Do you get lightheaded when you stand up? Or maybe after exercising for a little bit? Do you know if your blood pressure drops when you are standing up vs. sitting or laying down? This is called orthostatic hypotension and it is common in Parkinson’s Disease. If you’ve been experiencing this, it may feel like you can’t do anything or that exercise is out of the question. But that’s not the case. It CAN get better! Keep reading to learn some top tips to help manage low blood pressure so that you can start or keep exercising for brain change.
- The first step is to determine if you do in fact have orthostatic hypotension. How do you determine this? It is helpful to have a blood pressure monitor handy at home, either next to your bed or close by. It may also be beneficial to take this with you if planning to be active or if going to the gym. If going to a facility, they hopefully should have a monitor on hand and can assist you with checking your blood pressure if you experience symptoms. You can do this at home by taking your blood pressure laying down (either upon awakening or after laying down fro at least 5 minutes), then sit up and take it again after sitting for at least 1 minute, and then one more time after standing for 1 minute and again after standing for 3 minutes. In general, it’s a good idea to write down your heart rate with each measurement as well. A drop of 20 mmHg or more of the systolic, or top, number and/or a drop by 10 mmHg or more of the diastolic, or bottom, number indicates orthostatic hypotension. You may also have symptoms of dizziness, lightheadedness, weakness or feeling faint. The other option is to visit with your doctor and have them check these for you.
- Next, you will want to figure out if you have any specific triggers. For instance, are you only briefly dizzy or lightheaded when you change position but it goes away after a few seconds? Or do you know your blood pressure drops with walking long distances? Or doing any intense exercise? Does the temperature make a difference? These are all things to look for and will have slightly different techniques used to manage. If you aren’t sure what your specific triggers are, I recommend taking 3-5 days to journal your blood pressure readings, symptoms and to notice your triggers.
- Once you learn what your triggers are, it’s time to make a plan! Here are the most common triggers and actions you can take:
- Waking up first thing in the am dehydrated/sitting up quickly in bed – Try drinking a glass/bottle of water BEFORE getting out of bed; bonus if you add himalayan sea salt to your water to increase absorption. You can also do some quick exercises while seated to get the blood flowing back towards the brain. These include heel raises, leg kicks, marching, arm raises overhead, arm circles, hand squeezes, etc.
- If you get lightheaded or dizzy in the shower, be sure to have a seat or chair in the shower. This could be a built-in seat or a portable shower chair or tub bench. You may also want to use water that is warm, but not hot.
- If you are usually pretty good but after an hour of exercise or after any intense exercise you get symptomatic (overly fatigued, lightheaded, faint, weakness in legs, etc), drink a glass of water prior to your exercise session drink water throughout the session. Better yet if you add some Himalayan salt or liquid IV , LMNT , HYDRATE or similar electrolyte supplements. Gatorade or Powerade is not recommended due to the high sugar content and artificial dye as well as artificial sweeteners in the lower calorie versions. Artificial sweeteners have been tied to increased cancer risk as well as metabolic syndrome. Another thing you can do while exercising is use some sort of compression. This could be compression socks (thigh high is better than knee high), bike shorts with compression, or an abdominal binder. A recent study found that abdominal binders typically provide better assistance with improving blood pressure than compression socks. Thigh high compression socks can be difficult to get on and off, which may contribute to their decreased effectiveness or lack of use. If you want to try leg compression but have trouble getting compression socks on, you can try compression garments with velcro. These can be pricey and, as mentioned, have been found to be less effective overall than an abdominal binder.
- Standing up for prolonged periods in one spot (standing still) – try to keep moving, shifting weight, changing positions frequently when standing. This can include putting one foot up on a stool or other surface, sitting periodically – especially with one ankle crossed across the other knee with figure 4 position, bending forward with hands on knees or on a stable object, cross legs with wide stance – hold on for balance if needed. If you feel symptomatic on walks or runs, it could be beneficial to use walking poles to help with stability and provide an opportunity to practice bending forward to relieve symptoms.
- Some people may feel lightheaded or faint after eating. This is called postprandial hypotension. It can be helpful to eat smaller, more frequent meals if this occurs and to avoid any super high carbohydrate meals. Avoiding or limiting alcohol is best. In contrast, if your blood pressure INCREASES when you lay down to hypertension levels, drinking a glass of wine at night has been shown to improve this.
- Other helpful tips to manage orthostatic hypotension:
- Elevating the head of the bed at night when sleeping – this can decrease risk of high blood pressure when laying down and can improve NOCTURIA, aka urinating frequently at night as well as decrease risk of being dehydrated when you wake up in the am. The angle of the head of bed needs to be fairly high. You could achieve this with multiple pillows, a recliner or an electric bed that raises the head and/or the feet.
- AVOID deconditioning, AKA not exercising. If you are sedentary, your body will further lose the ability to adjust to position changes. If you have been sedentary for some time, or have never exercised, it is important to meet with a physical therapist who can assess you and determine what exercise is best for you to get started with. You may need one on one therapy and/or exercise sessions to start.
- Increase salt intake – after a discussion with your physicians.
- If you feel symptoms coming on, assume one of the positions that can ease drop in pressure – crouching down, sitting in figure 4 position in a chair, standing with legs crossed in a wide stance, leaning forward (if can do safely and have something to hold onto).
- If you haven’t done so already, it is important to have all of your medications reviewed by a physician to see if any of them may be contributing to your orthostatic hypotension. This could be your Parkinson’s medications but could also be other medications such as cardiovascular, urinary, pain medications, etc.
- Avoid Valsalva (holding your breath) – don’t strain during bowel movements (this could cause fainting and is also hard on your pelvic floor which could increase trouble with constipation), don’t hold your breath when lifting or changing positions, etc.
- Bolus water drinking – if really symptomatic and/or you suspect dehydration, it could be helpful to do a “bolus drink”. This involves chugging 16 oz of water within 2-3 minutes. This can elicit a sympathetic reflex within 5-10 minutes and increase bp.
- If you have tried all of these things and your blood pressure is still dropping, talk with your physician about trying medications that can increase blood pressure when you are upright. There are several different ones. These can be helpful but do present challenges in that they can cause high blood pressure when laying down. Typically, you will want to avoid laying down within several hours of taking these medications.
So, as you can see, if you have low blood pressure or orthostatic hypotension, there are several options that you can try in order to decrease symptoms and allow you to exercise safely. If you aren’t sure where to start, reach out to us at Big Heart Center for Brain Change for a consultation. We’re more than happy to help you set up a plan.