title: Is home orthostatic self-training effective in preventing neurally mediated syncope?
abstract: BACKGROUND
  Repeated orthostatic stress may prove to be of benefit in the regulation of neurally mediated syncope. But the role of home orthostatic self-training is not established to prevent symptoms in patients with neurally mediated syncope. We performed a prospective and randomized study to evaluate the effectiveness of repeated home orthostatic self-training in preventing tilt-induced neurally mediated syncope.
  
  
  RESULTS
  Fourty-two consecutive patients (24 males and 18 females, mean age 39 years, 16-68 years) with recurrent neurally mediated syncope were randomized into the tilt training and control groups. The home orthostatic self-training program consisted of daily sessions for 7 days a week for 4 weeks. In order to determine the effects of home orthostatic self-training, we repeated the head-up tilt test in both groups 4 weeks later. Among the tilt-training group, 9 of 16 patients (56%) had a positive response on follow-up head-up tilt test. Among the untreated control group, 9 of 17 patients (53%) had a positive response on follow-up head-up tilt test. In subgroup analyses according to the number of tilt-training sessions or the classified type, we found no differences in the follow-up head-up tilt test responses. Spontaneous syncope or presyncope over mean follow-up of 16.9 months were observed in 42.9% versus 47.1% in the tilt-training and control group, respectively.
  
  
  CONCLUSIONS
  Home orthostatic self-training was ineffective in reducing the positive response rate of head-up tilt test in patients with recurrent neurally mediated syncope.
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young Keun
authors.initials: YK
authors.lastname: On
authors.forename: Jungwae
authors.initials: J
authors.lastname: Park
authors.forename: June
authors.initials: J
authors.lastname: Huh
authors.forename: June Soo
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D012648:Self Care; D018709:Statistics, Nonparametric; D019462:Syncope, Vasovagal / Q000503:physiopathology / Q000517:prevention & control*; D018667:Tilt-Table Test; D016896:Treatment Outcome