Did you know that you can use an Apple Watch to conduct one part of a “poor man’s tilt table test” at home?

A “Poor Man’s (DIY) Tilt Table Test”, clinically known as orthostatic vital signs, is a quick and easy test to track your heart rate’s response when moving from a lying to a standing position. Your body’s response to positional changes can be a key indicator of postural orthostatic tachycardia syndrome (POTS) or orthostatic hypotension. To complete the test in its entirety, you would also require a blood pressure cuff to check how your blood pressure reacts to the same position changes. But a modified version of the test can be done just by using your Apple Watch. The “Poor Man’s Tilt Table test” is sometimes called an Active Stand Test.

As mentioned in our previous post on tilt table testing for POTS, most people do not need a tilt table test to obtain or confirm a diagnosis of POTS. Tilt table testing can sometimes be helpful in cases where POTS is suspected, but orthostatic vital signs are normal.

Tilt Table Test vs Poor Man’s Tilt Table Test

For people who are dealing with symptoms of orthostatic intolerance (feeling unwell with standing up or prolonged standing), there are a few different benefits to performing the “Poor Man’s Tilt Table Test” (Active Stand Test) instead of a tilt table test:

• Orthostatic vital signs can be sufficient to obtain a diagnosis
• Tilt table tests can cost up to $2000
• Obtaining a tilt table test typically requires a lot of coordination and an available clinician to administer the test

Here we’ll provide you with some tips for how you can assess your heart rate’s response to positional changes with your Apple Watch from the comfort of your home.

What is POTS?

For those unfamiliar with postural orthostatic tachycardia syndrome (POTS), it is defined in part by a sustained increase in heart rate when a person changes position from lying/sitting to standing, accompanied by symptoms that may include:

• Dizziness or lightheadedness
• Heart palpitations
• Weakness
• Fatigue

POTS itself is not a disease, but rather a syndrome, which means that it is a presentation of different symptoms that tend to cluster together. For some people, these symptoms have an underlying cause that can be identified, such as anemia or thyroid dysfunction. In other cases, these symptoms are most likely provoked by a combination of genetic and environmental factors. Unfortunately, there is a lot that remains unknown about the exact mechanisms that lead to this experience.

Setting Up Your Apple Watch for an Active Stand Test

Before you begin your DIY tilt table test, it’s important to ensure that your Apple Watch is correctly set up to provide accurate heart rate data. Here’s how to prepare:

1. Check Your Watch’s Fit

   • Proper fit: Ensure your Apple Watch is snug but comfortable on your wrist. A secure fit ensures more accurate heart rate readings.

2. Get Familiar with Heart Rate Tracking

   • View Heart Rate Data: Open the Heart Rate app directly on your Apple Watch to access real-time heart rate information during the test.

3. (Optional) Accessing Health Data on iPhone:

   • Health App Overview: While the Apple Watch automatically tracks your heart rate in the background, you can view historical heart rate data on your iPhone by opening the Health app and navigating to the Heart section to review your heart rate trends and other related metrics.

Tutorial to the DIY Tilt Table Test on Apple Watch

Once your apple watch is fit snuggly and you are familiar with its heart rate tracking app, the DIY tilt table test is straightforward and takes just a few minutes to complete. The following tips can help you complete a version of orthostatic vital signs, though it’s important to keep in mind that the formal testing also requires checking blood pressure:

Step 1: Record Your Resting Heart Rate

1. Lie Down for a Few Minutes: Find a quiet, comfortable place where you can lie down undisturbed like a bed or a couch
2. Check Your Resting Heart Rate: After five or so minutes, open the Heart Rate app on your Apple Watch or check your recent resting heart rate through the Health app on your phone.
3. Record the Resting Rate: Make a mental note or jot down the starting heart rate for reference.

Step 2: Stand Up Slowly

1. Move to a Standing Position: Stand up calmly, avoiding any sudden or fast movement that could artificially spike your heart rate.
2. Wait a Moment: Stand still, allowing your body a moment to adjust.

Step 3: Record the Heart Rate After Standing

1. Measure Immediate Response: Open the Heart Rate app again to view your heart rate right after standing. Note this initial reading.
2. Track Your Heart Rate at Intervals: Check and record your heart rate after 1 minute, 2 minutes, 5 minutes, and 10 minutes of standing to observe any sustained changes.
3. Identify Significant Spikes: According to general POTS criteria, a rise of 30 bpm or more from from rest to standing within 10 minutes may suggest POTS, though this DIY test is not a definitive diagnosis.

Step 4: Compare starting and standing heart rates

Take a look at your starting and standing heart rates:

• Normal response: A slight increase (usually less than 20 bpm) when standing is normal.
• More investigation is recommended: A sustained increase of 30 bpm or more that is accompanied by symptoms warrants a more formal evaluation with the guidance of a healthcare provider.

A POTS diagnosis requires a sustained heart rate increase of 30bpm or more

After completing your DIY tilt table test, it’s important to consider what your results mean and what to do with the data. As we mentioned previously, this test can help with diagnosis only when it is done in its entirety (checking both heart rate and blood pressure at the appropriate intervals).

For people who complete the heart rate testing only, if you notice sustained or prolonged increases in heart rate of more than 30 beats per minute when moving from rest to a standing position, we recommend that you discuss your results with a healthcare provider. Your doctor can help offer guidance for any next steps that may be important to receive a comprehensive and accurate evaluation.

How to book an appointment with a POTS specialist

At Empirical Health, you can take your health monitoring to the next level. Our app not only facilitates detailed heart rate tracking, but also provides access to board-certified doctors who can help answer questions about your data and can help you bridge the gap between self-monitoring and traditional healthcare. If you are experiencing symptoms that are concerning to you or your health metrics are not where you would like them to be, you can easily book an appointment with our dedicated healthcare professionals to discuss a plan for evaluation and treatment that fits your lifestyle.