What lifestyle modifications and non-pharmacological treatments should I consider for managing POTS in primary care?

Lifestyle modifications and non-pharmacological treatments for managing postural orthostatic tachycardia syndrome (POTS) in primary care include:

• Education and reassurance: Explain the mechanisms causing orthostatic intolerance and POTS symptoms to the patient to improve understanding and self-management.
• Physical activity management: Encourage incorporation of physical activity that maintains joint and muscle flexibility without worsening symptoms, undertaken within the patient's energy limits to avoid post-exertional malaise.
• Activity modification: Advise patients to avoid triggers that worsen symptoms, such as prolonged standing or rapid posture changes, and to pace activities to prevent symptom exacerbation.
• Hydration and salt intake: Although not explicitly detailed in the provided context, standard practice includes advising increased fluid and salt intake to support blood volume, which can be considered in primary care management.
• Symptom monitoring: Encourage patients to keep a record of symptoms, triggers, and activities to help identify and avoid exacerbating factors.
• Referral and safety advice: Provide advice on safety, including driving restrictions if symptoms cause syncope or near-syncope, and refer to specialist care if symptoms are severe or diagnosis is uncertain.

These approaches aim to support independence and improve quality of life by managing symptoms through lifestyle and behavioural strategies in primary care settings NICE NG206,NICE CG109.