment recommendations and intervention design.

This study consisted of a series of focus groups (n = 29) and an online survey of adults with POTS (n = 255) focusing on exercise engagement, beliefs, barriers, and facilitators. Qualitative data were analyzed using an iterative inductive-deductive approach, informed by social cognitive theory, which resulted in a conceptual framework and a series of themes.

Survey results showed that participants reported a wide range of exercise frequency prior to the onset of POTS symptoms, and overall lower exercise engagement post-POTS. In both survey results and qualitative findings, participants reported believing that exercise is important in managing POTS, but identified barriers to exercise training, including most saliently, their symptom burden. Participants also identified important needs and facilitating factors that could support them in engaging in regular exercise to help manage their condition.

These findings shed light on the patient experience of exercise in POTS, which can inform both the tailoring of exercise recommendations and the design of interventions to support exercise engagement specific to the POTS population.