How to Climb with POTS

How to Climb with POTS

In this post we’ll cover all things climbing when it comes to POTS, such as tips for the approach, climbing, and belaying – whether you have POTS or you want to support your climbing partner who has POTS.

Disclaimer:  This article is not medical advice and I am not a doctor. Please talk to your doctor if you suspect you have POTS or if you have questions about treatment for your POTS. 

Jump to sections:

• How does POTS affect climbing?
• What is POTS?
• Helpful tips for climbing with POTS
• Helpful tips for belaying with POTS
• How to support a climbing partner with POTS
• Links to learn more

How does POTS affect climbing?

Imagine you’re hiking up to the crag. You feel lightheaded and overheated, and you start to get the feeling of presyncope (like you might pass out), so you tell your partner you need to sit down for a minute. You’re nauseated, sweating, out of breath, and have pain in your chest while your heart feels like it just did a somersault. Your head is pounding and it’s hard to think from the brain fog as you watch your hands shake uncontrollably. You take some deep breaths between sips of water and hope you don’t faint before you even get to go climbing. Once you get to the crag, standing in one spot to belay aggravates your dizziness, and your heart rate skyrockets while climbing.

Unfortunately, I’ve experienced that exact scenario countless times. To an outside observer, it may seem like the warning signs of a heart attack, or severe overexertion. To someone with POTS, that can just be a regular day of dealing with the consequences of trying to be active. I’m grateful that with the proper treatment, I rarely have such severe episodes now, but for many people with POTS, that is their daily battle. POTS can have a huge influence on climbing ability, safety, and enjoyment.

For a couple of years, my POTS affected me so much that I basically had to quit climbing. When I looked for resources on how to climb with POTS, I came up empty-handed. When I tried to find examples of pro climbers or elite paraclimbers with POTS, I couldn’t find any role models to guide the way. With a lot of trial and error, sweat, tears, and time, I have been able to return to climbing stronger than ever. Since developing POTS, I have achieved my hardest sport and trad redpoints and onsights, and gained the best climbing sponsorships of my career. It is difficult in many ways, but I want to share what I’ve learned so no other climbers with POTS feel like they need to reinvent the wheel. You’re not alone! POTS doesn’t have to mean the end of your climbing career.

I wrote about my journey with chronic illness, including how I was diagnosed with POTS and hEDS and the impact those have had on my climbing, at this link. I also spoke about it on the Deliberate Living podcast.

For this article, I got in touch with another climber/adventurer with POTS, Andrew Moreland. He said the hardest thing for him about being active outdoors with POTS is the worry that he’ll become a burden or endanger his group. “It’s also the anxiety of having to constantly monitor my symptoms, taking salt and ensuring I have all the water and nutrition I need,” Andrew added. “This becomes more difficult the further I go into the backcountry with limited resources, balancing the need to carry minimal gear/weight.”

What is POTS? 

POTS stands for Postural Orthostatic Tachycardia Syndrome (doesn’t exactly roll off the tongue, does it?). It’s a bit of a misnomer since it involves a lot more than just tachycardia from being upright. POTS is a form of dysautonomia, which is an umbrella term describing various malfunctions of the autonomic nervous system. Dysautonomia disrupts body processes that are supposed to be automatically regulated, such as blood pressure, heart rate, digestion, sleep, body temperature, and more. Because of this, the symptoms of POTS are wide-ranging and include many different systems in the body.

Common symptoms of POTS (adapted from this site):

• Increase in heart rate/tachycardia when standing or upright
• Lightheadedness
• Syncope (fainting)
• Heart palpitations
• Fatigue
• Headaches
• Exercise intolerance
• Insomnia/sleep disruption
• Nausea
• Brain fog or diminished concentration
• Tremulousness (shaking)
• Chest pain and shortness of breath
• ‘Coat-hanger’ pain in the neck and upper back
• Reddish-purple color in the legs from blood pooling or poor circulation
• Low blood pressure and/or low blood volume
• High levels of plasma norepinephrine while standing

Things that can exacerbate POTS symptoms:

• Warm or hot environments, such as showering or hot weather
• Prolonged standing
• Inadequate hydration and salt intake
• Exercise
• Being on your period
• Being on bed-rest/deconditioning
• Travel
• Drinking alcohol
• High altitude
• High stress levels
• Sleep deprivation
• Acute illness

Why people develop POTS is still being researched, but there are illnesses that can trigger it and risk factors that can make developing it more likely. POTS can start after viral illnesses (such as COVID), or surgery or trauma to the body. People with Ehlers Danlos Syndrome (EDS), mast cell activation (MCAS), certain autoimmune conditions, and other illnesses are predisposed to developing POTS as well.

There is no cure for POTS, and it can range from mild to completely debilitating. Treatment for POTS often includes very high salt/electrolyte intake, hydration with lots of fluids, compression garments, specific exercise programs, certain medications to regulate heart rate or blood pressure, managing sleep and stress levels, and more.

To learn more about POTS and dysautonomia, check out the resources from Dysautonomia International, the Cleveland Clinic, and John Hopkins Medicine.

Helpful tips for climbing with POTS

Managing POTS as a climber and athlete has been a challenge. There was a time when I was unsure if pushing myself in climbing was even possible because of the impact POTS has on my life and health. Thankfully, I’ve discovered strategies for both climbing and belaying to make it possible (and safe) for me and my climbing partners — and I hope these tactics can help others too.

Tips for climbing and hiking with POTS:

• Get plenty of sleep beforehand if possible. Sleep deprivation is one of my biggest symptom triggers, so being well-rested helps significantly.
• Stay hydrated and consume the amount of salt/electrolytes outlined in your treatment plan. 
  • Hydrating and loading up on electrolytes before, during, and after climbing can help keep lightheadedness more manageable. 
  • I personally aim for 4-5 liters of water a day, each with a TriOral Rehydration Salts packet (the electrolyte mix I have found most effective for me). On hot days, I will add in a liter or two of full-sugar Gatorade (don’t be afraid of sugar — it is crucial to proper sodium absorption in the gut).
  • Freezing bottles the night before can help your fluids stay cold if you have a long/hot day of climbing ahead.
• Bring easy-to-stomach foods and salty snacks to give you energy.
• Give yourself extra time for approaches, and take breaks while hiking as needed. If the approach is in the sun, try to get an early start. To cool off, sometimes I will dip a shirt in cold water (from a stream if available) and wear it over my shoulders/neck.
• Double check that you have any needed medications in your backpack (if applicable).
• Lie down between climbs to aid recovery.
• Wear compression if possible. Compression socks might be difficult to wear with climbing shoes, but compression leggings or abdominal binders can both help prevent blood pooling (and therefore dizziness).
• Remember to take deep breaths while climbing, and really use your rests! If there’s a big jug to hang on or a ledge to stand on, milk it! I will rest and shake out for a long time to wait for my heart rate to decrease. 
• If you have a heart rate monitor or Fitbit-style device, use that data to help guide your climbing session and inform rests between routes. I also have brought my portable blood pressure cuff/monitor to the crag before when I was dealing with big blood pressure swings from a medication I used to take.
• Select climbs to match your energy and symptom level. If you’re having a really symptomatic day, maybe opt for easier climbs rather than a hard project. Sometimes I have managed to climb hard even when symptomatic, so do what feels right for you in the moment. Do what you can, and be gracious with yourself and your performance. Self compassion has been essential in managing my chronic illness and athletic performance. 
• Communicate with your partner or group. When they understand your struggles, they can help you more. This also gives me less anxiety about needing to go slow on approaches, having to lie down at the crag, etc.

When I asked Andrew for his best tips, he agreed with the above about salt, water, sleep, etc, and added, “Consistent cardio throughout the week seems to help reduce the severity of my symptoms (even a small amount per day).” He also mentioned that consistently eating healthy foods throughout the day has been a huge help with his POTS.

Tips for belaying with POTS:

• To keep blood from pooling, cross your legs, shift your weight back and forth, do calf raises, and squat down and stand back up frequently. 
  • Moving around in these ways while belaying keeps blood pumping up to the heart and brain, which helps with the lightheadedness/fainting from standing in one place.
• Use an assisted braking device. Having a GriGri makes me feel a lot better in case I’m worried about fainting while belaying (worst case scenario that thankfully has never happened, but it’s good to be prepared).
• Sit if it’s safe to do so. I’ll usually sit while top rope belaying, but not while lead belaying.
• Wear belay glasses. They help a lot with ‘coat-hanger’ pain and dizziness from looking up.
• Wear compression socks while belaying and hiking. You can take them off for climbing if needed, or leave them on if your shoes still fit with them. I usually just wear compression leggings since I can hike, climb, and belay in them the entire time.
• If it’s hot, try to belay in the shade, or choose climbs that are shady at least at the base.
• Lean against a rock or tree if available.
• If you’re on a multi-pitch climb, try to plan the pitches so that you can avoid hanging belays if possible. Belaying from a ledge is much easier with POTS so you can move around, prevent blood pooling in the legs, etc. I’ve found that linking pitches is great for me so I can be moving continuously as much as possible. 
• Communicate with your partner and make a plan. 
  • If I am feeling really lightheaded, I won’t belay at all just to be safe. 
  • If I feel ok to belay but am worried about it getting worse, I’ll tell my partner that if I reach a certain point of dizziness, I will tell them to take, and lower them off the climb before it gets too bad. 
  • Check in with yourself and use your best judgment for your skill level.

How to support a climbing partner with POTS

If you have a climbing partner with POTS, hopefully they feel comfortable communicating with you about their symptoms, the challenges they face in climbing, and what you can do to help them. Asking relevant questions, being understanding and patient, and educating yourself on POTS is a great start. 

In my experience, (and Andrew’s) some of the best things partners have done for me to help my POTS are:

• Offer to belay if there is a group so the climber with POTS can focus on their own climbing (rather than aggravating symptoms from belaying).
• Offer to carry more of the weight on the approach. Sometimes the hike is harder than the climbing for me because of the heart rate and body temperature issues (not to mention the joint pain I have from hEDS)!
• Remind them to drink plenty of water and electrolytes, and stay fueled with snacks.
• Point out good spots to rest on the climb, or shady spots to cool off.
• If they are frustrated with their symptoms, try to be understanding and remind them that it’s normal for performance to fluctuate depending on how their body feels.
• Check in with them and communicate to make sure they are comfortable.

I also asked Andrew what he wished he’d known about POTS from the start. He said, “Even with POTS you can still get out and do hard things. With the right nutrition, hydration, salt supplements, and daily habits in life you can overcome things that seem impossible. When I first started having symptoms I thought I would never be able to get back into the outdoors. I didn’t think that I’d ever be able to do the things I used to do. It was heartbreaking and scary. Ironically it was a huge catalyst for change and has made me more grateful for the strengths I do possess.”

If you have any tips that have helped you as a climber with POTS that aren’t listed here, or have any questions about climbing with chronic illness, please comment and/or message me on Instagram @fallonclimbs

Links to Learn and Support More

• Dysautonomia International
• The Cleveland Clinic
• John Hopkins Medicine
• Fallon’s Piece on climbing with Chronic Illness at Medium.com
• Fallon Interviewed on Deliberate Living podcast
• Fallon’s Interview on the Enormocast