Programming considerations for Trainee with PoTs

Hey everyone,

My girlfriend has Postural tachycardia syndrome aka PoTs and wants to start training with me in the gym. As the “expert” (according to her anyway) on training I was wondering if I should have any special considerations for training someone with a fairly severe case of PoTs. I have noticed several issues that I suspect will be a barrier to training, hopefully the forum can help with some solutions.

first and most obvious, she gets very lightheaded from exercise, especially cardio. I taught her how to squat, deadlift, overhead press, row, and bench when she tagged along with me to the gym, and aside from needing a bit longer rest periods, she tolerated it well, granted with low RPEs. I suspect this will become more of an issue with higher RPE work.

second, her conditioning is extremely poor, and she has very low motivation to improve it via cardio. She has the mindset that she simply “can’t do it” because of her condition. Obviously simply telling her she can has not worked, so ways to show her she can would be appreciated.
related to this, she takes beta blockers and (at least according to her smart watch) her heart rate spikes to the 150-180 range very quickly from even a flight of stairs. I am concerned that cardio training may cause this to reach dangerous levels.

third, she gets extreme fatigue after exercise, specifically cardio. She tolerated weight training fairly well at low RPEs, but often says she feels exhausted for a day or more after fairly mild cardio exercise (for example, a trip to the mall). I am not sure how to combat this as she doesn’t have any glaringly terrible recovery habits like sleep or nutrition, though they could be better.

the good news is, she is very motivated to train weights and has picked up on technique very quickly. I am just concerned about how to effectively manage fatigue while still getting enough training stimulus to drive adaptation and hopefully improve quality of life. Thanks in advance for your responses.

In this situation I’d probably really leverage her motivation to train with weights and focus on that in the early phase, in order to build up some strength/capacity and confidence which can later be translated towards some conditioning-type activities. You don’t have to force everything all at once up front.

Regarding her strength training, I’d really base it on her abilities, preferences/goals, and any limitations. In other words, if she’s enjoying the main lifts but feels worse when getting close to failure/at high RPEs, then it’s perfectly fine to keep her strength training in the 5-7 RPE range if that’s what she tolerates best, for example. Instead of pushing towards 9-10 RPE, she can simply do a few more sets at the moderate/lower RPE range.

As her capacity and tolerance improve, you can start incorporating short conditioning bouts (starting as little as a minute or two of moderate-intensity activity) and seeing how she tolerates before progressing from there.

Thanks for the advice Austin. I will start her on the weights and hopefully be back in a few months with good news!