Exercise Physiology for POTS & Dysautonomia
Postural Orthostatic Tachycardia Syndrome and Orthostatic Intolerance are poorly understood, often mismanaged conditions. We offer something rare: clinician-led exercise care from someone who has lived it.
✓ Medicare, NDIS and DVA accepted ✓ No referral needed to start ✓ Clinician with lived experience in POTS
"I have lived with Dysautonomia myself. I know what it takes to manage these conditions day to day, and I know what good care looks like. That is what I bring to every person I work with."
A real, physical condition. Not anxiety. Not laziness. Not just being unfit.
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia, a dysfunction of the autonomic nervous system that regulates heart rate, blood pressure, digestion and many other automatic body functions.
In POTS, the body fails to properly regulate blood flow when you stand. Heart rate surges, blood pools in the lower body and the brain receives less oxygen than it needs. The result is a constellation of symptoms including racing heart, dizziness, brain fog, extreme fatigue and nausea that can make even basic daily activities feel impossible.
Orthostatic Intolerance (OI) is a broader term for conditions where symptoms worsen on standing and improve when lying down. Many people with POTS also experience overlapping OI. Both conditions are frequently dismissed, misdiagnosed as anxiety or panic disorder, and left untreated for years. That delay causes real harm. Getting the right support, sooner, changes outcomes.
Exercise is one of the most effective treatments for POTS, but the wrong kind of exercise can make things significantly worse.
This is not a condition where a standard exercise prescription applies. Upright exercise, high-intensity training and programmes that ignore orthostatic stress can trigger symptom flares, prolong recovery and erode the trust people with POTS have in exercise as a tool at all.
The research is clear: a carefully graduated, largely recumbent or semi-recumbent programme that progressively builds cardiovascular and postural tolerance is an evidence-based first-line treatment. The clinical skill is knowing exactly how to structure, progress and adapt that programme for your specific presentation, including on the days when your body simply will not comply. That is what we do.
What people get wrong about POTS and exercise
People with POTS hear a lot of well-intentioned but unhelpful advice. Here is what the evidence actually says.
POTS is just deconditioning. Push through it and you will get better on your own.
While deconditioning can worsen POTS, the condition has distinct autonomic and sometimes structural causes. Unguided push-through exercise frequently causes post-exertional symptom flares and sets people back significantly.
If you cannot stand up properly, exercise is too dangerous to attempt.
Evidence-based POTS exercise begins in recumbent positions including rowing, swimming and cycling, specifically because it avoids orthostatic stress while building the cardiovascular base needed to tolerate upright activity over time.
POTS is a psychological condition. The symptoms are caused by anxiety.
POTS is a physiological disorder with measurable autonomic dysfunction. Anxiety is a common consequence of living with debilitating undiagnosed symptoms, not the cause. Appropriate physical treatment is the primary intervention.
Rest is the safest approach while waiting to see a specialist.
Prolonged rest accelerates cardiovascular deconditioning and worsens POTS symptoms over time. Even low-intensity recumbent activity, introduced carefully, is preferable to extended bed rest while awaiting specialist review.
A program built around your autonomic system, your symptoms and your life
Every POTS program at Beachside EP begins with a thorough assessment of your symptom profile, functional capacity and daily limitations. We design from there, not from a template.
Graduated recumbent exercise
We begin where your body is. Rowing machines, recumbent cycling and swimming-based programmes build cardiovascular fitness without triggering orthostatic symptoms. Upright activity is introduced gradually as tolerance improves.
Postural tolerance training
Progressive exposure to upright positions, managed carefully using heart rate monitoring and symptom response, helps retrain your autonomic nervous system's response to standing over time.
Strength and muscle pump work
Building lower limb and core strength improves the venous muscle pump, reducing blood pooling and supporting better blood return to the heart when upright.
Heart rate monitoring and load management
We monitor heart rate throughout every session and teach you to manage your own load using evidence-based heart rate targets for POTS. You leave each session knowing how to train safely between appointments.
Fatigue and post-exertional management
We understand pacing. For those with concurrent ME/CFS or post-exertional malaise, we structure programmes that build capacity without triggering crashes.
Breathwork and nervous system regulation
Breathing techniques that support parasympathetic activation help manage the acute symptom response and support autonomic regulation between exercise bouts.
Education and self-management tools
Understanding your condition changes how you manage it. We explain the physiology of POTS in plain language and give you practical strategies for fluid intake, salt loading, compression garments and activity pacing.
Coordination with your care team
We communicate regularly with your cardiologist, GP, neurologist or other treating clinicians. Written progress reports ensure your exercise programme is aligned with your broader medical management.
Who we see
POTS and dysautonomia present differently in every person. We work across the full spectrum.
Not sure if this is you? You do not need a confirmed diagnosis to book. Many people we see are still in the process of being investigated. We assess your symptoms and function, not your paperwork.
Book an initial assessment →Care from someone who understands from the inside
Sierra is an Accredited Exercise Physiologist at Beachside EP with personal lived experience of Dysautonomia, including Postural Orthostatic Tachycardia Syndrome and Orthostatic Intolerance.
She knows first-hand the impact these conditions have, not just on the person living with them, but on the families around them. The exhaustion of unexplained symptoms. The frustration of being dismissed. The fear of exercise when your body has taught you that movement comes with consequences.
That lived experience shapes how she practises. Sierra brings deep compassion alongside her clinical training, meeting each person where they are and building programmes that are meaningful to that individual, not just clinically sound in a textbook sense. Her focus is long-term health outcomes that matter to the person in front of her.
Working with Sierra
- ✓Accredited Exercise Physiologist registered with ESSA
- ✓Lived experience in Dysautonomia, POTS and Orthostatic Intolerance
- ✓Evidence-based, individually tailored programming
- ✓Compassionate, unhurried clinical approach
- ✓Experienced with complex and overlapping presentations
- ✓Coordinated care with your existing medical team
What to expect from your first appointment
We assess before we prescribe. Every POTS program is individual because every patient's symptom profile, triggers and goals are different.
Initial assessment
A thorough review of your symptom history, triggers, current medications and what daily life looks like for you right now. We assess your current functional capacity in positions your body can tolerate and identify your starting point. This takes 45 to 60 minutes.
Personalised program design
We build a programme around your specific POTS presentation, recumbent where needed, progressive always, and structured around what is meaningful to you. We explain the rationale for every choice so you understand what we are doing and why.
Supervised sessions with real-time monitoring
Sessions are supervised with heart rate monitoring and symptom tracking throughout. Your clinician adjusts intensity in real time based on your response. You also receive your programme via our exercise app so you can train between sessions with confidence.
Regular review and progression
We review your programme at regular intervals, progress loading as your tolerance improves and adapt quickly when symptoms fluctuate. Written reports are sent to your GP, cardiologist or neurologist after every review so your whole team stays aligned.
Multiple ways to fund your POTS program
POTS and Dysautonomia qualify as chronic conditions under several funding pathways. In many cases your out-of-pocket cost per session is significantly reduced.
Chronic Disease Management
Up to 5 subsidised allied health sessions per calendar year with an active CDM plan from your GP. POTS qualifies as a chronic condition.
$61.80 rebate per session
Improved Health & Wellbeing
Exercise Physiology is funded under the Improved Health and Wellbeing support category for self-managed and plan-managed NDIS participants.
Self and Plan Managed
Gold and White Card
DVA Gold Card holders have all clinically necessary Exercise Physiology sessions covered with no gap fee.
No gap fee (Gold Card)
Extras Cover
Most extras policies cover Exercise Physiology. Check your fund for your annual limit and rebate amount.
Varies by fund
Injury and Illness Support
WorkCover and TAC funding can apply where POTS or dysautonomia is linked to a workplace injury or transport accident.
Case managed
No Referral Needed
Book directly and pay privately. No GP visit or referral is required to get started. We will guide you on rebate options at your first appointment.
No referral required
POTS program FAQs
Is exercise safe for someone with POTS? +
I have had terrible experiences with exercise before. Will this be different? +
I do not have a formal POTS diagnosis yet. Can I still book? +
Do I need a referral to book? +
I also have hEDS, MCAS, Long COVID or ME/CFS. Can you still help? +
Can I attend via telehealth? +
What does a typical first appointment involve? +
You deserve care from someone who gets it.
Book your initial assessment with Sierra. We will start where you are, move at your pace and build a program around what matters to you.
✓ Takes 60 seconds ✓ No referral needed to start ✓ Medicare, NDIS, DVA accepted ✓ Clinician with lived experience in POTS