Orthostatic (postural) Hypotension

Just wondering if anyone else is suffering from this and noticing a correlation with their fitness state. My siblings both suffer from mildly compromised autonomic systems. My own dip in that collective gene pool seems to be a legacy of more frequent than usual lightheadedness spells on standing up due to reduced blood pressure. I have just started to notice that these event correlate more with increased fitness. So I did a bit of digging on it and it seems that while exercise increases the blood plasma and thus reduces the susceptibility to these low blood pressure events, it also increases the heart stroke volume which raises the sensitivity in trained individuals…

My own experience is that I seem more prone when I am fitter and also on the day of a serious effort: If I have to get out of the sofa, I do take it very gingerly or brace for it.

I also found reference to a twins study where they got one to do core strength work and found him subsequently robust to it compared to his twin… So I guess I know what I have to do…

you may be becoming hyponatremic. Add some salt to your recovery drink and it will likely help.

Yeah I thought that too but I am not really a low sodium sort of guy if you follow me. The wife describes me as the guy who puts salt on a curry. I do use the SiS Electrolyte tabs off the bike for sodium replacement. Hyponatremia was a noted issue with HFLC diets. Which I have well and truly left behind now.

Still fair point worth some more attention… Anything to save me from having to do some core work!

Here’s a short summary, with some refs to follow.
There’s probably been a bit more research since then but I haven’t looked into any of it.

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I have this as part of EDS and regularly get very lightheaded when standing up (always have done). Not sure if it’s worse when I’m fitter but I could believe it.
I would like to say I’m careful and don’t stand up quickly but I frequently forget until it happens and I’m about to faint.
I just crouch down or lean over before it’s too late!

I’ve noticed this after hard workouts. The last two workouts, I tacked on 15 min mid zone 2, and it doesn’t seem as severe. I usually find myself squatting fairly often the rest of that day, but not so much now.

I do. Whenever I’m consistently training I appear to be at risk for it. I used to workout for several months and then just stop or get very inconsistent. Generally it would go away during these times. Another big trigger for me is alchohol. And anytime I’m outside doing yardwork that requires squatting (eg, gardening) it’s like every time.
I suspect there some volume- and electrolyte-depletion at play here even though I’m aggressive in trying to stay on top of it. To make it more exciting I’m hypertensive and am on medication for that.

I’ve passed out a couple times in the past, but i’m now pretty in tune with it. I feel it coming on with a good few seconds notice and can take countermeasures (grab a chair or something, dip your head). Very occasionally it comes on very quickly and I just need to get on the floor asap. Better to look like an idiot than pass out and smash your head.

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A trick I learned from my flying days was the good old AGSM (Anti-G straining maneuver): There are a few variants of it. It is sort of a combination of core bracing and a hands free version of the Valsalval Maneuver. You basically brace your guts as if straining to poop (Goes without saying: don’t poop!) and breathily and rapidly repeat “The Word”; Here’s where the variations come in… “Hook” and “Hank” have their fans but I prefer “Hink”. You don’t really vocalize it but the point is to force the air back up to the top of your lungs so you should feel the pressure of saying it fully in your nose. The advantage of this process is that you can continue about your business while doing it. No need to squat or park your ass quickly. It really drives your BP up fast so between 3 to 5 seconds to clear it from onset for me.

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Interesting… I shall experiment myself there.

I have never passed out from standing up yet thankfully. I did have one episode on the bike about 12 years ago. I was taking the scenic way into work the Monday after a long, hot, Sunday spin. I was still within a few k’s of home when I had to stop at some lights. Just as I stopped pedaling someone turned my lights out. They started to come back on as my head passed the cross bar. By the time I hit the ground the lights were back on but there was nobody in so to speak. Took a short while for all the circuits to come back. Some very nice people were swarming all over me trying to help. We never ever got to the bottom of that. Although I suspect hyponatremia, my sensitivity and just the BP hydrostatics of stopping your main movers from firing all combined. It never happened again but for years I was like a cat on a hot tin roof with every ride.

I get this daily when i workout and it always goes away with hydration. Never been worried, doctor agrees.

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Yes, add salt it has really helped me to increase my salt intake. athletes need more salt then the average person. Only a few hundred grams though.


milligrams… I’ll slam 1/4tsp or 1/2tsp before hard or hot/long workouts, whatever that weighs.

I’ll get this after hard days. I hop up from the couch and hop up the stairs and by the time I’m walking, I’m feeling light-headed. Wears off in a sec. Never worried about it.

I have it pretty severely. It is worse now than when I was younger. 46 now. I am also more fit now than in any time I can remember. I get it basically any time I go from squatting to standing. I am currently refinishing a front doorway and going low/high to follow the brush stroke is the worst. As is most outdoor yardwork.

Curiously, I almost never get it on the bike, or directly after. Nor do I get it when doing squats, burpees, yoga or other workout moves that simulate those movements. I also only get it very rarely from chair or bed to standing. But that low squat to standing move, which I tend to be in a lot it seems (formerly small kids, dogs, yardwork, house repairs), is the worst.

One doctor explained it has to do with the blood rushing to my lower legs once I come out of the squat. Normal nervous systems tell the body to restrict the vessels in order to keep from having the blood rush out of your brain too fast.

Stress, heat, humidity all seem to be factors for me.

I also have low blood pressure and Reynaud’s. I am pretty sure it is auto immune related.

Adding salt to my diet and drinking lots in order to try to ameliorate it helps a bit. I have been to an auto immune doctor. They wanted to put me on steroids to first get by BP up, then vasodialators for the Reynaud’s and Ortho. I didn’t yet want to go that route. The Ortho is annoying. The Reynaud’s is more life and mood impacting.

I’ve been experiencing same issues last couple of years. Symptoms also strongly correlate with fitness - the fitter I get the more often it happens to me. Since winter I’ve been doing similar core brace and leg muscles crimp practice when standing up and feeling light-headed. @simonicusfacilis Thanks for describing the procedure.

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Not really surprising . Your BP is elevated when you exercise and your legs are clenched. So the blood stays up.