Exercise and Non-pharmacological interventions

– by Dr. Debbie Turner


As a rule of thumb, exercise for those affected by autonomic dysfunction should be focused on gentle progressive efforts promoting greater venous return and prevention of deconditioning. Endurance is not a goal, rather short intervals of activity alternating with rest. Beginning routines may be ten minutes in duration. As tolerance develops this may be increased to two or three daily intervals. Some suggested exercises include:

Isometric flex/ release of lower body muscle groups /contract and release times. These maneuvers should never produce breath holding or straining.

Marching in place. One easy method, while watching TV, is to stand beside a chair during commercials and march in place. Hydrate and rest during the program.

Recumbent Bicycle riding. Short ten minute intervals with minimal resistance are best.


• Afternoon exercise is often better tolerated due to circadian patterns impacting vascular tone.

• Avoid straining or lifting weights greater than ten pounds. Do not use leg press or other resistance machines and avoid lifting weight above the head.

• Avoid temperature extremes. In particular avoid overly warm rooms and excessive stimuli (noise, smells, etc.) Heat causes vasodilatation and venous pooling.

• Avoid alcohol, caffeine or exercise within an hour after a meal.

• Do exercise daily.

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