Orthostatic Heart Rate Test
The Orthostatic Heart Rate Test is the difference between Resting Heart Rate taken when lying down and Heart Rate when standing (the Orthostatic Heart Rate.) The test measures how the heart responds to the added stress of standing up, which requires the heart to pump against gravity. The Orthostatic Heart Rate is sometimes considered a Symptom of Overtraining Syndrome.
Performing the Orthostatic Heart Rate Test
There are wide variations[1] in the details of how to perform this test, so the following is based on a research study that compared different approaches to determine the optimal solution[2].
- For monitoring Overtraining Syndrome, the test should be performed in the same way and under the same conditions each day.
- This test is normally performed on waking in the morning. If performed at other times, avoid things that change Heart Rate such as exercise, stress or Caffeine before the test.
- Taking the Heart Rate reading should be done in such a way that it requires no effort on the part of the subject. A Heart Rate Monitor is ideal, and a Pulse Oximeter works well.
- The Resting Heart Rate should be taken after lying down for at least 5 minutes, preferably 10 minutes[2]. Lying down for longer is not required, but it is also not a problem.
- Stand up gently and remain still for 2 minutes before taking a second Heart Rate reading[2].
- The difference between the two readings is the Orthostatic Heart Rate.
What does the Orthostatic Heart Rate Test detect?
A high Orthostatic Heart Rate has been suggested as a symptom of Overtraining Syndrome, but it can also be caused by a viral infection, diabetes mellitus, as well as autoimmune and neurodegenerative disorders [3]. There seems to be little evidence to support the Orthostatic Heart Rate Test as a reliable method of predicting or detecting Overtraining Syndrome. However, this test is generally easy to perform and may be useful when considered as one possible indicator that can be factored in.
What does the number mean?
An Orthostatic Heart Rate rise of 30 BPM or more can be a sign of Postural Orthostatic Tachycardia Syndrome (see below) and would indicate that a medical evaluation is appropriate. It has been suggested that an Orthostatic Heart Rate rise of 10-15 BPM is 'normal'. For monitoring training, what matters is a change from your own baseline, which makes it tough to use this test for suspected Overtraining Syndrome unless there is a history of measurement that can be used for comparison. There is no validated threshold for how large a change indicates overtraining.
Use in Elite Sport
Measuring heart rate and Heart Rate Variability lying down and then standing is standard practice in some elite programs, particularly in Nordic skiing. In French national-team Nordic skiers followed for four years, fatigue came with higher heart rate, lower HRV and much more scattered HRV[4], and the lying and standing measurements have been used to sort fatigue into different patterns[5]. Standing measurements may also help where resting HRV is "saturated" in very fit athletes[6]. However, I'm not aware of any trial showing that orthostatic testing improves training decisions. See Training Readiness for other ways of judging readiness.
Postural Orthostatic Tachycardia Syndrome
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition in which people have problems such as lightheadedness or fainting when upright. A recent review gives the diagnostic criteria as a sustained heart rate increase of at least 30 BPM (or at least 40 BPM in those aged 12–19) within 10 minutes of standing, without a significant drop in blood pressure, and with symptoms lasting at least 3 months[7]. A large rise on an orthostatic test is therefore a reason to see a doctor, not a diagnosis.
Polar Orthostatic Test
Some Polar watches (Grit X Pro, Vantage V2 and Street X) include an Orthostatic Test[8]. It takes 4 minutes: 2 minutes lying or seated, then 2 minutes standing. It reports resting and standing heart rate, the peak heart rate after standing, and resting and standing HRV (RMSSD). After at least four tests in 28 days, the latest result is compared with your own normal range. Polar describes the test as a tool for monitoring the balance between training and recovery, but there is no evidence that it predicts or detects Overtraining Syndrome.
References
- ↑ Medscape Log In http://www.medscape.com/viewarticle/474822_2
- ↑ 2.0 2.1 2.2 Comparison of different methods of obtaining o... [Clin Nurs Res. 2000] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/11881701
- ↑ Orthostatic heart rate and blood pressure in ... [J Child Neurol. 2010] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/20197269
- ↑ Schmitt L, Regnard J, Desmarets M, Mauny F, Mourot L, Fouillot JP, Coulmy N, Millet G. Fatigue shifts and scatters heart rate variability in elite endurance athletes. PLoS One, 2013, 8(8):e71588. doi:10.1371/journal.pone.0071588
- ↑ Schmitt L, Regnard J, Parmentier A, Mauny F, Mourot L, Coulmy N, Millet G. Typology of "fatigue" by heart rate variability analysis in elite Nordic-skiers. International Journal of Sports Medicine, 2015, 36(12):999–1007. doi:10.1055/s-0035-1548885
- ↑ Plews D. The practical application of heart rate variability: monitoring training adaptation in world class athletes. PhD thesis, Auckland University of Technology, 2014. Link
- ↑ Raj SR, Fedorowski A, Sheldon RS. Diagnosis and management of postural orthostatic tachycardia syndrome. Canadian Medical Association Journal, 2022, 194(10):E378–E385. doi:10.1503/cmaj.211373
- ↑ Polar. Orthostatic test with Grit X Pro/Street X/Vantage V2. Polar Support (accessed 29 October 2026). Link (Commercial product.)
