Aquatic Therapy for a Patient with Postural Orthostatic Tachycardia Syndrome: a Case Report

Abstract

Background and Purpose: Postural Orthostatic Tachycardia Syndrome (POTS) can have a debilitating effect on an individual’s quality of life. The purpose of this case report is to describe the use of interval training in an aquatic environment to decrease the symptoms of Postural Orthostatic Tachycardia Syndrome. Aquatic therapy provides benefits for individuals with cardiovascular issues, mainly through the principle of hydrostatic pressure. Hydrostatic pressure aids in shunting the blood from the extremities back to the heart, thus increasing cardiac output while reducing the individual’s heart rate. Description: An 18 year-old female high school student who had been experiencing Postural Orthostatic Tachycardia Syndrome symptoms for approximately one year. These symptoms prevented her from participating in school or recreational activities. Intervention: The patient underwent 11 sessions of an aquatic interval program. Her subjective report, heart rate, blood pressure, and rate of perceived exertion were monitored throughout each session. Outcomes: After completing physical therapy, the patient had attained all of her functional goals including standing for 45 minutes, walking between classes at school, and attending her prom. The patient reported that she had not had a fainting spell in over 4 weeks. Despite these functional gains, the patient’s Quality of Life score, as measured by the World Health Organization Quality of Life-BREF questionnaire (a condensed version of the original World Health Organization Quality of Life-100), declined in the following categories: physical health, psychological health, and environment. Discussion: The patient’s exercise-specific heart rate and rate of perceived exertion decreased as sessions progressed, demonstrating an increased activity tolerance. It is hypothesized that the positive effects of hydrostatic pressure on the cardiovascular system contributed to the improvement in exercise tolerance and ultimately to her overall conditioning and activity tolerance. The results of this case report suggest that aquatic therapy may be an appropriate exercise modality for patients with Postural Orthostatic Tachycardia Syndrome. Continued research on the effects of aquatic therapy on the symptoms of Postural Orthostatic Tachycardia Syndrome is warranted.