When standing up feels like a workout: breathing and PoTS
- Air Physiotherapy
- Aug 5
- 4 min read
It starts subtly - maybe you feel lightheaded when you stand, your heart races after walking across the room, or you’re totally wiped out after doing what used to be simple everyday tasks. If this sounds familiar, you might be dealing with Postural Orthostatic Tachycardia Syndrome, or PoTS.
At The Breathing MOT, we’re seeing a growing number of people with these symptoms. Many have been through exhaustive rounds of testing and appointments. Some have a formal diagnosis, while others are still stuck in symptom limbo. But there’s one thing most of them share: their breathing is out of sync with their body’s needs.
What Is PoTS, and What’s Going On in Your Body?
PoTS is a form of autonomic dysfunction, meaning the automatic systems that regulate things like heart rate, blood pressure, and digestion aren’t working properly.
Specifically, PoTS affects how your body manages blood flow when you move to an upright position. When you stand, gravity pulls blood toward your legs. In a healthy system, blood vessels constrict and the heart makes slight adjustments to maintain stable blood pressure and flow to the brain.
In PoTS, that adjustment doesn’t happen efficiently. Your heart compensates by speeding up dramatically - often increasing by 30+ beats per minute within 10 minutes of standing.
This can cause:
Dizziness or lightheadedness
Breathlessness
Heart palpitations
Nausea or blurred vision
Fatigue and “crashing” after activity
Occasionally, fainting
Some people also experience “brain fog,” chest discomfort, or difficulty regulating temperature or digestion.
How Breathing Affects PoTS Symptoms
Breathing plays a major role in how your nervous system responds to positional changes. If your breathing is too fast, too shallow, or stuck in your upper chest, it can throw off your body’s delicate balance even more.
Many people with PoTS also show signs of dysfunctional breathing, where the diaphragm isn’t being used properly and the accessory muscles (like those in the neck and shoulders) are doing most of the work.
Here’s how poor breathing makes PoTS worse:
Chest breathing stimulates the sympathetic nervous system (fight or flight), keeping your body in a state of alert even when you should be at rest.
Over-breathing can cause low carbon dioxide levels, which leads to lightheadedness, dizziness, and a feeling of air hunger.
Shallow or erratic breathing reduces oxygen delivery to tissues, adding to fatigue and brain fog.
And when your nervous system is already under strain, every little imbalance compounds the issue.
In short, if you’re breathing in an inefficient or stressed way, your heart has to work even harder, and your symptoms can spiral.
How the Breathing MOT Can Help
At The Breathing MOT, we don’t just treat the symptoms, we evaluate how your entire breathing system is working and how it may be contributing to your instability.
During your MOT, we assess:
How your diaphragm is functioning
Your breathing pattern in different positions (lying, sitting, standing)
How your posture and breathing interact
Whether your nervous system is being overstimulated by your current breathing habits
For example, if we find that you're breathing rapidly from your chest, we work to retrain your pattern to encourage slow, diaphragmatic, nose-based breathing, especially during postural changes or light activity, to give you the control you need over your symptoms.
What You Can Expect from Treatment
Every treatment plan is personalised, but for people with PoTS, we often use a combination of the following:
Breathing control techniques
You’ll learn how to slow your breathing, engage your diaphragm properly, and use nose breathing to regulate your nervous system, especially during transitions from lying to sitting or sitting to standing.
Pacing strategies
We’ll help you break down movements into smaller, manageable steps, with built-in breathing checkpoints to avoid sudden drops in blood pressure or spikes in heart rate.
Confidence building
Many patients develop fear around movement because of how often it triggers symptoms. We help you rebuild trust in your body using safe, structured progressions.
Graded activity tolerance
Not "exercise" in the traditional sense, but strategic, incremental exposure to upright activity that’s sustainable, not overwhelming. We may also introduce some recumbent exercises.
Symptom awareness training
We’ll teach you how to recognise early signs of dysfunctional breathing and how to correct it in real time, so symptoms don’t snowball.
Building a More Stable Baseline
While there’s no known cure for PoTS, effective breathing retraining can give your system a more stable baseline, meaning your heart doesn’t have to work as hard when you stand, and your nervous system doesn’t stay in overdrive.
You may not be able to control every aspect of PoTS, but you can learn to regulate your breath, calm your system, and conserve your energy - all of which makes a real difference in how you feel day-to-day.
If This Sounds Like You…
If you're struggling with dizziness, fatigue, or breathlessness and feel like your breathing is working against you, we’re here to help.
The Breathing MOT is your starting point to understanding what’s really going on and changing the patterns that are keeping you stuck.