Whether you have been newly diagnosed or have had POTS for a while, exercise is a great way to improve your symptoms. Here is my advice on how to exercise with the Levine Protocol Plan!
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What is the Levine Protocol and how does it help?
The Levine Protocol is an exercise therapy plan for patients with POTS created by a cardiologist named, Benjamin Levine. His studies revealed that consistent exercise is a crucial part for improving the lives of those with POTS.
POTS is different from case to case, but one common symptom is having a low tolerance level to physical activity. This is caused by the extreme heart rate spikes and fatigue that happens with POTS. The Levine Protocol is designed to help increase your tolerance to physical activity through target heart rate cardio exercises and strength training.
Must Haves for How to Exercise with the Levine Protocol
Since exercise is very difficult for those with POTS, you will need all the help you can get! Here are some must have items I suggest that will make following the Levine Protocol easier for you!
Helpful Equipment for The Levine Protocol
- Heart Rate Monitor– this is a BIG must have. Check out this post on My Top 5 POTS Savers for some suggestions on which ones to get!
- Portable Personal Fan– I use mine on cardio days to help keep my body temperature down!
- Nalgene Water Bottle– I recommend this because these things are indestructible and they have measurements so you can track how much water you are drinking throughout the day.
Helpful Apparel for the Levine Protocol
- Cooling Neck Towel– avoiding heat is a necessity if you have POTS. This will help keep you cool as you get your sweat on.
- Compression stockings– this will help with recovery and your blood circulation.
- Moisture wicking workout clothing– trust me, you will sweat a lot so you need clothes that won’t just collect sweat and moisture.
Shop these name brands here for some great options for workout clothing and gear!
Disclaimer: this post contains affiliate links and I may receive income made from qualifying purchases at no additional cost to you. Full disclaimer here
Other Helpful Suggestions
- Electrolyte Packets– My favorite is LMNT! They are loaded with sodium, taste great, and have no artificial flavors or sweeteners!
- Gym Membership- for best results, you will need to do a combination of cardio and strength training on circuit and cardio machines. ALWAYS start off exercising sitting down until you can build up a higher tolerance to standing and walking. Machines like the seated rower, recumbent bike, or swimming with a kick board is best to start with!
How to Actually Exercise with the Levine Protocol Plan
Ok so now that you have all the equipment needed, it’s time to learn how to actually follow the Levine Protocol plan!
Thankfully, the protocol has a daily chart that can be found here that tells you what to do, how long to do it, and what your target heart rates should be. All you need to do is follow the chart and keep pushing forward!
However, in order to follow this chart, you will need to know how to calculate your target heart rates. This can be done by following the steps below or by meeting with a physical trainer or cardiologist who can help you figure it out.
Here are the different target heart rates:
- Max Heart Rate (MaxHR)
- Heart Rate Reserve (HRR)
- Maximal Steady State (MSS)
- Recovery Pace
- Interval Pace
- Race Pace
All of these target heart rates will be used if you do the entire 8 months of workout plans. You can use the equations below to calculate your heart rates. It is a good idea to recalculate them every year or if you see a consistent change in your resting heart rate.
Important Disclaimer:
**Please note that you CANNOT use this formula if you are currently on Beta Blockers. Please consult your doctor to find out how to calculate your target heart rate instead.**
- Step 1– Find your Max Heart Rate or MaxHR: 220 – your age = MaxHR
Example: 220 – 40 = 180 bpm MaxHR
- Step 2- Find your Heart Rate Reserve or HRR: MaxHR – Supine Resting Heart Rate
Example: 180 – 60 = 120 bpm HRR (Measure your Supine Resting Heart Rate before you get out of bed)
- Step 3- Multiply HRR by .75 = 75% of HRR
Example: 120 x .75 = 90 bpm ( If needed, round to nearest whole number ex. 90.5 round up to 91)
- Step 4- Find Maximal Steady State or MSS: 75% of HRR + Resting Heart Rate = MSS HR
Example: 90 + 60 = 150 bpm MSS
- Step 5- Find MSS Pace: MSS HR +/- 5 bpm = MSS Pace
Example: 150 +/- 5 = 145-155 MSS Pace
- Step 6- Find Base Pace: Subtract 20bpm from the LOW end of MSS Pace
Example: 145 – 20 = 125-139 bpm Base Pace
- Step 7- Find Recovery Pace: Any bpm LOWER than Base Pace
Example: Recovery Pace = Any bpm lower than 125 bpm
- Step 8- Find Race Pace: Multiply Max HR x .95 and use Highest Base Pace bpm
Example: 180 x .95 = 171 bpm
Race Pace = 139-171 bpm (139 is highest Base Pace bpm)
- Step 9- Find Interval Pace: = any bpm higher than greatest Race Pace number to Max HR
Example: 171-180 bpm
Now that you have taken your math test on calculating your heart rates, you can follow the daily chart and let the fun begin!
Levine Protocol Cardio Training Guidelines
- Experiment with different cardio machines until you find the one that works best for you! (The recommended options are the recumbent bike, seated rower, or swimming)
- You should try to rotate your cardio workout types so you don’t get bored with the same thing over and over.
- ALWAYS be sure to do your 10 minute warm up before and 10 minute cool down after your workouts
- Be sure to stretch after your 10 minute cool down
- Don’t forget your water bottle, cooling neck towel, and portable fan!
Levine Protocol Strength Training Guidelines
The strength training workouts focus on your lower body, chest, and core. You can always try different machines and exercises, but here are the ones the Levine Protocol suggests:
- Seated Leg Press
- Leg Curls
- Calf Raise
- Chest Press
- Seated Row
It is recommended that you do 3 sets of 8-10 reps each. Do as many reps as you can on the last set. If you can do more than 10, then you will need to increase the weight the next time you workout. I would also recommend to try doing the seated rower for at least 5 minutes with little to no resistance before and after your workout. This will help loosen up your muscles and get the blood flowing throughout your body.
Personally, I now add more upper body exercises to my workouts as well. I was not able to do this physically at first but have worked my way up to a full body workout!!
Lastly, always be sure to have a day of rest in between your strength training workouts to give your muscles time to recover.
Can You Exercise with the Levine Protocol at Home?
Ideally the Levine Protocol should be done at a gym that has cardio and circuit training machines. However, sometimes a gym membership can be out of reach financially. Thankfully, the daily chart comes with some exercise ideas you can do at home as well! Please note, only doing the additional exercises listed on the chart will not allow you complete the Levine Protocol. However, you can still do these exercises to help!
Other At Home Exercise Programs
- Beach Body- this is NOT geared for those with POTS but it does have some great yoga workouts!
- YouTube- there are tons of free workout videos on YouTube!
- Wall sits- try holding for 30 seconds to 1 minute
- Crunches and sit ups- start with 3 sets of 10 and work your way up
- Planks- try to hold for 30 seconds to 1 minute
Purchasing At Home Gym and Cardio Equipment
Another option would be to purchase your own equipment to use at home. Obviously, this would require you having the space and budget to create a home gym. However, gym memberships do have to be renewed every year and that can add up! At home equipment is a one time purchase instead of an annual membership fee. Home equipment can also provide everything you need to complete the Levine Protocol in the comfort of your own home! Here are some options for at home workout equipment:
Cardio Machines for the Levine Protocol Plan
- Schwinn Recumbent Bike
- Concept 2 Seated Rower
- Schwinn Indoor Cycling Bike
- Nordic Trac Treadmill
- Bowlfex Elliptical Machine
- Peloton
Strength Training Machines for the Levine Protocol Plan
- Bowflex– Bowflex offers every type of home gym and cardio machine you will ever need!
- Marcy Stack Home Gym
Closing Thoughts for How To Exercise With the Levine Protocol Plan
The Levine Protocol is definitely a big commitment to make but it’s well worth it in the end! You will need to go to the gym and work out a LOT in order to follow the plan. This will take a daily commitment to fulfill. However, you can combine your workouts and do strength training after a cardio workout IF you feel up to it to create less days in the gym.
You will feel worse before you begin to feel better! Remember, this is a journey and not an overnight fix. Most people begin to see and feel changes in their POTS symptoms after 2-4 months. I just started month 4 and FINALLY have noticed a big improvement in the way I feel!
Also, don’t give up!! It is hard work and some days you will not feel like doing anything. However, the end result will be worth it! You can do it!
Lastly, don’t forget to stay hydrated! I recommend drinking an LMNT Electrolyte Packet BEFORE you work out. It is way easier to maintain your electrolyte and hydration levels instead of trying to replenish them after a workout.
Good luck and I hope this post has helped you learn how to exercise with the Levine Protocol Plan! As always, please be sure to share your stories in the comments below!