Experiences of individually tailored physical exercise in COVID-19-induced postural orthostatic tachycardia syndrome: A qualitative content analysis

Background Postural Orthostatic Tachycardia Syndrome (POTS) is a phenotype of post-COVID-19 Condition (PCC), characterised by orthostatic intolerance and a range of debilitating symptoms. Exercise is a frequently implemented intervention in the treatment of POTS and PCC. However, patients’ experiences with exercise as a therapeutic modality remain largely unexplored. This study aimed to explore the experiences of individuals diagnosed with PCC and POTS who underwent an individually tailored physical exercise intervention. Methods A qualitative study design with an inductive approach was applied. Twenty-three participants who completed a feasibility study, involving semi-supervised tailored exercise, were recruited for individual interviews. Data were collected using a semi-structured interview guide and analysed through qualitative content analysis. Results Five main categories emerged, underscoring the importance of individualised design of exercise programs, flexible modalities, and continuous support from physiotherapists with expertise in PCC and POTS. Participants experienced improvements in physical, mental, and social functioning, although setbacks and symptom fluctuation were common. Strategies for energy management, alongside informal and formal support, were identified as facilitators and reduced barriers to exercise as a treatment. Psychological dimensions, including hope, motivation, goal setting, emotional adaptation, acceptance, and coping strategies, were central to participants’ experiences. The combination of the intervention structure, therapeutic support, and effective strategies was perceived as contributing to the intervention’s effectiveness, and many participants viewed exercise as a key pathway to recovery. Conclusions This study highlights the need for a flexible and individualised rehabilitation approach in COVID-19-induced POTS. Moreover, exercise should be closely monitored by a physiotherapist with condition-specific expertise, who not only adapts the exercise to symptom fluctuations but also addresses diverse psychosocial needs and individual resources. The participants’ experiences indicate that a holistic, multidisciplinary, and person-centred rehabilitation model may support recovery and contribute to improved long-term wellbeing in individuals with PCC and POTS.