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Cardiopulmonary Exercise Testing Responses in Pediatric Postural Orthostatic Tachycardia Syndrome and Orthostatic
Garett J Griffith1, Brittany Holst2, Jillian Myers2
1Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,USA.
Pediatric Exercise Science
|February 19, 2026
Summary
Pediatric patients with postural orthostatic tachycardia syndrome (POTS) and orthostatic intolerance (OI) exhibit reduced exercise capacity and abnormal heart rate responses during and after exercise compared to healthy peers.
Area of Science:
- Cardiology
- Pediatric Exercise Physiology
- Autonomic Dysfunction
Background:
- Postural orthostatic tachycardia syndrome (POTS) and orthostatic intolerance (OI) are conditions affecting autonomic nervous system regulation.
- Understanding exercise limitations in pediatric patients with these conditions is crucial for management.
Purpose of the Study:
- To compare exercise testing outcomes in pediatric patients with POTS/OI versus healthy controls.
- To investigate heart rate (HR) kinetics during and after exercise in these groups.
Main Methods:
- Maximal exercise testing using the Bruce protocol.
- Analysis of HR kinetics during exercise (percentage of test completion vs. % maximal HR).
- Assessment of HR recovery post-exercise.
Main Results:
- POTS/OI patients demonstrated lower exercise duration, peak aerobic capacity, and predicted peak aerobic capacity.
- Elevated submaximal HR responses and blunted HR recovery were observed in POTS/OI patients.
- No significant differences in exercise capacity or HR kinetics were found between POTS and OI groups.
Conclusions:
- Pediatric POTS/OI patients have impaired exercise capacity and altered HR responses compared to healthy peers.
- Abnormal HR kinetics, including reduced time to peak HR, may contribute to exercise intolerance.
- HR kinetics could serve as a valuable metric for exercise prescription and monitoring outcomes in pediatric POTS/OI.
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