POTS EXERCISE REHABILITATION
The protocols behind Pacecraft™
Pacecraft™ doesn’t invent exercise programs. It runs published ones, as written — and explains how the rest of them relate, because the names are a mess and nobody tells you that.
First, the names.
Levine and Dallas are the same research program: one name comes from Dr. Benjamin Levine, the other from the city where his team developed it. CHOP Modified Dallas is the same underlying structure adapted into week-by-week calendars with a gentler, more legible ramp. If your PDF has monthly training calendars, you probably have the CHOP version — even if the file is labeled “Levine Protocol.”
So: one research program, one clinical adaptation, and a shorter recumbent option for people who cannot use heart-rate zones.
EXPLAINED HERE · NOT YET IMPLEMENTED
Levine / Dallas Protocol
The original program, built around calculated heart-rate paces over roughly seven to eight months. It includes pre-month stages for people who cannot begin at Month 1 and higher-intensity intervals in later stages. Its pace calculations depend on a maximum heart-rate figure best obtained through exercise testing, so Pacecraft™ explains it rather than approximating it.
Best with: clinical support to set up accurate heart-rate paces.
FULLY IMPLEMENTED IN PACECRAFT™
CHOP Modified Dallas POTS Exercise Program
The Levine program rewritten as eight monthly training calendars. Cardio starts horizontal or seated — recumbent bike, rowing, swimming, or seated stepper — before upright work appears months later. Intensity is set by clinician-prescribed heart-rate zones, with weekly progression earned through completed sessions.
Best with: a heart-rate monitor, clinician-set zones, and recumbent cardio equipment.
FULLY IMPLEMENTED IN PACECRAFT™
CHOP AADP Recumbent Training Program
A shorter recumbent program that uses rate of perceived exertion rather than heart rate. This is not the “easy” option: it is the appropriate measurement when heart rate is not a usable signal, including for people taking beta blockers, people without a monitor, or people whose exertion does not track reliably with heart-rate numbers.
Best with: beta blockers, no target zones, or an exertion-based approach.
What Pacecraft™ doesn’t include
Pacecraft™ does not start graded exercise for people who screen positive for post-exertional malaise. It does not self-administer protocols that require supervised maximal testing. And it does not add unpublished programs or unlisted changes. If a program is not published and citable, it is not in Pacecraft™.
Further reading & attribution
Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience, 2018.
Ziaks L, et al. Adaptive Approaches to Exercise Rehabilitation for Postural Tachycardia Syndrome and Related Autonomic Disorders. Archives of Rehabilitation Research and Clinical Translation, 2024.
Pacecraft™ is not affiliated with, endorsed by, or sponsored by the Children’s Hospital of Philadelphia, the Institute for Exercise and Environmental Medicine, UT Southwestern, or Dysautonomia International. Protocol names identify published programs Pacecraft™ implements or describes. Pacecraft™ does not provide medical advice; talk to your clinician before beginning any exercise program.