Tilt - Training

From [[ #103

Why to do – help recognize prodromal symptoms so can avoid syncope
At home, patients can lean against a wall with their feet
approximately 15 cm away from the wall and increase the
length of time to 30 minutes over days to weeks.126 Patients
should be observed by family members for safety reasons
while attempting this maneuver. A recent study demonstrated
that a regimen of once daily orthostatic self training
for 30 minutes after an initial twice daily program was
highly effective in preventing the recurrence of neurocardiogenic
syncope in patients who were refractory to standard
therapy.127

126. Abe H, Kondo S, Kohshi K, et al. Usefulness of orthostatic self-training
for prevention of neurocardiogenic syncope. Pacing Clin Electrophysiol.
2002;25:1454 –1458.
127. Abe H, Kohshi K, Nakashima Y. Efficacy of orthostatic self-training in
medically refractory neurocardiogenic syncope. Clin Exp Hypertens.
2003;25:487– 493.

Tilt training:
This was first described in 1998.  It has been studied in a small number of people who have a problem with fainting often.  Those who learned how to do it and used it did better on the tilt table test when it was done for the study. It takes about 4 weeks for it to really work for many people.

How to do tilt training:

•  You will be standing and leaning against the wall.  Make sure the area you do this training is safe.  That means there should be no sharp objects or furniture close by that you could hit if you fall.  You might even want some pillows around you if you tend to faint easy.
• A timer will help you tell how long you are doing the training. 
• If this is the first time you are doing this, you might want to start the timer and see how long you can stand leaning against the wall.  Or you can set it for a short time, like 1 or 2 minutes, and then lean against the wall.
• The Training:
• Stand with your feet about 15 cm (….. inches) from the wall. 
• Lean back so the top of your back, by your shoulders leans on the wall. 
• Stand still. 
• If you feel like you’re going to faint, squat down immediately or lie down.
• Stop the session.
• How long to stand-lean and how to increase the time
• Each day, you can increase the time until you can stand and lean back for 30 minutes. 
• Keeping track of how you’re doing:
• Write down the date and time you did the training.  Write down how long you were able to stand.  If you have to stop before the time you planned, write down the time and why you stopped.
• Do this two times a day.
• Do exercises for your legs too.

This information was taken from http://www.dizziness-and-balance.com/treatment/rehab/tilt%20training.html

 

References in the medical literature on that website: 

• Abe, H., K. Kohshi, et al. (2003). "Effects of orthostatic self-training on head-up tilt testing and autonomic balance in patients with neurocardiogenic syncope." J Cardiovasc Pharmacol 41 Suppl 1: S73-6.
• Abe, H., K. Kohshi, et al. (2003). "Efficacy of orthostatic self-training in medically refractory neurocardiogenic syncope." Clin Exp Hypertens 25(8): 487-93.
• Abe, H., K. Kohshi, et al. (2005). "Home orthostatic self-training in neurocardiogenic syncope." Pacing Clin Electrophysiol 28 Suppl 1: S246-8.
• Abe, H., S. Kondo, et al. (2002). "Usefulness of orthostatic self-training for the prevention of neurocardiogenic syncope." Pacing Clin Electrophysiol 25(10): 1454-8.
• Abe, H., M. Sumiyoshi, et al. (2003). "Effects of orthostatic self-training on head-up tilt testing for the prevention of tilt-induced neurocardiogenic syncope: comparison of pharmacological therapy."Clin Exp Hypertens 25(3): 191-8.
• Benditt DG, Nguyen JT. Syncope Therapeutic approaches. Journal of the American College of Cardiology, 53(19), 2009, 1741-1751
• Di Girolamo, E., C. Di Iorio, et al. (1999). "Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: A controlled study." Circulation 100(17): 1798-801.
• Duygu, H., M. Zoghi, et al. (2008). "The role of tilt training in preventing recurrent syncope in patients with vasovagal syncope: a prospective and randomized study." Pacing Clin Electrophysiol 31(5): 592-6.
• Ector, H., T. Reybrouck, et al. (1998). "Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance." Pacing Clin Electrophysiol 21(1 Pt 2): 193-6.
• Franke, W. D., K. K. Mills, et al. (2003). "Training mode does not affect orthostatic tolerance in chronically exercising subjects." Eur J Appl Physiol 89(3-4): 263-70.
• Gabbett, T. J., G. C. Gass, et al. (2001). "Does endurance training affect orthostatic responses in healthy elderly men?" Med Sci Sports Exerc 33(8): 1279-86.
• Gajek, J., D. Zysko, et al. (2006). "Influence of tilt training on activation of the autonomic nervous system in patients with vasovagal syncope." Acta Cardiol 61(2): 123-8.
• Gajek, J., D. Zysko, et al. (2006). "Efficacy of tilt training in patients with vasovagal syncope." Kardiol Pol 64(6): 602-8; discussion 609-10.
• Howden, R., J. T. Lightfoot, et al. (2002). "The effects of isometric exercise training on resting blood pressure and orthostatic tolerance in humans." Exp Physiol 87(4): 507-15.
• Lu CC and others. Water ingestion as prophylaxis against syncope. Circulation 2003; 108;2660-2665
• Nazar, K., A. Gasiorowska, et al. (2006). "Effect of 6-week endurance training on hemodynamic and neurohormonal responses to lower body negative pressure (LBNP) in healthy young men." J Physiol Pharmacol 57(2): 177-88.
• On, Y. K., J. Park, et al. (2007). "Is home orthostatic self-training effective in preventing neurally mediated syncope?" Pacing Clin Electrophysiol 30(5): 638-43.
• Reybrouck, T. and H. Ector (2006). "Tilt training: a new challenge in the treatment of neurally mediated syncope." Acta Cardiol 61(2): 183-9.
• Reybrouck, T., H. Heidbuchel, et al. (2000). "Tilt training: a treatment for malignant and recurrent neurocardiogenic syncope." Pacing Clin Electrophysiol 23(4 Pt 1): 493-8.
• Ueno, L. M. and T. Moritani (2003). "Effects of long-term exercise training on cardiac autonomic nervous activities and baroreflex sensitivity." Eur J Appl Physiol 89(2): 109-14.
• Verheyden, B., H. Ector, et al. (2008). "Tilt training increases the vasoconstrictor reserve in patients with neurally mediated syncope evoked by head-up tilt testing." Eur Heart J 29(12): 1523-30.
• Van Dijk NV, and others. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the physical counterpressure manoevres trial (PC-trial). J. Am Coll Cardiol 2006; 48: 1652-1657
• Wieling, W., N. Colman, et al. (2004). "Nonpharmacological treatment of reflex syncope." Clin Auton Res 14 Suppl 1: 62-70.
• Zion, A. S., R. De Meersman, et al. (2003). "A home-based resistance-training program using elastic bands for elderly patients with orthostatic hypotension." Clin Auton Res 13(4): 286-92