The Effect of Orthostatic Training in the Prevention of Vasovagal Syncope and Its Influencing Factors

Abstract

SUMMARYRecently orthostatic training has been proposed as an effective treatment for vasovagal syncope, even though some patients may relapse. This study was undertaken to assess the effect of orthostatic training on patients with vasovagal syncope and its influencing factors.The study group comprised 125 consecutive patients (51 males and 74 females), aged 40 ± 19 years, with a history of syncope and a positive head-up tilt test. They were randomized into an orthostatic training group (64 patients) and a no treatment group (controls, 61 patients). The training programme consisted of daily 30-minute sessions of upright standing against a vertical wall 6 days a week for at least 4 weeks.After one year of follow-up, 45 (72.6%) of 62 orthostatic trained patients reported no syncopal recurrence, while only 22 of 61 controls (36.1%, P < 0.05) reported the same. Furthermore, in the training group, the patients with recurrence were older, and the number of syncopal spells in the preceding year was less than in the patients with no recurrence in the same group.Orthostatic training is an effective therapy for the prevention of vasovagal syncope. This kind of therapy was of greater benefit to patients who were younger or experienced frequent spells of syncope. (Int Heart J 2008; 49: 707-712)

2018 ESC Guidelines for the diagnosis and management of syncope

“…In highly motivated young patients with recurrent vasovagal symptoms triggered by orthostatic stress, the prescription of progressively prolonged periods of enforced upright posture (so-called tilt training) has been proposed to reduce syncope recurrence. 265 While some studies suggested modest benefit with outpatient tilt training, 266,267 most controlled trials reported no significant effect. [268][269][270][271][272] Moreover, this treatment is hampered by the low compliance of patients in continuing the training programme for a long period.…”

Medical Therapy and Physical Maneuvers in the Treatment of the Vasovagal Syncope and Orthostatic Hypotension

“…Many investigators therefore attempted outpatient orthostatic training (standing against a wall for 30 min, 1–2 times per day). The data for home training are mixed, with 1 Chinese trial suggesting a benefit 18 while multiple studies reported negative findings. 19–21 Home training is not costly and is relatively free of harm, but may suffer from limited compliance which might limit its efficacy.…”

Electrocardiography-Derived Predictors for Therapeutic Response to Treatment in Children with Postural Tachycardia Syndrome

“…It is believed that orthostatic training can reduce vascular compliance and cardiopulmonary sensor sensitivity, activate the autonomic nervous system, and reduce the accumulation of blood in the lower extremities while standing, thereby helping prevent or ameliorate the recurrence of OI symptoms. 36 Fu et al 37 and Shibata et al 38 have reported that a physical exercise regimen is superior to oral propranolol in improving the orthostatic hemodynamic condition and improving the quality of life for adolescents with POTS. Two experiments conducted in Chinese children, some of whom suffered from OI symptoms but not POTS, have suggested that skin rubbing could improve the clinical symptoms of OI and reduce the positive response to the HUT.…”