When you get a POTS diagnosis, physical activity is one of the first things doctors recommend. But exercises like weight lifting, running, or even walking can push symptoms into overdrive. I once thought I was going to be sick in the middle of the gym just because I paused during my cardio.

A woman with POTS following the CHOP Protocol on an upright bike at the gym.

The CHOP Exercise Protocol

The CHOP Exercise Protocol, designed by the Children’s Hospital of Philadelphia, gradually builds exercise tolerance. It starts with simpler, less strenuous exercises and increases in difficulty over time, which helps avoid triggering severe symptoms early on.

The idea

Start with exercise your body can tolerate today, then slowly progress toward what you want to do tomorrow.

What the plan looks like

  1. Months 1–3: supine cycling, recumbent bike, swimming with a kickboard, rowing, seated stepper.
  2. Month 4: recumbent bike, swimming, rowing, upright biking.
  3. Month 5: upright biking, treadmill walking (flat grade), elliptical (stationary arms).
  4. Month 6 and beyond: progress to more difficult exercises as tolerated.

The duration also ramps up. The first month starts at about 28 minutes per session. By the last month, sessions run about an hour and 5 minutes.

Working with a healthcare provider

Every experience with POTS is different. It’s important to work with a healthcare provider before starting a new exercise program to make sure it fits your specific health situation. Even while I was progressing through the CHOP, I checked in with my provider and physical therapist regularly.

My personal experience

I followed the CHOP protocol for five months, and it meaningfully improved my ability to manage my POTS symptoms. What helped most was having a structured way to gradually increase what I was doing instead of trying to jump straight back into the kinds of exercise I could tolerate before POTS.

I wrote more about what the experience was actually like, including the exercises I started with and how things changed over time, in How I learned to exercise with POTS.

Making the CHOP Exercise Protocol easier to follow

One thing I found frustrating about following the CHOP protocol was having to keep going back to the PDF to figure out what I was supposed to do next.

That’s why I added the CHOP program to POTSie. The app breaks the program down by month and day, so I could quickly see exactly what I was supposed to do that day. Having the cardio targets and strength exercises together in one place meant I didn’t have to keep reopening the PDF or figuring out where I left off.

POTSie CHOP Exercise Protocol showing monthly cardio targets and strength exercises

Seeing everything laid out for me meant there was less to keep track of, which made going to the gym feel much more manageable. I liked having cardio notifications so I easily knew when I had finished each section without having to keep checking my phone or interrupt whatever I was watching. Over time, exercise became part of my normal POTS routine—and after five months, I noticed a significant improvement in my symptoms.