Yes, swimming may help some people with postural orthostatic tachycardia syndrome (POTS) because it lets them exercise in a more horizontal position rather than staying upright. The water’s pressure may also help circulation. Swimming is not a cure, and it can still cause dizziness, a racing heart, or fatigue. Starting slowly, following a clinician-guided plan, and never swimming alone are important for safety.
Why Might Swimming Help People With POTS?
POTS affects the body's ability to regulate heart rate and blood flow when changing position, particularly when standing upright. Some people experience a fast heartbeat, lightheadedness, fatigue, or exercise intolerance. These symptoms can make conventional activities, such as walking or exercising while standing, difficult to manage.
Swimming offers a way to exercise while the body is supported by water and kept in a more horizontal position. According to Johns Hopkins Medicine, aquatic therapy may benefit some people with POTS because the water creates pressure around the body. This may make exercise more manageable for people who struggle with upright activity, although the response varies from person to person.
What Benefits Can Swimming Offer for POTS?
Swimming can be one option for building physical fitness without requiring prolonged upright exercise. It provides aerobic activity and involves muscles throughout the body. When included in an appropriate exercise program, it may help improve exercise tolerance and make everyday physical activities easier over time.
A review published in the medical literature, available through PubMed, describes swimming, rowing, and recumbent cycling as useful starting options for exercise training in POTS. The review supports gradually building cardiovascular fitness through structured exercise, but it also notes the need for further research into non-drug treatments. This means the evidence supports exercise as part of POTS management more broadly, rather than proving that swimming alone will improve symptoms for everyone.
Swimming may make exercise easier to tolerate
For someone who struggles to remain standing during exercise, swimming may provide a practical alternative. The horizontal position reduces the need to exercise while upright, and the water supports the body during movement. However, swimming still requires energy and can increase heart rate. It should not be assumed to be automatically easier or safer than every other form of exercise.
It can be part of a gradual fitness plan
Improving fitness with POTS usually involves a planned, gradual approach rather than sudden increases in activity. A suitable program may combine swimming or another form of aerobic exercise with strengthening exercises for the legs and core. The right combination depends on current fitness, symptom patterns, other health conditions, and how well activity is tolerated.
How Should You Start Swimming With POTS?
Before starting a swimming routine, discuss your plans with a healthcare professional, particularly if you experience fainting, have unpredictable symptoms, or find even gentle exercise difficult. A physical therapist familiar with POTS can help you choose an appropriate starting point and adjust the activity as your tolerance changes.
The UK National Health Service (NHS) includes swimming among the gentle activities that people with POTS may try and advises stopping if symptoms occur. This guidance is important because the goal is to build activity safely, not to push through symptoms or complete a predetermined workout.
Practical steps for a safer swimming routine
- Start with an easy session. Begin with an amount of activity that feels manageable rather than aiming for long distances or vigorous laps.
- Increase activity gradually. Extend the duration or intensity only as tolerated and in line with your clinician's advice. Avoid making several large increases at once.
- Choose a controlled environment. A familiar swimming pool with lifeguard supervision is generally preferable to swimming in open water, particularly when symptoms are unpredictable.
- Never swim alone. Swim with a trusted companion or in a supervised setting. Someone should be available to help if dizziness, weakness, or faintness develops.
- Pay attention to symptoms. Stop if you develop lightheadedness, unusual weakness, a racing heartbeat that feels concerning, or other symptoms that make continuing unsafe.
- Leave the water carefully. Change positions slowly when getting out of the pool, using a handrail or assistance if needed. Standing up quickly can bring on symptoms in people with POTS.
- Follow your hydration plan. Follow any individualized fluid and electrolyte recommendations from your healthcare professional, especially when exercising or spending time in warm conditions.
According to PoTS UK, people with POTS should swim with friends, family, or in a supervised place and follow water-safety guidance. These precautions matter because dizziness or fainting in water can quickly become dangerous, even if symptoms are usually manageable on land.
Can Swimming Make POTS Symptoms Worse?
Yes. Although some people tolerate swimming well, others may experience worsening fatigue, dizziness, palpitations, or reduced exercise tolerance. The effort required to swim can still place demands on the cardiovascular system. Water can also make it harder for a person to recognize or respond safely to symptoms if they develop while away from the pool's edge.
Heat is another consideration. The Cleveland Clinic identifies warm environments as a possible trigger for worsening POTS symptoms. People who are sensitive to heat may find very warm pools or hot-water environments uncomfortable. Choosing a comfortable setting and avoiding excessive heat may help reduce this particular challenge.
If swimming repeatedly leaves you feeling significantly worse during the activity or afterward, do not keep increasing the workload. Discuss the pattern with your healthcare professional so the exercise plan can be reassessed. New, severe, or unusual symptoms also deserve prompt medical evaluation rather than being attributed automatically to POTS.
Is Swimming Better Than Walking or Other Exercises for POTS?
Swimming is not universally better than walking, cycling, or other forms of exercise. Its main potential advantage is that it allows aerobic activity in a horizontal position, which may be helpful when standing or upright movement brings on symptoms. Someone who tolerates walking comfortably may prefer a different activity, while someone with more pronounced difficulty staying upright may benefit from starting with a recumbent or water-based option.
Other possible starting activities include recumbent cycling and rowing. Depending on an individual's needs and abilities, a program may also include seated, lying-down, or other adapted strengthening exercises. The choice should reflect symptom response, safety, and exercise tolerance rather than a requirement to use one particular activity.
How Much Swimming Should You Do for POTS?
There is no single swimming duration or weekly schedule that is appropriate for everyone with POTS. A person who is already active may tolerate more exercise than someone who has been unable to exercise regularly because of symptoms. A healthcare professional or physical therapist can help determine how much activity is reasonable initially and when to progress.
It is usually more helpful to establish a repeatable, manageable routine than to attempt an intense session and need an extended recovery afterward. Keep track of how you feel during exercise and later in the day. If activity causes persistent or disproportionate symptom worsening, the plan may need to be slowed, modified, or evaluated for other contributing conditions.
Is Swimming Enough to Manage POTS?
Swimming may be a useful part of POTS management, but it is not a complete treatment on its own. Exercise is often combined with other individualized measures, which may include changes to fluid and salt intake, compression garments, medication, and adjustments to daily activities. Not everyone needs the same combination, and changes to medication or dietary salt should be discussed with a healthcare professional.
For children and teenagers with POTS, exercise should also be adapted to their age, abilities, and symptoms, with guidance from an appropriate healthcare professional and support from a parent or caregiver where needed. The aim at any age is to make physical activity as safe and sustainable as possible.
Overall, swimming may help some people with POTS improve their fitness while avoiding prolonged upright exercise. The best results are more likely to come from a gradual, personalized approach that includes appropriate water-safety precautions. If you are unsure whether swimming is suitable for you, or if symptoms interfere with daily life, seek advice from a clinician who understands POTS.