Orthostatic HypotensionNCT07579026
Effects of Breathing Retraining Exercises in Pregnant Females With Postural Orthostatic Tachycardia Syndrome.
A study testing diaphragmatic breathing exercise and educational retraining in people with Orthostatic Hypotension and Heart Rate, run by Riphah International University at 1 site in Pakistan.
Trial summary
Postural orthostatic tachycardia POTS is characterized by excessive increase in heart rate when moving from lying to standing position, often accompanied by symptoms such as dizziness, fatigue, brain fog, lightheadedness, rapid heartbeat and palpitation.it most commonly effects the females of reproductive age and can… Read more about this study
- Who is it for?
- Ages 19 to 35 years, women only
- Conditions the study is for
- Orthostatic Hypotension, Heart Rate, Blood Pressure
- What is being tested?
- diaphragmatic breathing exercise and educational retraining
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 44 participants
- Where
- 1 sitePakistan
- Study dates
- 31 Aug 2025to Sep 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 to 35 years
- Women only
- No healthy volunteers
- Adult
Who may be able to join
- • Pregnant female between the age of 19 to 35 years.
- Active standing results in a sustained increase in heart rate (HR) of at least 30 bpm or ≥120 bpm.
- POTS patients with a subacute onset of lightheadedness, dizziness, and presyncope provoked by standing.
- palpitations with chest discomfort, breathing difficulties, or feeling faint
Who cannot join
- • Uncontrolled hypertension/pre-eclampsia
- cardiovascular disorder
- Patients with uncontrolled diabetes
- Patient with Anemia, severe heart failure and neurodegenerative diseases.
- Females with the history of deep venous thrombosis.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Bashir hospital sialkot, fatima hospital
Sialkot, Punjab Province, 54000
Masooma Saleem, MSPT WH, 03320711342, masooma.saleem@riphah.edu.pk
humera urfan, MSPT WH
About this study
Official title: Effects of Breathing Retraining Exercises on Heartrate, Blood Pressure and Orthostatic Intolerance in Pregnant Females With Postural Orthostatic Tachycardia Syndrome.
Postural orthostatic tachycardia POTS is characterized by excessive increase in heart rate when moving from lying to standing position, often accompanied by symptoms such as dizziness, fatigue, brain fog, lightheadedness, rapid heartbeat and palpitation.it most commonly effects the females of reproductive age and can be triggered by events like viral infections, trauma and hormonal changes. During pregnancy females may experience worsening of symptoms in first trimester due to hormonal changes and decreased blood volume later on in second and third trimester the blood volume begins to increase. However, breathing exercises helps to regulate the nervous system, improves parasympathetic activity and reduce sympathetic activity.
The study will be randomized clinical trial and will be conducted at Bashir hospital Sialkot and Fatima hospital Sialkot. The study will be completed in 10 months of duration after the approval of synopsis. Non probability convenience sampling will be used and 44 participants will be included in the study after randomization. The subjects will be divided into two groups. Group A (experimental group) will receive diaphragmatic breathing exercises whereas Group B (control group) will receive educational retraining whereas both groups will receive baseline treatments which includes progressive muscle relaxation techniques. The tools used for the study will be Vanderbilt orthostatic symptom score VOSS to evaluate orthostatic intolerance, blood pressure will be measured using non-invasive blood pressure measurement and pulse oximetry will be used to access the heart rate. After data completion data will be analyzed by using SPSS version 21.
Read the detailed description
Postural orthostatic tachycardia POTS is characterized by excessive increase in heart rate when moving from lying to standing position, often accompanied by symptoms such as dizziness, fatigue, brain fog, lightheadedness, rapid heartbeat and palpitation.it most commonly effects the females of reproductive age and can be triggered by events like viral infections, trauma and hormonal changes. During pregnancy females may experience worsening of symptoms in first trimester due to hormonal changes and decreased blood volume later on in second and third trimester the blood volume begins to increase. However, breathing exercises helps to regulate the nervous system, improves parasympathetic activity and reduce sympathetic activity.
The study will be randomized clinical trial and will be conducted at Bashir hospital Sialkot and Fatima hospital Sialkot. The study will be completed in 10 months of duration after the approval of synopsis. Non probability convenience sampling will be used and 44 participants will be included in the study after randomization. The subjects will be divided into two groups. Group A (experimental group) will receive diaphragmatic breathing exercises whereas Group B (control group) will receive educational retraining whereas both groups will receive baseline treatments which includes progressive muscle relaxation techniques. The tools used for the study will be Vanderbilt orthostatic symptom score VOSS to evaluate orthostatic intolerance, blood pressure will be measured using non-invasive blood pressure measurement and pulse oximetry will be used to access the heart rate. After data completion data will be analyzed by using SPSS version 21.
- Conditions
- Orthostatic Hypotension, Heart Rate, Blood Pressure
- Being tested
- diaphragmatic breathing exercise, educational retraining
- Keywords
- pregnancy, blood pressure, vital signs, orthostatic intolerance, postural orthostatic tachycardia syndrome
- Medical subject headings
- Hypotension, Orthostatic, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
diaphragmatic breathing exerciseOther
The treatment group will receive diaphragmatic breathing exercise. Pregnant women will be asked to relax for 5 minutes in the supine posture. One hand will be placed on the abdomen, the other on the upper chest wall. When inhaling, the hand on the abdomen will move upward and the other hand remain as still as possible. When exhaling, the hand on the abdomen will move downwards. Inhale through the nose and exhale through the mouth. Pregnant ladies will be instructed to carefully exhale using controlled expiration. While the other hand will stay as still as possible. Following the breathing exercise, pregnant women will be asked to rest for 5 minutes. After learning the method, the exercises can be performed while sitting. Over the period of 30 days, the intervention group will be instructed to perform diaphragmatic breathing exercises for 5 minutes once a day
educational retrainingOther
The control group will receive educational retraining. The participants will be asked to rise gradually from supine or sitting positions, particularly in the morning, after meals, and after urination/defecation. Avoid prolonged standing, high ambient temperatures, and excessive humidity. A daily hydration intake of at least 2.5 liters will be advised. Use of compression garments/ stocking to reduce peripheral pooling of lower limb.
| Study group | Role | What they receive |
|---|---|---|
| Diaphragmatic breathing exercises | Experimental | The treatment group will receive diaphragmatic breathing exercise. Pregnant women will be asked to relax for 5 minutes in the supine posture. One hand will be placed on the abdomen, the other on the upper chest wall. When inhaling, the hand on the abdomen will move upward and the other hand remain as still as possible. When exhaling, the hand on the abdomen will move downwards. Inhale through the nose and exhale through the mouth. Pregnant ladies will be instructed to carefully exhale using controlled expiration. While the other hand will stay as still as possible. Following the breathing exercise, pregnant women will be asked to rest for 5 minutes. After learning the method, the exercises can be performed while sitting. Over the period of 30 days, the intervention group will be instructed to perform diaphragmatic breathing exercises for 5 minutes once a day. Receives: Other: diaphragmatic breathing exercise |
| educational retraining | Active comparator | The control group will receive educational retraining. The participants will be asked to rise gradually from supine or sitting positions, particularly in the morning, after meals, and after urination/defecation. Avoid prolonged standing, high ambient temperatures, and excessive humidity. A daily hydration intake of at least 2.5 liters will be advised. Use of compression garments/ stocking to reduce peripheral pooling of lower limb. Receives: Other: educational retraining |
What is being measured
The primary outcome is the main question the study is designed to answer.
Vanderbilt Orthostatic symptom score
It describes the following nine symptoms: mental clouding, brain fog, shortness of breath, palpitations, tremor, headache, chest tightness, blurred vision, and nausea. VOSS will help to evaluate if the symptoms will get severe, after tilting back. Participants will be asked to rate the expression of their symptoms on a scale of 0 to 10.
Measured: 6 weeks
Non-invasive blood pressure measurement
Non-invasive blood pressure (NIBP) measurement will be used by pressuring cuff around the arm or leg. The auscultatory approach will detect blood pressure by detecting the sound of the limb artery opening and closing. The oscillometer approach will measure the vibration of the cuff during pressurized air release. NIBP is considered as a gold standard test
Measured: 6 weeks
Pulse oximetry
Pulse oximeters are commonly used for the non-invasive, simultaneous measurement of hemoglobin oxygen saturation. They are reliable, accurate, relatively affordable, and portable. Pulse oximeters are commonly used to determine heart rate during rest and during activity
Measured: 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 May 2026
- Study start31 Aug 2025
- Primary completionSep 2026 (estimated)
- Study completionSep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Orthostatic HypotensionStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 44 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Masooma Saleem, MSPT WH, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07579026
- Sponsor's protocol ID
- Riphah/G-III/RCR&AHS/B45-068
- Status last verified
- May 2026
- First submitted
- 5 May 2026
- Last updated
- 11 May 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Raj SR, Bourne KM, Stiles LE, Miglis MG, Cortez MM, Miller AJ, Freeman R, Biaggioni I, Rowe PC, Sheldon RS, Shibao CA, Diedrich A, Systrom DM, Cook GA, Doherty TA, Abdallah HI, Grubb BP, Fedorowski A, Stewart JM, Arnold AC, Pace LA, Axelsson J, Boris JR, Moak JP, Goodman BP, Chemali KR, Chung TH, Goldstein DS, Darbari A, Vernino S. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting - Part 2. Auton Neurosci. 2021 Nov;235:102836. doi: 10.1016/j.autneu.2021.102836. Epub 2021 Jun 30.
PubMed 34246578Goodman BP. Treatment updates in postural tachycardia syndrome. Current Treatment Options in Neurology. 2020;22:1-13.
Boris JR, Shadiack EC 3rd, McCormick EM, MacMullen L, George-Sankoh I, Falk MJ. Long-Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes. J Am Heart Assoc. 2024 Jul 16;13(14):e033485. doi: 10.1161/JAHA.123.033485. Epub 2024 Jul 3.
PubMed 38958137Morgan K, Smith A, Blitshteyn S. POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment. Int J Womens Health. 2022 Dec 24;14:1831-1847. doi: 10.2147/IJWH.S366667. eCollection 2022.
PubMed 36590760Reilly CC, Floyd SV, Lee K, Warwick G, James S, Gall N, Rafferty GF. Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention. Auton Neurosci. 2020 Jan;223:102601. doi: 10.1016/j.autneu.2019.102601. Epub 2019 Nov 12.
PubMed 31743851
Study at a glance
From the registry record, last updated by the sponsor on 11 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Breathing Retraining Exercises on Heartrate, Blood Pressure and Orthostatic Intolerance in Pregnant Females With Postural Orthostatic Tachycardia Syndrome.
- ClinicalTrials.gov ID
- NCT07579026
- Acronym / sponsor ID
- Riphah/G-III/RCR&AHS/B45-068
- Conditions
- Orthostatic Hypotension, Heart Rate, Blood Pressure
- Keywords
- pregnancy, blood pressure, vital signs, orthostatic intolerance, postural orthostatic tachycardia syndrome
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 44 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 31 Aug 2025 (actual)
- Primary completion
- Sep 2026 (estimated)
- Study completion
- Sep 2026 (estimated)
- First posted
- 11 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Postural orthostatic tachycardia POTS is characterized by excessive increase in heart rate when moving from lying to standing position, often accompanied by symptoms such as dizziness, fatigue, brain fog, lightheadedness, rapid heartbeat and palpitation.it most commonly effects the females of reproductive age and can be triggered by events like viral infections, trauma and hormonal changes. During pregnancy females may experience worsening of symptoms in first trimester due to hormonal changes and decreased blood volume later on in second and third trimester the blood volume begins to increase. However, breathing exercises helps to regulate the nervous system, improves parasympathetic activity and reduce sympathetic activity.
The study will be randomized clinical trial and will be conducted at Bashir hospital Sialkot and Fatima hospital Sialkot. The study will be completed in 10 months of duration after the approval of synopsis. Non probability convenience sampling will be used and 44 participants will be included in the study after randomization. The subjects will be divided into two groups. Group A (experimental group) will receive diaphragmatic breathing exercises whereas Group B (control group) will receive educational retraining whereas both groups will receive baseline treatments which includes progressive muscle relaxation techniques. The tools used for the study will be Vanderbilt orthostatic symptom score VOSS to evaluate orthostatic intolerance, blood pressure will be measured using non-invasive blood pressure measurement and pulse oximetry will be used to access the heart rate. After data completion data will be analyzed by using SPSS version 21.
Detailed description
Postural orthostatic tachycardia POTS is characterized by excessive increase in heart rate when moving from lying to standing position, often accompanied by symptoms such as dizziness, fatigue, brain fog, lightheadedness, rapid heartbeat and palpitation.it most commonly effects the females of reproductive age and can be triggered by events like viral infections, trauma and hormonal changes. During pregnancy females may experience worsening of symptoms in first trimester due to hormonal changes and decreased blood volume later on in second and third trimester the blood volume begins to increase. However, breathing exercises helps to regulate the nervous system, improves parasympathetic activity and reduce sympathetic activity.
The study will be randomized clinical trial and will be conducted at Bashir hospital Sialkot and Fatima hospital Sialkot. The study will be completed in 10 months of duration after the approval of synopsis. Non probability convenience sampling will be used and 44 participants will be included in the study after randomization. The subjects will be divided into two groups. Group A (experimental group) will receive diaphragmatic breathing exercises whereas Group B (control group) will receive educational retraining whereas both groups will receive baseline treatments which includes progressive muscle relaxation techniques. The tools used for the study will be Vanderbilt orthostatic symptom score VOSS to evaluate orthostatic intolerance, blood pressure will be measured using non-invasive blood pressure measurement and pulse oximetry will be used to access the heart rate. After data completion data will be analyzed by using SPSS version 21.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Diaphragmatic breathing exercises | Experimental | Other: diaphragmatic breathing exerciseThe treatment group will receive diaphragmatic breathing exercise. Pregnant women will be asked to relax for 5 minutes in the supine posture. One hand will be placed on the abdomen, the other on the upper chest wall. When inhaling, the hand on the abdomen will move upward and the other hand remain as still as possible. When exhaling, the hand on the abdomen will move downwards. Inhale through the nose and exhale through the mouth. Pregnant ladies will be instructed to carefully exhale using controlled expiration. While the other hand will stay as still as possible. Following the breathing exercise, pregnant women will be asked to rest for 5 minutes. After learning the method, the exercises can be performed while sitting. Over the period of 30 days, the intervention group will be instructed to perform diaphragmatic breathing exercises for 5 minutes once a day. |
| educational retraining | Active comparator | Other: educational retrainingThe control group will receive educational retraining. The participants will be asked to rise gradually from supine or sitting positions, particularly in the morning, after meals, and after urination/defecation. Avoid prolonged standing, high ambient temperatures, and excessive humidity. A daily hydration intake of at least 2.5 liters will be advised. Use of compression garments/ stocking to reduce peripheral pooling of lower limb. |
Who may qualify
- Ages
- 19 to 35 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- • Pregnant female between the age of 19 to 35 years.
Key exclusion criteria (5 listed)
- • Uncontrolled hypertension/pre-eclampsia
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| diaphragmatic breathing exerciseThe treatment group will receive diaphragmatic breathing exercise. Pregnant women will be asked to relax for 5 minutes in the supine posture. One hand will be placed on the abdomen, the other on the upper chest wall. When inhaling, the hand on the abdomen will move upward and the other hand remain as still as possible. When exhaling, the hand on the abdomen will move downwards. Inhale through the nose and exhale through the mouth. Pregnant ladies will be instructed to carefully exhale using controlled expiration. While the other hand will stay as still as possible. Following the breathing exercise, pregnant women will be asked to rest for 5 minutes. After learning the method, the exercises can be performed while sitting. Over the period of 30 days, the intervention group will be instructed to perform diaphragmatic breathing exercises for 5 minutes once a day | Other | Diaphragmatic breathing exercises |
| educational retrainingThe control group will receive educational retraining. The participants will be asked to rise gradually from supine or sitting positions, particularly in the morning, after meals, and after urination/defecation. Avoid prolonged standing, high ambient temperatures, and excessive humidity. A daily hydration intake of at least 2.5 liters will be advised. Use of compression garments/ stocking to reduce peripheral pooling of lower limb. | Other | educational retraining |
Primary outcome
Vanderbilt Orthostatic symptom score
Time frame: 6 weeks
It describes the following nine symptoms: mental clouding, brain fog, shortness of breath, palpitations, tremor, headache, chest tightness, blurred vision, and nausea. VOSS will help to evaluate if the symptoms will get severe, after tilting back. Participants will be asked to rate the expression of their symptoms on a scale of 0 to 10.
Non-invasive blood pressure measurement
Time frame: 6 weeks
Non-invasive blood pressure (NIBP) measurement will be used by pressuring cuff around the arm or leg. The auscultatory approach will detect blood pressure by detecting the sound of the limb artery opening and closing. The oscillometer approach will measure the vibration of the cuff during pressurized air release. NIBP is considered as a gold standard test
Pulse oximetry
Time frame: 6 weeks
Pulse oximeters are commonly used for the non-invasive, simultaneous measurement of hemoglobin oxygen saturation. They are reliable, accurate, relatively affordable, and portable. Pulse oximeters are commonly used to determine heart rate during rest and during activity
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 May 2026.
- Background: PubMed 34246578Raj SR, Bourne KM, Stiles LE, Miglis MG, Cortez MM, Miller AJ, Freeman R, Biaggioni I, Rowe PC, Sheldon RS, Shibao CA, Diedrich A, Systrom DM, Cook GA, Doherty TA, Abdallah HI, Grubb BP, Fedorowski A, Stewart JM, Arnold AC, Pace LA, Axelsson J, Boris JR, Moak JP, Goodman BP, Chemali KR, Chung TH, Goldstein DS, Darbari A, Vernino S. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting - Part 2. Auton Neurosci. 2021 Nov;235:102836. doi: 10.1016/j.autneu.2021.102836. Epub 2021 Jun 30.
- BackgroundGoodman BP. Treatment updates in postural tachycardia syndrome. Current Treatment Options in Neurology. 2020;22:1-13.
- Background: PubMed 38958137Boris JR, Shadiack EC 3rd, McCormick EM, MacMullen L, George-Sankoh I, Falk MJ. Long-Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes. J Am Heart Assoc. 2024 Jul 16;13(14):e033485. doi: 10.1161/JAHA.123.033485. Epub 2024 Jul 3.
- Background: PubMed 36590760Morgan K, Smith A, Blitshteyn S. POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment. Int J Womens Health. 2022 Dec 24;14:1831-1847. doi: 10.2147/IJWH.S366667. eCollection 2022.
- Background: PubMed 31743851Reilly CC, Floyd SV, Lee K, Warwick G, James S, Gall N, Rafferty GF. Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention. Auton Neurosci. 2020 Jan;223:102601. doi: 10.1016/j.autneu.2019.102601. Epub 2019 Nov 12.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Masooma Saleem, MSPT WH principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing diaphragmatic breathing exercise and educational retraining in people with Orthostatic Hypotension and Heart Rate, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 11 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact imran amjad, phd (03324390125, imran.amjad@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Vanderbilt Orthostatic symptom score (time frame: 6 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07579026, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 May 2026.