Why Exercise Often Makes POTS or MCAS Symptoms Worse in EDS
If you live with Ehlers-Danlos Syndrome (EDS) or hypermobility, you may recognise this pattern:
You try to exercise in a “gentle” or graded way.
One session feels okay.
The next leaves you dizzy, exhausted, flared, or unwell for days.
You’ve been told:
“Just keep moving”
“Your fitness will build over time”
“It’s deconditioning”
“You just need to be consistent”
But for many people with EDS, especially those with POTS, dysautonomia, or MCAS-type symptoms, movement intolerance isn’t a willpower issue.
It’s a systems-level load problem.
The Overlap Between EDS, POTS and MCAS
People with EDS frequently experience overlapping conditions, including:
POTS (Postural Orthostatic Tachycardia Syndrome)
dysautonomia
mast cell activation syndrome (MCAS)
chronic fatigue and exercise intolerance
While these conditions are different, they often coexist because connective tissue, circulation, and nervous system regulation are closely linked.
When one part of the system struggles to manage stress, symptoms can cascade.
What Is POTS — and Why Exercise Can Trigger Symptoms
POTS is characterised by difficulty regulating heart rate and blood pressure when upright.
Common POTS symptoms include:
dizziness or light-headedness
rapid heart rate
chest pressure
breathlessness
fatigue
poor heat tolerance
symptom worsening after exercise
In EDS, exercise can worsen these symptoms when movement increases circulatory demand without sufficient mechanical support.
If force is leaking through joints and posture, the autonomic system has to compensate — raising heart rate, breathing demand, and stress output.
This makes even low-intensity exercise feel overwhelming.
MCAS and Movement Intolerance
Mast cell activation syndrome (MCAS) involves inappropriate or exaggerated inflammatory responses.
Common mast cell activation symptoms include:
flushing
fatigue
headaches
gastrointestinal upset
“flare” responses to stress or exertion
In people with EDS, poorly tolerated movement can act as a mechanical stressor, triggering downstream immune or inflammatory responses.
This is why some individuals feel worse after:
repetitive exercise
long periods of standing
poorly coordinated strength training
breath-holding or bracing strategies
It’s not that movement is harmful — it’s that how movement is organised matters.
Why “Gentle Exercise” Still Isn’t Always Appropriate
Gentle does not automatically mean low stress.
When mechanics are inefficient:
even low loads accumulate irritation
repetition compounds instability
the nervous and autonomic systems stay on high alert
recovery capacity is exceeded quietly, then suddenly
Many people with EDS report that:
symptoms don’t appear during exercise
they flare hours or days later
tolerance feels unpredictable
This delayed response is a hallmark of system overload, not failure.
Movement, Mechanics and Autonomic Load
Movement intolerance in EDS is often driven by a combination of:
inefficient gait mechanics
poor postural organisation
excessive muscular guarding
altered breathing strategies
unstable load transfer through the pelvis and trunk
When these factors are present, the body must work much harder to produce the same movement.
That extra cost shows up as:
fatigue
dizziness
breathlessness
shutdown or flares
This is why improving mechanical efficiency often reduces physiological stress, even without increasing fitness.
Rebuilding Tolerance Without Crashes
For people with EDS, POTS or MCAS-type symptoms, progress depends on:
sequencing before strengthening
coordination before repetition
gait before conditioning
tolerance before intensity
Effective progression should:
avoid forced stretching
avoid maximal effort early
build capacity gradually
prioritise consistency over volume
respect recovery signals
The goal isn’t pushing through — it’s expanding what the system can tolerate without backlash.
Where Assessment Fits In
Because symptoms overlap and vary day-to-day, generic exercise advice often misses the mark.
A biomechanical assessment looks at:
posture and load distribution
walking mechanics
breathing patterns
balance strategies
how stress accumulates across the system
This allows movement support to be tailored — rather than guessed.
➡️ If you want to understand how this applies to you, our EDS & Hypermobility Support assessment focuses on mechanics, tolerance, and safety — not pushing symptoms.