Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic nervous system disorder in which a person develops an excessive heart-rate increase when moving from lying or sitting to standing, together with a cluster of symptoms including lightheadedness, palpitations, fatigue and exercise intolerance. The number of people diagnosed with POTS since the start of COVID has reached into the millions.

Common symptoms

Patients with POTS often experience a combination of:

• Orthostatic intolerance (dizziness, near-syncope, lightheadedness on standing)
• Palpitations and rapid heartbeat
• Fatigue and exercise intolerance
• Headache, brain fog, difficulty concentrating (“brain fog”)
• Nausea, bloating and other GI symptoms
• Poor sleep, temperature dysregulation, and sometimes tremulousness or anxiety-like sensations.
  Because POTS is heterogenous, symptom severity and the exact mix of complaints vary between people. NCBI+1

Has COVID-19 increased POTS cases?

Multiple studies and clinic reports have documented a sharp rise in POTS and other forms of dysautonomia after SARS-CoV-2 infection (post-acute sequelae of SARS-CoV-2, or PASC / “long COVID”). Interrupted-time-series and cohort analyses have reported a statistically significant increase in POTS incidence following the pandemic period compared with baseline. Importantly, estimates vary widely depending on the population studied, case-finding method, and whether cases were actively screened with orthostatic testing. PubMed+1

Bottom line: COVID-19 appears to have meaningfully increased new POTS diagnoses (and referrals for orthostatic intolerance), but exact counts depend heavily on the dataset. Refer to recent cohort studies for precise local estimates. PubMed+1

Why physical therapy (PT) matters in POTS

POTS commonly involves (or is worsened by) deconditioning, reduced plasma volume, and autonomic dysregulation. Graded, structured exercise rehabilitation is one of the best-supported non-pharmacologic treatments: it increases blood volume, improves vascular tone and venous return, and rebuilds orthostatic and aerobic tolerance. PT is crucial because it provides professionally guided, progressive programs that begin with recumbent/semirecumbent exercise and gradually restore upright tolerance — minimizing symptom flares and maximizing safe gains. Reviews of exercise interventions for POTS support supervised, individualized exercise-rehab programs as core therapy. PMC+1

Two widely used PT protocols: Utah ADaPT and the CHOP/modified Dallas program

Utah ADaPT (Adaptive Approaches to Dysautonomia/PT)

• The ADaPT program from the University of Utah is an adaptive, clinician-led exercise and education program for autonomic dysfunction (including POTS). It emphasizes: individualized assessment, foundation (recumbent) conditioning, interval training that respects orthostatic limits, symptom/fluids/salting education, and home-based progression with objective logging. The ADaPT materials include provider manuals, patient handouts, and structured interval-based sessions so therapists can tailor progression to each patient’s orthostatic tolerance and comorbidities. ADaPT is explicitly designed to be used by PTs/rehab teams experienced in dysautonomia and to integrate conservative medical recommendations. U of U Health Medicine+1

Typical ADaPT elements (high level): commence with recumbent cycling or rowing, daily short sessions, gradually increase duration and intensity in a stepwise way, then introduce upright exercise once orthostatic tolerance improves. Education about hydration, salt intake, compression garments and pacing is embedded in the program. U of U Health Medicine

CHOP / Modified Dallas protocol (often called the CHOPped or CHOP modified protocol)

• The CHOP (Children’s Hospital of Philadelphia) modified Dallas exercise program is a widely used pediatric/adolescent POTS exercise progression that starts with recumbent and semi-recumbent aerobic training and slowly transitions patients toward upright exercise over months. Core features include supine/recumbent cycling, rowing or swimming early on (months 1–3), then progressive introduction of upright biking, treadmill walking and longer upright sessions across months 3–6 and beyond. The program is intentionally slow to allow cardiovascular and autonomic adaptation without provoking major symptom setbacks. Many adult PTs adapt the CHOP/Dallas approach for older patients with POTS as well. Dysautonomia International+1

How Can a Physical Therapist Help?

 Patients are taught to monitor their symptoms, heart rate and blood pressure and use this information to monitor progress. The physical therapist can also monitor symptoms and cardiovascular response to determine when it is appropriate to progress. Pots rehabilitation is aimed at reducing symptoms and improving function. Through building up tolerance by exercising in an upright position, patients improve their daily function over time and manage, or even eliminate, their symptoms.

References & further reading

1. Postural Orthostatic Tachycardia Syndrome — NCBI Bookshelf (overview and symptoms). NCBI
2. Dulal D. et al., Impact of COVID-19 pandemic on the incidence and prevalence of POTS (PubMed summary / incidence analysis). PubMed
3. University of Utah — ADaPT program page and provider manual (ADaPT protocol materials & provider manual). U of U Health Medicine+1
4. Dysautonomia International / CHOP Modified Dallas POTS Exercise Program (CHOP/Dallas exercise PDF and program description). Dysautonomia International
5. Rocco PGL et al., Exercise interventions in the management of POTS (review of exercise approaches). PMC