As someone who has had POTS/exercise intolerance for as long as I can remember and only recently got diagnosed, here are some things that help me. Going outside/hiking is a huge part of my mental health so it’s important for me to keep it accessible. This only applies to my level of POTS, so if yours is more severe, these tips might not work or need to be modified further.
1. Training for hiking helps, especially in the off season so you don’t suddenly have a huge spike in activity that can trigger flare-ups. PACE protocol approved exercises like gentle swimming, rowing machines or mat strength exercises (I like Pilates) can help keep conditioning and know your body’s fitness level at a given time.
2. Plan for less mileage than you think you can do, and try to make sure you’re turning back when you have over half your energy left even if your plan isn’t completed. It’s better to do a little bit often and enjoy what you can than fail to pace yourself and trigger a flare up that will set you back.
3. Keep your pace slow-moderate and take more breaks than you think you need. Especially if you have been an athlete at any point, you may be tempted to push yourself. Remember that at this point hiking at all is pushing yourself. Try not to get to the point of being meaningfully out of breath or feeling lightheaded.
4. Use hiking poles. Compression stockings help too but I’ve never found medical grade ones that are durable enough to hike in without ruining. Invest in comfortable, breathable clothing that will keep you cool and safe from the sun. If it looks like it’s for old people, that’s probably what you want. Wear good hiking boots/shoes.
5. Bring salt tablets and NSAIDs and antihistamines and puffers and any other medications that you could possibly need or might make you more comfortable. Bring 2 water bottles and electrolyte tablets (I like NUUN). Bring a small water filter if there are water sources around. You want to balance being hydrated with carrying too much weight. I also find low blood sugar can be a factor for me so bringing snacks and eating small amounts often helps (having a variety that offer different things like easy sugar, easy salt as well as complex carbs, fat and protein helps tailor your food to your body that day).
6. Keep your base weight down as much as possible. If you have an able-bodied friend or partner or dog, ask them to carry as much stuff as possible. It’s already hard work for you and added effort means less mileage before you get into the danger zone.
7. Have an exit strategy. Don’t go far into the backcountry unless you’re relatively certain you’ll be able to handle that distance. Places where someone could access you with a car if you get stuck are ideal.
8. Sometimes, standing up to do dishes is too hard, but you still want to go outside. I love backcountry and I don’t like lookouts or front country camping as much, but they’re still better than staying home. Driving or bicycling in can be easier (biking doesn’t work for me but it might for you). Driving somewhere peaceful and sitting there can be nice too.
9. It might be more accessible in cooler weather
I recognize there are a lot of barriers to access to all these things, namely time, money, cars, friends, etc. Hopefully they’re able to help someone or can be modified to your circumstances. My POTS is episodic and so there have been times when none of these worked, but it has come around again, and so hopefully that happens for you, too.
