Standing Tests for POTS: Active Stand, NASA Lean

Standing Tests for POTS: Active Stand, NASA Lean

If you’ve been digging into postural orthostatic tachycardia syndrome (POTS), you’ve probably come across something called the tilt table test. It’s the traditional way doctors confirm a diagnosis: you lie flat, get strapped onto a table, and then the table tilts you upright while monitors track your heart rate and blood pressure. It’s requires specialized equipment, it is very uncomfortable, and isn’t available everywhere.

That’s where two simpler tests come in: the Active Stand Test and the NASA Lean Test.

The Active Stand Test

This one is exactly what it sounds like. You rest lying down for a bit, then stand up. Your heart rate and blood pressure are measured over several minutes while you stay standing. For someone with POTS, the heart rate often jumps quickly—by 30 beats per minute or more—along with dizziness, palpitations, or fatigue.

It’s easy to perform in most clinics and sometimes even at home, which makes it an important tool when tilt tables aren’t around.

The NASA Lean Test

NASA developed this test years ago while studying astronauts who had trouble standing upright after returning from space. It’s a bit more structured than just standing. The person leans lightly against a wall with their heels a few inches away. This position reduces the help your leg muscles normally give in pumping blood back to the heart, so it puts more stress on your circulation.

Like the Active Stand Test, your heart rate and blood pressure are measured for up to 10 minutes. Because it mimics the passive nature of a tilt table but without the big equipment, it’s become popular among specialists who work with POTS, ME/CFS, and Long COVID.

The tilt table test is not always practical, and it can provoke strong symptoms like fainting, vomiting and anxiety—sometimes more than patients can tolerate.

The Active Stand and NASA Lean tests shine because they’re accessible. They don’t require a hospital lab, just a blood pressure cuff, a heart rate monitor, and some patience. They often reveal enough information to confirm POTS, especially when symptoms appear during the test.

The tests mimic everyday situations like standing in line or leaning at a counter, the results often feel more true to lived experience.

Videos

Here are some clear demonstrations of the NASA Lean Test and related evaluations:

• What the NASA Lean Test looks like
• The Active Stand Test and the NASA Lean Test

These videos show the setup, the posture, and what patients report feeling during the test.

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