title: Endurance exercise training in orthostatic intolerance: a randomized, controlled trial.
abstract: Orthostatic intolerance is a syndrome characterized by chronic orthostatic symptoms of light-headedness, fatigue, nausea, orthostatic tachycardia, and aggravated norepinephrine levels while standing. The aim of this study was to assess the protective effect of exercise endurance training on orthostatic symptoms and to examine its usefulness in the treatment of orthostatic intolerance. 2768 military recruits were screened for orthostatic intolerance by questionnaire. Tilt-table testing identified 36 cases of orthostatic intolerance out of the 2768 soldiers. Subsequently, 31 of these subjects with orthostatic intolerance entered a randomized, controlled trial. The patients were allocated randomly to either a "training" (3 months jogging) or a "control" group. The influence of exercise training on orthostatic intolerance was assessed by determination of questionnaire scores and tilt-table testing before and after intervention. After training, only 6 individuals of 16 still had orthostatic intolerance compared with 10 of 11 in the control group. The Fisher exact test showed a highly significant difference in diagnosis between the 2 groups (P=0.008) at the end of the study. Analysis of the questionnaire-score showed significant interaction between time and group (P=0.001). The trained subjects showed an improvement in the average symptom score from 1.79+/-0.4 to 1.04+/-0.4, whereas the control subjects showed no significant change in average symptom score (2.09+/-0.6 and 2.14+/-0.5, respectively). Our data demonstrate that endurance exercise training leads to an improvement of symptoms in the majority of patients with orthostatic intolerance. Therefore, we suggest that endurance training should be considered in the treatment of orthostatic intolerance patients.
authors.affiliation: Division of Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. robert.winker@meduniwien.ac.at
authors.forename: Robert
authors.initials: R
authors.lastname: Winker
authors.forename: Alfred
authors.initials: A
authors.lastname: Barth
authors.forename: Daniela
authors.initials: D
authors.lastname: Bidmon
authors.forename: Ivo
authors.initials: I
authors.lastname: Ponocny
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Otmar
authors.initials: O
authors.lastname: Mayr
authors.forename: David
authors.initials: D
authors.lastname: Robertson
authors.forename: André
authors.initials: A
authors.lastname: Diedrich
authors.forename: Richard
authors.initials: R
authors.lastname: Maier
authors.forename: Alex
authors.initials: A
authors.lastname: Pilger
authors.forename: Paul
authors.initials: P
authors.lastname: Haber
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Rüdiger
mesh_terms: D000328:Adult; D000409:Alanine; D001341:Autonomic Nervous System / Q000503:physiopathology; D002307:Cardiography, Impedance; D004247:DNA / Q000235:genetics; D005080:Exercise Test; D006439:Hemodynamics; D006801:Humans; D007024:Hypotension, Orthostatic / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D007590:Jogging; D009154:Mutation; D050484:Norepinephrine Plasma Membrane Transport Proteins; D010806:Physical Education and Training; D010807:Physical Endurance; D011392:Proline; D027981:Symporters / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D050484:Norepinephrine Plasma Membrane Transport Proteins; C493227:SLC6A2 protein, human; D027981:Symporters; D004247:DNA; D011392:Proline; D000409:Alanine