Evaluation of an Innovative Pathway Through Cardiac Rehabilitation for Individuals with Postural Orthostatic Tachycardia Syndrome (POTS)

Tailored POTS Rehabilitation Pathway This study is a single-arm uncontrolled clinical trial including both quantitative and qualitative components. Rehabilitation will be completed in two phases. Phase one involves 12 weeks of supervised rehabilitation sessions. Two one-hour supervised sessions, separated by at least one day, will be completed either in person or virtually each week. In person rehabilitation sessions and assessments will be completed in the Jaghu Gym (Hayden Centre) or delivered out of the rural hospitals (Laidley, Esk, Gatton and Boonah) within the West Moreton HHS. Virtual rehabilitation sessions will be delivered in real-time via the Queensland Health Virtual Clinic. Supervised exercise sessions will completed in a small group (maximum 4 participants). Three in-person assessments will be completed across phase one (pre, mid and post). Rehabilitation exercises will be individualised based on subjective information gathered during the initial assessment completed pre-rehabilitation. Rehabilitation sessions will include a combination of aerobic and resistance exercises. Initial aerobic exercise modalities may include recumbent cycling, rowing and swimming. As tolerated, upright cycling, walking or the elliptical may be introduced, Strength or resistance exercises will focus on lower body and core strength. Exercises may be body weight or utilise a resistance band, Example strength exercise include: leg extension, leg curl, leg press, calf raises, chest press and row. Exercise prescription will be gradually progressed weekly throughout the program based on assessment results and participant feedback. Phase two involves a further 12 weeks of unsupervised exercise. Participants will be provided with a home exercise program to complete during these unsupervised exercise sessions. During each week of phase two, participants will be asked to undertake four sessions, with each session lasting up to one-hour. Session duration will be individualised based on the duration achieved during the final supervised exercise sessions. Two phone reviews will be completed across this 12 week period. Intervention adherence will be assessed through supervised session attendance and unsupervised session completion discussed at assessments and during phase two phone reviews. Rehabilitation sessions, assessments and follow up phone reviews will be completed by the principal investigator (Accredited Exercise Physiologist with >3 years of clinical experience in Cardiopulmonary rehabilitation).