Structuring a Yoga Class for folks with POTS

For individuals with POTS (Postural Orthostatic Tachycardia Syndrome), yoga can serve as a gentle, therapeutic method to manage symptoms, improve autonomic balance, and promote relaxation. However, due to the condition’s sensitivity to posture, transitions, and autonomic dysfunction, the class should be carefully designed.

POTS, Autonomic Dysfunction & Autism:

Owens, A. P., Mathias, C. J., & Iodice, V. (2021) examined the relationship between autonomic dysfunction (AD) and Autism Spectrum Disorder (ASD) in their comprehensive review. The study highlights how disruptions in the autonomic nervous system (ANS) may contribute to common features of Austism Spectrum, including altered sensory processing, emotional regulation, and social interaction challenges. The study discusses findings suggesting elevated resting heart rate, altered blood pressure regulation, and increased sympathetic dominance in individuals with ASD.

Please note: There are potential links between neurodivergent populations (ASD and ADHD) and POTS, although additional research is needed to establish direct connections.

General Advice: What to Avoid

1. Avoid Prolonged Upright Postures:  

  - As Andrade et al. (2024) highlight, upright exercises exacerbate tachycardia and cardiovascular stress in POTS patients. Prolonged standing poses, such as Mountain Pose (Tadasana) or Warrior Poses (Virabhadrasana series), should be avoided as they can worsen orthostatic intolerance.

2. Avoid Rapid Postural Transitions:  

• Sudden changes from supine to seated or standing positions may trigger autonomic instability (Andrade et al., 2024). Avoid fast-paced flows like Sun Salutations (Surya Namaskar), where quick transitions could exacerbate symptoms.

3. Minimise Cardiovascular Strain and Overexertion:  

• Intense poses, such as Wheel Pose (Urdhva Dhanurasana) or unsupported inversions (e.g., Headstand (Sirsasana)), place unnecessary strain on the cardiovascular system and should be replaced with gentler alternatives.

4. Avoid Excessive Sympathetic Activation:  

• Class elements that increase sympathetic nervous system activity—such as vigorous sequences or competitive cues—should be excluded. Stick et al. (2024) suggest incorporating practices that enhance parasympathetic activity for symptom relief.

Core Elements of a POTS-Friendly Yoga Class

1. Start with Gentle Breathing Practices 

Incorporate breathing practices based on findings from Stick et al. (2024), which demonstrated the clear benefits of deep abdominal breathing in reducing heart rate and symptoms during orthostatic stress.

  Deep Abdominal Breathing (Diaphragmatic Breathing):

• Folks can lie on their backs (Savasana) or remain semi-recumbent with a bolster for shoulder and neck support.  

• Offer slow, deep inhalations through the nose, expanding the belly (not the chest), followed by controlled exhalations out of the mouth.  

• Maybe aim for a breath cycle of 4-6 seconds inhale, 6-8 seconds exhale. 

• Encourage awareness of the parasympathetic activation (calming sensation) as they focus on their breath.

Simple Pranayama:

• Nadi Shodhana (Alternate Nostril Breathing), emphasizing slow, rhythmic breathing, which restores autonomic balance and helps calm the nervous system. Avoid breath retention (kumbhaka), as it may increase cardiovascular strain.  

2. Warm-Up with Supine and Semi-Recumbent Shapes

Based on Andrade et al. (2024), starting in supine (lying) or semi-recumbent positions reduces orthostatic stress, facilitates venous return, and prepares the body for movement.  

 Recommended Poses:

• Legs-up-the-Wall Pose (Viparita Karani): Encourages circulation and counters the effects of orthostatic intolerance.  

• Reclined Bound Angle Pose (Supta Baddha Konasana): Opens the hips gently while keeping the body grounded. (PLEASE NOTE THAT THIS SHAPE ISN’T ADVISED FOR A TRAUMA INFORMED CLASS)

• Supine Twist (Jathara Parivartanasana): A gentle spinal twist to release tension and promote relaxation.  

• Bridge Pose (Setu Bandhasana): Strengthens the core and legs without challenging the cardiovascular system—ensure the movement is slow and controlled.

3. Seated and Grounded Shapes

Transition into seated or grounded poses slowly to protect against sudden blood pressure fluctuations. These poses improve flexibility and strength while keeping autonomic stress low.

Recommended:

• Easy Pose (Sukhasana): Engage the spine and use blocks or cushions for added hip support.  

• Seated Forward Bend (Paschimottanasana): Slowly fold forward, keeping the head supported on a block or bolster if needed.  

• Child’s Pose (Balasana): Promotes relaxation while keeping the heart rate stable. Encourage adding slow abdominal breaths in this pose.

4. Cool-Down and Gentle Stretching 

Return to supine or fully supported positions to signal to the body that it is safe to relax. This phase further slows heart rate and enhances parasympathetic regulation.

Recommended Poses:

• Lying Down aka Corpse (Savasana): End practice with a long Savasana, incorporating slow diaphragmatic breathing and a guided body scan to promote full relaxation.  

• Happy Baby (Ananda Balasana): Gently stretches the hips and lower back while lying down.

Optional Element for Relaxation: Use weighted items or sandbags lightly placed on the thighs or pelvis during Savasana to enhance grounding and support venous return. Weighted blankets if on hand might be nice. 

Important Class Guidelines:

• Hydration and Compression (Optional):  

  • Encourage students to remain hydrated before and after class. If they find it helpful, wearing compression garments during the session can aid in circulation and minimise dizziness.

• Slow, Deliberate Movements:  

  • Transitions between poses (e.g., from lying to sitting) should be performed slowly to prevent sudden blood pressure drops or heart rate spikes. Encourage students to take breaks as needed. 

• Avoid Overexertion:  

  • Teachers should emphasise a non-competitive, restorative atmosphere to reduce sympathetic activation. Use props (e.g., bolsters, blankets, blocks) to support poses as needed.

• Emphasis on Deep Breathing Throughout:  

  • Integrate slow (over-breathing is likely going to be problematic) diaphragmatic breathing into every phase of the class to stabilise heart rate and autonomic responses, as shown in Stick et al. (2024).

• USE ALL THE PROPS!

What to Look Out For in POTS Students During Yoga Class

1. Physical Signs and Symptoms

POTS is characterised by an abnormal heart rate response to changing postures, especially when moving to or maintaining an upright position. Keep an eye out for:

  - Dizziness or Lightheadedness: Often occurs when transitioning from lying/seated to standing.

  - Fatigue or Weakness: May be a result of reduced blood flow to the brain or overexertion.

  - Palpitations (Racing Heart): Be attentive if they look distressed or mention feeling their heart pounding.

  - Sweating or Flushing: This may happen as their body attempts to compensate for blood pooling in the extremities.

  - Shortness of Breath: Indicates difficulty regulating the autonomic nervous system with exertion.

  - Clamminess or Nausea: Can signal sudden drops in blood pressure or autonomic dysregulation.

2. Emotional Responses

While POTS is primarily a physical condition, autonomic dysregulation can also lead to emotional distress during class. Be mindful of:

  - Overwhelm or Anxiety: Physical symptoms (e.g., palpitations or dizziness) can feel intense and sometimes induce panic.

  - Frustration or Fear: If someone worries about "keeping up" with others in the class or fears exacerbating symptoms, they may need reassurance.

3. Triggers to Watch For

Certain movements, poses, and environmental factors can exacerbate POTS symptoms. Keep an eye out for potential triggers during your class:

  - Rapid Postural Changes: Fast transitions, such as moving quickly from lying to standing, can cause dizziness due to delayed blood flow adjustments.

  - Prolonged Upright Postures: Holding poses like Mountain Pose or Warrior Poses for long periods can lead to blood pooling in the legs, worsening tachycardia.

  - Overheating: A warm room or intense exertion can exacerbate symptoms. Watch for flushed faces, sweating, or signs of discomfort.

  - Overexertion: Students may try pushing themselves too hard, resulting in breathlessness, fatigue, or palpitations.

  - Poor Hydration: Signs like dry mouth or lightheadedness may indicate dehydration, which can worsen POTS symptoms.

  - Low Blood Sugar: If yoga class takes place around meal times, low energy levels may exacerbate fatigue and dizziness.

Conclusion:

A yoga class for individuals with POTS should focus on supine and semi-recumbent poses, slow transitions, and deep abdominal breathing practices to promote parasympathetic activation and reduce orthostatic stress. Based on Andrade et al. (2024) and Stick et al. (2024), restorative yoga approaches combined with diaphragmatic breathing exercises offer an excellent, low-impact way to manage symptoms and support cardiovascular stability. Such classes should prioritise gentle movements, relaxation, and individual pacing, making yoga accessible and therapeutic for POTS patients.

References:

Andrade, C. P., Zamunér, A. R., Barbic, F., Porta, A., Rigo, S., Shiffer, D. A., Bringard, A., Fagoni, N., Ferretti, G., & Furlan, R. (2024). Effects of different postures on the hemodynamics and cardiovascular autonomic control responses to exercise in postural orthostatic tachycardia syndrome. European Journal of Applied Physiology. https://doi.org/10.1007/s00421-024-05662-5

Stick, M., Leone, A., Fischer, F., Schulz, J. B., & Maier, A. (2024). Deep abdominal breathing reduces heart rate and symptoms during orthostatic challenge in patients with postural orthostatic tachycardia syndrome. European Journal of Neurology, 31(10), e16402-n/a. https://doi.org/10.1111/ene.16402

The Adult ADHD Assessment Process ~ A step by step guide

Reckon you have ADHD? Watch below to get started!

More info here: https://adhdfoundation.org.au/news/the-pathway-to-adhd-diagnosis

We are spending more attention cash than our brain wallets have, and our cognitive debts are trying desperately to tell us something: “It might be time for a brain budget”

We are collectively living and working in a way that rapidly depletes our ‘attention resources’. This concept is similar to “living within one’s means” or understanding and actively knowing and not choosing to push your body beyond its functional limit (I cannot run as fast as a racehorse, I have tried and it didn’t end well). So we can think of attention resources in the same light, but applied to your brain—finite and essential to everything we do. There is only so much thinking and processing our brains can manage. 

I am not just talking about neurodivergent folks brains here, this idea about cognitive capacity applies to every type of brain.

Attention resources refer to the limited cognitive capacities that we allocate to the critical task of processing and responding to stimuli. Let me roll that out one more time: they are FINITE (NB: I always read the word ‘finite’ in an Italian accent, try it, go on). Ok so these limitations profoundly shape our ability to function, and the societal glorification of hyper-productivity alongside the technological hijacking of our focus has created a world entirely hostile to sustained, deep attention. This depletion is not an individual problem—it’s a systemic and societal one, eroding the way we work, live, and engage with the world. We don’t (and we shouldn’t) blame addicts when the thing they picked up to help them feel ok was 100% designed to be insanely addictive. 

The constant overharvesting of our brain power, whether from incessant phone notifications or the relentless pace of modern communication and work, is leading to significant psychological consequences. One major (I think it is major, you might think otherwise) outcome is a lack of depth in our experiences. With our attention repeatedly fragmented, we flit from one thing to the next (like a golden retriever unleashed in a room with 25 bowls of food) without connecting deeply enough to truly understand, reflect, or even feel a sense of accomplishment. We’ve become locked in a cycle of constant surface-level task switching, perpetually rushed and overwhelmed, holding a belief of “there’s just so much to do.” 

Another well-documented effect of draining our attention resources is STRESS. While stress can motivate us in small, short-term doses, chronic stress—like the kind many of us experience daily—has detrimental impacts on both mental and physical health. Yet, asking someone overwhelmed to “just slow down” often makes things worse. It triggers resistance, as slowing down feels incompatible with the relentless to-do lists we face and even threatening to an overtaxed nervous system that is already running on fumes. What happened the last time you were feeling stressed and cooked and someone (well meaning I am sure) told you to calm/slow down? (Didn’t go down well?…didn’t think so). 

It’s also worth considering how our brains are wired for energy conservation, often pushing us to take the easiest, most immediate path. While this is natural, it’s important to acknowledge that challenging ourselves—like perhaps choosing a more intentional, analogue path over a digital one—may offer a profound sense of achievement, reward, and confidence. I really do wonder, what might happen if we had a bit more mental and emotional capacity….hell, you might take up painting again like you used to, or be able to meditate, or finish a book. For me? Well I would finally learn the piano part from ‘November Rain’ by Guns ‘n’ Roses. 

So perhaps the more difficult, yet worthwhile, question is this: How might we begin to recalibrate the balance between the analogue and the digital in our daily lives to reclaim focus, reduce stress, and protect our mental reserves?

Will go and buy that piano right now!

References:  

Wickens, C. D., Gutzwiller, R. S., & McCarley, J. S. (2023).

Applied attention theory (2nd ed.). CRC Press.Unlocking the Stress Cycle. (2024). Probate and Property, 38(1), 62–63.

So you have just been diagnosed with ADHD, now what?

So, you’ve just received the news: you have an ADHD brain!

Likely up to this point you have been scared shitless that you would be told that you didn’t have ADHD, and that you’d be left thinking there was something seriously ‘wrong’ with you. This is a super common concern for those in the gaunTlet that can be the diagnosis process, and the good news is that there is absolutely nothing wrong with you.

So you have ADHD…..what now?

——————————————————————————————————————————

Let’s just talk for a moment about what this diagnosis could mean for you, and how you might navigate this new (and frankly a tad chaotic) chapter of your life. There will be time spent looking back and thinking “if only I’d known” and making sense of your past behaviours, decisions and experiences through the lens of this new information, it can be griefy and overwhelming this part….BUT then looking forward to the future armed with some deeper knowledge about how your brain works can be exciting. You have choices.

First off, let’s make sure this old saying lands: “PILLS (or no pills depending on what path you have chosen) DO NOT MAKE SKILLS”. Really what this means is that unless you understand what ADHD is and the ways it can trip you up, you may not fully get your head around its impact, nor may you feel strong enough to willingly grab it by the proverbial horns and (kindly) make it work for you. You get the diagnosis from the doc, but its often left up to the individual to follow the white rabbit down the neurodivergent hole of information.

As Kylie Minogue wisely advised us, it is indeed ‘Better the devil you know’. Maybe you have a script for meds, maybe you want to manage it the natural way, and whatever you have chosen is cool, but what does it actually mean to be neurodivergent?

Step 1:

Getting educated about what ADHD actually is and how it can rear its ugly head is crucial. Learn about the Executive Functions, and the parts of the brain that can be impaired by ADHD. You don’t have to become well versed in neuropsychology (unless your hyperfocus drags you into that particular research hole) just getting a basic understanding of what brain functions might not work as well is probably going to be helpful. Go easy my ADHD friend, we tend to take things to extremes, and the internet can be a wild west of misinformation. Start on this old faithful here: ADDitude Magazine for well researched and easy to comprehend info.

Understanding your brain is the first step to navigating the unpredictability that comes with it—after all, you can’t tackle what you can’t identify (and I repeat the Kylie reference above).

Step 2:

Now after some education, you can get clear about how your unique ADHD strengths and weaknesses manifest! Everyone’s expression is going to be different and influenced by genetics, environment, culture and many other biopsychosocial factors. Learning how your ADHD gets in your way and how to work WITH it (rather than against it) is going to be a game changer. ADHD can lead to difficulties with attention, impulsiveness, and hyperactivity (just to name a few) across relationships, work, and pretty much all domains of this thing called life (Prince fans, spin it), which can turn even the simplest tasks into Herculean challenges eg: why is it so hard to respond to that one email??? You will find out when you learn about executive dysfunction.

But I promise things can only get better (Professor Brian Cox was the keyboard player in D:REAM and my god, that fact still blows my mind) when you learn and know more. Some smart chap said “knowledge is power” if my rubbish memory serves me correctly. And that smart chap was right.

Let’s not sugarcoat this: ADHD can often feel like a you’re a one legged man in an arse kicking tournament (anyone who is not Australian, please don’t be alarmed, this is kinda how we speak). Individuals with ADHD face a significantly higher risk of developing anxiety and depression—about three times more likely, in fact (Kessler et al., 2006). Without the right strategies, it can seem like you’re wading through treacle while trying to do basic tasks like hold down a job, be a friend / partner / parent, manage to remember to take your damn clothes out of the dryer (you know exactly what I am talking about) and make time to enjoy life without being in a constant state of stress, overwhelm and hyper-vigilance. But don’t fret my friend, acceptance is half the battle—you are not alone (MJ fans you can revisit that, let’s be honest, not so great song here) in this mad house; plenty of others are out there, just as bewildered.

So, what can you do next?

1. Educate yourself through podcasts, here is a list I have curated especially for the new neurodivergents in town, you can find it on Spotify here.

   • You like Instagram? Here are some educators.

   • Consider reading/listening to some books on the topic, below is a photo of some of my favs, but here are some bangers:

     • “Unmasked” by Ellie Middleton

     • “ADHD 2.0” by Edward M. Hallowell, MD and John J. Ratey, MD

     • “Self-Care for People with ADHD” by Sasha Hamdani, MD

     • “Divergent Mind” by Jenara Nerenberg

     • “The Year I Met My Brain: A travel companion for adults who have just found out they have ADHD” by Matilda Boseley 

     • “Your Brain’s Not Broken: Strategies for Navigating Your Emotions and Life with ADHD” by Tamara Rosier PhD

     • “Taking Charge of Adult ADHD: Proven Strategies to Succeed at Work, at Home, and in Relationships” by Russell A. Barkley PhD

     • “We're All Neurodiverse: How to Build a Neurodiversity-Affirming Future and Challenge Neuronormativity” by Sonny Jane Wise (aka The Lived Experience Educator)

     • “Unmasking Autism: The Power of Embracing Our Hidden Neurodiversity” by Devon Price

2. Consider ADHD counselling and neurodiversity training for yourself or for your workplace, educating the close people in your life about how your (and theirs) brain works is going to be helpful. Know that there are resources and professionals available who can help you find your footing amid the new diagnosis chaos. Finding the right support can make navigating life with ADHD feel a little less like being on a ship with many holes in the bottom.

As you can see, they have been dog-eared and post-it-noted (ignore the yoga ones unless you are into that too!)

Through the process of looking back and reframing the unhelpful stories from your (unknowingly unsupported) past, with tools to move forward in a way that works for you, is incredibly freeing. I highly recommend it.

If I can help you through this then you know where to find me…Actually, you know what they say about those who ‘assume’, so actually you can find me here.

Alright, onwards we go my neurodivergent beauties!

Caz x

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References

• Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., ... & Zaslavsky, A. M. (2006). The Adult ADHD Clinical Research Network: A 3-Year Study of Adults with ADHD. The Journal of Clinical Psychiatry, 67(12), 1944-1953. doi:10.4088/JCP.v67n1205

• Polanczyk, G., de Lima, M. S., Hwang, I., Oliveira, A., Yoshimasu, K., & Kato, M. (2015). Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345-365. doi:10.1111/jcpp.12381

• Sibley, M. H., Pelham, W. E., Kaizar, E. E., Langberg, J. M., & Datu, N. S. (2016). The role of parental functional impairment in the association between ADHD and the use of mental health resources. Journal of Attention Disorders, 20(3), 227-236. doi:10.1177/1087054712459421

Do No Harm: What to Do When an Employee or Colleague Discloses Their ADHD, Autism, or Other Neurodivergence in the Workplace.

It saddens me to hear that many people feel unsafe disclosing their neurodivergence in the workplace, fearing judgment or being deemed less capable by managers or colleagues due to differences in how their brains work.

Trigger Warning: This article mentions facts related to suicide.

Let's kick off with a few key terms regarding #Neurodiversity

Neurodiversity is a term used to describe the vast array of human minds, reflecting the diverse neurocognitive abilities present among individuals. It's akin to biodiversity, but for human minds.

Put simply:

• Neuro = Mind

• Diversity = Many types

Some people view their neurodivergence as a disability, while others do not. Support needs vary from person to person.

Right, so let's bust out a few more terms you might find helpful:

• Neurodivergent Sometimes abbreviated as ND, means having a mind that functions in ways which diverge significantly from the dominant societal standards of “normal”.

• Neurodivergence the state of being neurodivergent.

• Neurotypical often abbreviated as NT, means having a style of neurocognitive functioning that falls within the dominant societal standards of “normal.” Other terms are ‘Allistic’ or ‘non-autistic/non-adhd’.

• Neuroaffirming Workplace is an organisation that has an intention to understand, manage, support, and promote inclusivity in the workplace. This intention is really a value, one that embodies and respects people’s differences and by doing so, doesn't cause harm and doesnt replicate damaging narratives around ableism (discrimination in favour of able-bodied people).

• Ableism looks like ignoring requests for accommodations or refusing to acknowledge someone's disability. Refusing to use the terms someone requests, like “deaf person,” “neurodivergent,” or “wheelchair user”.

For managers, there is a duty of care to try and protect the wellbeing of employees, and to also be aware of inherent power imbalances that exist between levels of the organisation, between management and their teams.

Types of neurodivergence (this is not an exhaustive list, I have included at the bottom of this article)

• ADHD (Complex brain differences affecting executive functioning - working memory, self-monitoring, impulse control, emotional regulation, challenges with changing circumstances/demands, planning and prioritisation, task initiation and organisation)

• Autism Spectrum (We call it a spectrum because everyone experiences Autism uniquely, with different difficulties and severity in communicating and socialising, as well as restricted and repetitive behaviours and interests).

• Dyslexia (challenges with reading, spelling, challenges with sound awareness, verbal memory and verbal processing speed)

• Dyscalculia (challenges understanding numbers, interpreting data, learning and following procedures - also considered a learning disability)

• DCD (Developmental Coordination Disorder, affecting motor skills, balance, coordination)

Inclusive, safe, and accessible workplaces are so important to either making or breaking the health and wellbeing of employees.

According to the “Mapping the State of Inclusion in the Australian Workforce" report by Diversity Council Australia (Diversity Council Australia, 2024):

• Post-pandemic, only 46% of workers felt their teams were inclusive, a decrease from previous years. Non-inclusive teams increased to 19% in 2023 from 11% pre-pandemic. Two-thirds of workers reported an inclusive organisational climate, but a rise in non-inclusive managers was noted.

• Discrimination and harassment increased, with nearly 1 in 3 workers experiencing such issues, particularly among marginalised workers.

• Workers feel less connected post-pandemic, with a decline in experiencing belonging and acceptance. An estimated 1 in 3 of Australians reported feeling lonely

• Ability to contribute to work discussions also decreased, despite increased communication tools. Younger men's support for D&I is on the decline. 75% of those who take their own life are male (Lifeline Australia, n.d.).

Hopefully this has set the stage to understand why creating an inclusive organisation is the first step in helping employees to feel safe enough to say "Hey, so I am Autistic, and I was wondering if I could talk to you about some reasonable adjustments?"

Here are some suggestions as to how to create that psychological safety when a staff member or colleague disclose their neurodivergence:

• Thank them for sharing, and let them know that all types of brains are welcome here (normalising).

• Ask them whether they need any accomodations or supports that might help (they are the experts of their own lives) you can even ask them what might help across these areas: socially, sensory, environmentally, cognitively.

• Ask them if it is ok to learn more and ask questions about their neurodivergence. Be open and interested to learn more if you have knowledge gaps.

• If your organisation doesn’t offer training around Neurodiversity or have policies and procedures related to reasonable adjustments, you can reach out to me here for more information about Neurodiversity in the Workplace training.

• Please tell them that this information will remain confidential, unless the person would like help in sharing their story. This is so very important.

• Remind them that it is ok to bring anything to work that helps them (eg: noise cancelling headphones, fidgets etc)

• Tell them you are open to feedback about how you, and the organisation, can be more #neuroaffirming (consult with those with lived experience).

I would be keen to hear any ideas or thoughts on why folks think this conversation is important to talk about, and what else might be helpful in the quest for workplace inclusion.

Cheers brains,

Caz :)

Other types of neurodivergence include Tourette's, dyspraxia, synesthesia, Down syndrome, epilepsy, and chronic mental health illnesses such as bipolar disorder, obsessive-compulsive disorder, borderline personality disorder, anxiety, and depression.