Home Testing for POTS: The Poor Man’s Tilt Table and NASA Lean Test

If you're dealing with unexplained fatigue, dizziness upon standing, or brain fog, you may have come across Postural Orthostatic Tachycardia Syndrome (POTS). This condition, part of a group of disorders under orthostatic intolerance (OI), is notoriously difficult to diagnose. Patients often wait years to receive an official diagnosis. Fortunately, there are two tests that can help individuals gather information at home: The Poor Man’s Tilt Table Test and the 10-Minute NASA Lean Test.

These tests measure how your heart rate and blood pressure respond to standing from a lying or seated position. They can assist your physician in diagnosing POTS, ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome), orthostatic hypotension (OH), and long COVID. These should not be performed alone. People with POTS are at risk of fainting. These tests should only be done with a medical professional’s guidance and at least one person physically present. If you feel like you’re going to pass out during the test, stop immediately.
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The Poor Man’s Tilt Table Test

The Tilt Table Test is the gold standard for diagnosing POTS, typically conducted in a clinical setting. However, due to limited accessibility, the Poor Man’s Tilt Table Test provides an alternative you can perform at home to gather valuable data for your doctor.

How to perform the Poor Man’s Tilt Table Test:

1. Lie down for 5–10 minutes. Stay still and relax.
2. Record your heart rate using a heart rate monitor.
3. Stand up slowly. Continue standing for 5–10 minutes if you can.
4. Record your heart rate at 5-minute intervals.
5. Stop if you feel faint.

If your heart rate increases by 30 beats per minute (bpm) or more upon standing, it may suggest POTS. For younger individuals (ages 12–19), a heart rate increase of 40 bpm is the diagnostic threshold​ .
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The 10-Minute NASA Lean Test

The 10-Minute NASA Lean Test was originally developed by NASA to monitor circulatory responses in astronauts. This test, now adapted for clinical use, is effective for diagnosing POTS, orthostatic hypotension, and orthostatic intolerance in patients with conditions like ME/CFS and long COVID​.

How to perform the 10-Minute NASA Lean Test:

1. Lie down for 10 minutes to establish a baseline.
2. Stand up with your heels 6-8 inches from the wall, keeping your shoulders against the wall.
3. Measure your heart rate and blood pressure at 1-minute intervals for 10 minutes.
4. Symptoms like dizziness, palpitations, or lightheadedness during the test may indicate orthostatic intolerance or POTS.

Studies show that the 10-Minute NASA Lean Test can effectively diagnose orthostatic intolerance, especially in long COVID patients. Research from the LOCOMOTION Consortium found that more than 50% of long COVID patients experienced orthostatic symptoms during the test, with 15% meeting the criteria for POTS and others showing evidence of orthostatic hypotension​ .
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What Do These Tests Measure?

Both the Poor Man’s Tilt Table Test and the 10-Minute NASA Lean Test assess your body’s response to postural changes. In a healthy individual, standing causes gravity to pull blood into the legs. The body compensates by constricting blood vessels and increasing heart rate slightly. In patients with POTS, ME/CFS, or orthostatic intolerance, the body’s response is abnormal, leading to exaggerated symptoms such as dizziness, fatigue, and brain fog​​ .
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Who Benefits from These Tests?

These tests are particularly useful for individuals experiencing symptoms related to the following conditions:

1. Postural Orthostatic Tachycardia Syndrome (POTS): Characterized by a significant increase in heart rate upon standing without a corresponding drop in blood pressure. Both tests are useful for identifying POTS in individuals with unexplained dizziness and rapid heartbeat​​.
2. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): People with ME/CFS often experience orthostatic intolerance. The 10-Minute NASA Lean Test has proven effective in identifying OI in these patients, with research showing nearly 40% of ME/CFS patients exhibiting POTS-like symptoms​ .
3. Orthostatic Hypotension (OH): In patients with OH, blood pressure drops significantly upon standing, leading to dizziness and fainting. The 10-Minute NASA Lean Test can detect this drop​.
4. Orthostatic Intolerance (OI): This condition encompasses various forms of autonomic dysfunction, where patients struggle to maintain adequate blood flow to the brain when standing. Both tests help assess the severity of orthostatic intolerance​​.
5. Long COVID: Many long COVID patients report symptoms of POTS and OI. Studies show that the NASA Lean Test can identify POTS and orthostatic hypotension in long COVID patients, with significant diagnostic accuracy​.

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Why is the 10-Minute NASA Lean Test preferred over the Tilt Table Test?

The 10-Minute NASA Lean Test has gained importance as a simple, effective tool for diagnosing orthostatic intolerance (OI) in conditions like POTS, ME/CFS, and long COVID. But with more advanced tests like the Tilt Table Test available, why does the NASA Lean Test stand out?

One of the key reasons is accessibility. The Tilt Table Test, while considered the gold standard, requires specialized equipment that is often unavailable in many medical settings. The NASA Lean Test, on the other hand, can be conducted in primary care clinics with just a few simple tools: a pulse oximeter, a blood pressure cuff, and an exam table. This makes it far more feasible to perform in routine clinical settings, allowing healthcare providers to easily assess orthostatic intolerance symptoms​.

Researchers at the Bateman Horne Center, along with teams from the University of Utah and Columbia University, have validated the effectiveness of this test through several studies. They found that the NASA Lean Test helps to identify abnormal circulatory responses triggered by standing, such as fatigue, brain fog, weakness, and palpitations. These symptoms are common in people with ME/CFS and long COVID​​.

A study involving 150 ME/CFS patients and 75 healthy controls showed that even when heart rate and blood pressure didn’t dramatically change, those with ME/CFS experienced reduced blood flow to the brain when standing. The most telling indicator was a drop in pulse pressure (PP)—the difference between systolic and diastolic blood pressure. When PP falls below 25% of systolic blood pressure, it signals severe circulatory issues​.

In subsequent research, the NASA Lean Test was used with patients who had long COVID. Results showed that these patients, especially those ill for less than two years, experienced even greater abnormalities in circulatory function during the test, including cognitive decline due to orthostatic stress​.

The simplicity of the NASA Lean Test empowers primary care providers to diagnose and manage orthostatic intolerance without needing high-tech tools. This is crucial for conditions like ME/CFS and long COVID, where OI can be a significant part of the illness and proper diagnosis is key to treatment​.

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Definitions of Relevant Conditions

1. Postural Orthostatic Tachycardia Syndrome (POTS): A disorder where the heart rate increases by at least 30 bpm within 10 minutes of standing without a significant drop in blood pressure, leading to dizziness, fatigue, and fainting. Many experts disagree on the exact definition of POTS, but this is common for many conditions. Disagreement on criteria is largely driven by research priorities rather than patient wellbeing.
2. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A complex, long-term illness characterized by extreme fatigue, brain fog, and orthostatic intolerance. Many ME/CFS patients exhibit symptoms of POTS.
3. Orthostatic Hypotension (OH): A condition where blood pressure drops by at least 20 mmHg systolic or 10 mmHg diastolic upon standing, causing dizziness and fainting.
4. Orthostatic Intolerance (OI): An umbrella term for disorders that make it difficult to stand due to abnormal blood flow to the brain. POTS and OH are specific forms of OI.
5. Long COVID: A condition where COVID-19 symptoms persist for weeks or months after the acute infection has resolved. Many long COVID patients experience POTS or other forms of orthostatic intolerance​ .
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Conclusion: A Helpful First Step

While the Poor Man’s Tilt Table Test and the 10-Minute NASA Lean Test are helpful tools for assessing POTS, ME/CFS, orthostatic hypotension, orthostatic intolerance, and long COVID, they are not a substitute for professional diagnosis. These tests provide useful data for your doctor but should be followed up with formal medical evaluation and treatment.

Disclaimer:
This article is strictly for informational purposes and does not provide medical advice, diagnosis, or treatment. It is not a substitute for professional medical advice. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition. Never disregard professional advice or delay in seeking it due to something you read here.

References

1. Bateman, Lucinda. "Why the 10-Minute NASA Lean Test?" Bateman Horne Center, 5 July 2022, batemanhornecenter.org/why-the-10-minute-nasa-lean-test/.
2. Lee, Jihyun, et al. "Hemodynamics during the 10-minute NASA Lean Test: Evidence of Circulatory Decompensation in a Subset of ME/CFS Patients." Journal of Translational Medicine, vol. 18, no. 1, 2020, p. 314. Springer Nature, doi:10.1186/s12967-020-02481-y.
3. Lee, Jihyun, et al. "Prevalence of Orthostatic Intolerance in Long COVID Clinic Patients and Healthy Controls." Journal of Medical Virology, vol. 96, no. 1, 2024, pp. 17-24. Wiley Online Library, doi:10.1002/jmv.28199.
4. Vernon, Suzanne D., et al. "Clinically Accessible Tools for Documenting the Impact of Orthostatic Intolerance on Symptoms and Function in ME/CFS." Work, vol. 66, no. 2, 2020, pp. 257-263. IOS Press, doi:10.3233/WOR-203169.
5. Bateman, Lucinda, et al. "Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting." Bateman Horne Center, 2024.
6. Isaac, Robert O., Joanna Corrado, and Manoj Sivan. "Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting." International Journal of Environmental Research and Public Health, vol. 20, no. 5804, 2023, pp. 1-10. doi:10.3390/ijerph20105804.
7. Bateman Horne Center. "10-Minute NASA Lean Test (a Standardized Passive Stand Test): Clinician Instructions." Bateman Horne Center, 2022.
8. University Hospitals Coventry and Warwickshire NHS Trust. "How to Complete a NASA Lean Test for Post-COVID Syndrome." Patient Information, 2022.
9. Sivan, Manoj, et al. "Prevalence of Dysautonomia in Long COVID Patients and Detection through the NASA Lean Test." Frontiers in Medicine, vol. 9, 2022, pp. 1-15. doi:10.3389/fmed.2022.917019.

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