Objective:

We describe a single-center experience with novel exercise-centered shared medical appointments (SMAs) for symptom management in Postural Orthostatic Tachycardia Syndrome (POTS). 

Background:

POTS is a chronic condition featuring diverse comorbidities, complicated by frequently inconsistent medication response. SMAs have gained recent popularity in the management of many chronic diseases as a platform for providers to deliver care to a group of patients at once, increasing efficiency and offering a sense of patient-patient community. Exercise can improve symptom control in POTS; it is unknown whether SMAs are an effective avenue for exercise-focused education. 

Design/Methods:

All patients with POTS seen at the Cleveland Clinic between 2022 and 2025 were recommended to participate in the exercise-centered SMA. The SMA provided exercise recommendations and templates specific to POTS, with an emphasis on strategies to overcome symptom barriers to physical activity. The Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire was used to assess symptom burden before and after the SMA; lower scores equal less symptom burden. Paired t-tests were used to compare COMPASS-31 scores between collected timepoints.

Results:

Of 376 patients who attended an SMA, 106 completed the COMPASS-31 before and after their session, with 76 of these patients completing an additional COMPASS-31 at six-month follow-up. COMPASS-31 scores were significantly improved following the SMA (mean decrease of -4.04 +/- 11.49 from baseline, p = 0.0005), and improvement persisted at six months (mean decrease of -7.00 +/- 13.19 from baseline, p < 0.0001). Patients who attended more than one SMA did not demonstrate different COMPASS-31 scores from patients who attended only one SMA.

Conclusions:

The exercise-centered SMA allows providers to efficiently provide exercise counseling to multiple patients at once. Early analysis suggests patients report lower autonomic symptom burden following SMA-provided exercise counseling; additional study is needed to determine which patients will benefit most from this intervention.