I am not sure how I do it to be honest. It took me a long time to get me to this level of working out. Because a year ago I all skin and bones and looked terrible, I could barely stand for more than a minute without going into a spell. If you told me to go exercise I would have said you are crazy and can go jump off a bridge. I tried and it took everything I had, I would push myself too hard (which I probably still do) because I've been an competitive athlete playing soccer year round ever since I was 10 up until college. That is what kills me about being in the gym I know what I used to be able to do and now that I can't its awful. I am still coming to terms with having POTS and how it plays a role into what I can and can't do and how I have to modify what I want to do....But when I would wind up in the hopsital with severe migranes, dehydration, nausea, vomiting, my hr and bp would be going nuts. But then I found a doctor who understood POTS and started getting on a game plan and got in to see Vanderbilt Universitys Automonic Dysfunction Clinic. Both my Dr. and Vanderbilt work together which is really nice. and they said that my job was to try and get in an exercise program (I just graduated from college in May and got married too! but since the economy was so bad and my husbands job had us moving to a different city for only 6 months I couldnt find a job and really didn't have the energy and ability to have a fulltime job at that point so thus the exercise plan started) it was slow at first, really slow. I would walk and watch tv. which helped distract me from what was going on with my heart and kept me calm. I've felt really great the past several months besides general symptoms that linger everyday that are annoying but the past few weeks my symptoms have picked back up more severely with fatigue, heart racing, numbness in fingers and feet, lightheadness, a feeling of drunkness, and my joints feel like they need some wd-40. so doctor has me wearing a heart monitor for 30 days to check things out. but i am continuing to workout because the dr says the progress made so far has been good and he'd hate for it to be lost, as would i! all that money invested in a gym and trainer! but also its worth those 30/45 mins of feeling on top of the world afterward. someone posted in a different thread about how saline IVs made them feel awesome, I feel the same way after my work out, it could be all the powerade i am guzzling down! How does everyone cope with ups and downs of POTS? I find so overwhelming