Orthostatic Intolerance (OI) impacts patients’ ability to perform activities of daily living (ADLs) often leading to symptom exacerbation and significant deconditioning over time. Exercise aids symptom control by increasing cardiac output and venous return. Creating and maintaining an exercise routine often requires additional supports.
A 15-year-old female was referred for a 6-month history of postural dizziness and presyncope. At the initial clinic visit, orthostatic testing was completed which showed a 27-bpm increase in heart rate. Baseline ECG showed sinus rhythm with normal intervals and review of systems was unremarkable. Patient history, symptoms and testing were noted to be consistent with OI. Initial interventions included general exercise resources and education materials, such as a daily aerobic walking plan (begin with 5-minute duration and increase by 5 minutes/week until 60 minutes total is achieved per day). Quarterly to bi-yearly clinic follow-ups showed no improvement in symptoms, despite reinforcing exercise recommendations and education at each visit. Follow up repeat testing, predicted aerobic capacity assessment, muscular endurance assessment, and surveys were completed. Exercise physiologist (ExP) initiated telehealth exercise sessions.
Prior to intervention, patient physical activity consisted of walking at work. ExP conducted eleven telehealth exercise sessions over a 3-month period (30 min duration, 2 times/week). Sessions included education on form, safety, exercise components, & intensity progression. Resistance exercises were completed with real-time supervision and feedback. Following completion of the telehealth program, testing showed decrease in symptom severity (-110%), increase in predicted aerobic capacity (+28%), maintenance of lower extremity muscular endurance (-6%), decrease in fatigue (-62%), and maintenance of mobility (-27%). One month post completion of telehealth intervention patient remained adherent to exercise prescription of aerobic exercise (2 times/week) & strength training (2 times/week).
Early clinic education emphasized the importance of exercise for this patient; however, neither education nor clinic resources resulted in adherence to an exercise routine. Virtually delivering high quantity, synchronized exercise sessions, allowed the patient to experience improvement in functional capacity and reduction in symptom intensity. Virtual delivery of exercise medicine sessions can be applied to multiple clinical conditions and wider delivery to varied patient populations should be explored.