What Astronauts and POTS Patients Have in Common: Lessons in Physical Adaptation

About This Blog

Dr. Joseph Schneider brings over 35 years of experience as a functional neurologist to his practice at the Hope Brain and Body Recovery Center. Working alongside Joseph Quirk, a specialized exercise rehabilitation expert, they have helped thousands of patients rebuild their nervous systems after various injuries and conditions. Their unique approach to treating Postural Orthostatic Tachycardia Syndrome (POTS) and dysautonomia sets them apart in a field where patients often wait months to see specialists at traditional medical centers.

In a recent podcast discussion, Dr. Schneider and Joseph Quirk explored a fascinating comparison: the similarities between astronauts returning from extended space missions and patients suffering from dysautonomia. This comparison isn't just clever—it provides a clear framework for understanding how our bodies adapt (or fail to adapt) to environmental changes and why a functional neurology approach focuses on rebuilding these adaptive capacities rather than simply managing symptoms.

The conversation tackles how our bodies' autonomic systems—those controlling circulation, digestion, and energy regulation—deteriorate when not properly stimulated, just as muscles atrophy in zero gravity or during prolonged inactivity. Through this lens, we gain new insights into why POTS and dysautonomia treatment requires a comprehensive approach that goes far beyond medication management to include lifestyle changes, nutrition modifications, and carefully calibrated exercise programs.

The Astronaut Analogy  

When astronauts return to Earth after months in space, they experience severe physical challenges adapting to gravity again. Their muscles have atrophied, their cardiovascular systems have changed, and even their nervous systems show altered function. Dr. Schneider describes how astronauts often appear ill during press conferences after returning, having lost peripheral nerve function, central nervous system capabilities, muscle mass, and capillary networks—essentially everything their bodies need to function normally in Earth's environment.

This same pattern occurs in patients with dysautonomia, though the trigger may be different. Instead of zero gravity, these patients may have experienced viral infections like COVID-19, physical trauma, or environmental toxins that compromised their body's ability to adapt. The nervous system, designed to help us react appropriately to our environment—whether it's changes in temperature, gravity, or oxygen levels—becomes dysregulated. The result is a cascade of symptoms affecting virtually every system in the body.

The comparison highlights a critical point about recovery: just as astronauts must methodically retrain their bodies to function in gravity again, POTS patients need systematic retraining of their autonomic nervous systems. Dr. Schneider emphasizes that our bodies are designed to adapt to environmental changes, but each person has different time constants and adaptation capacities. This explains why cookie-cutter approaches to POTS treatment often fail—each patient's nervous system requires an individualized rehabilitation program based on their specific deficits and adaptation abilities.

The Whole-Body Impact of Dysautonomia  

While POTS is often characterized primarily by cardiovascular symptoms—rapid heart rate upon standing, lightheadedness, and blood pressure fluctuations—Dr. Schneider and Quirk emphasize that dysautonomia affects virtually every system in the body. They describe patients experiencing everything from digestive issues and chronic pain to severe fatigue and cognitive dysfunction. These wide-ranging symptoms reflect the autonomic nervous system's role in regulating all involuntary bodily functions.

The podcast reveals how these comorbidities create complex challenges for patients. Many experience chronic fatigue, widespread pain, headaches, nausea, gastrointestinal issues, and even eating disorders as their bodies struggle to maintain normal function. One particularly interesting discussion centers on constipation—a common symptom Dr. Schneider also experienced after his stroke. He describes how autonomic dysfunction can affect the basal ganglia, leading to digestive motility issues that become not just physically uncomfortable but emotionally distressing over time.

This whole-body perspective explains why traditional medical approaches focusing solely on heart rate and blood pressure management often fall short. When a patient presents with POTS, they're not just experiencing cardiovascular dysregulation—they're dealing with a complex interplay of systems all governed by an autonomic nervous system that's no longer properly responding to environmental demands. This understanding drives the functional neurology approach, which aims to address the central nervous system connections often overlooked in conventional treatment.

Dr. Schneider's Personal Journey  

Dr. Schneider shares personal insights from his stroke recovery journey, providing a vulnerability and authenticity that enriches the conversation. After experiencing three concussions and then a stroke, which he describes as "shake the shit out of me hard" difficult, he faced many of the same challenges his patients encounter. His previous active lifestyle—biking, running, water skiing, swimming—became almost impossible as he dealt with loose ankles that would easily sprain, making even walking difficult.

This personal experience taught him valuable lessons about recovery that he now applies with patients. One key insight is that consistent daily movement—even just 10 minutes—proves more beneficial than sporadic intense exercise for rebuilding adaptive capacity. After eight years of recovery efforts and struggling with his weight, he realized that daily consistency matters more than duration or intensity. He now approaches exercise with the mindset that doing something small every day yields better results than pushing hard occasionally.

His stroke also led to autonomic issues like constipation, which helped him understand the emotional impact of these seemingly "minor" symptoms. This personal experience allows him to connect more deeply with patients and develop more effective treatment strategies. By sharing his own journey from athleticism through injury to gradual recovery, Dr. Schneider demonstrates that rebuilding autonomic function is possible but requires patience, consistency, and respect for the body's current limitations.

Finding Your Metabolic Sweet Spot  

Exercise presents both significant challenges and therapeutic opportunities for POTS and dysautonomia patients. Many experience severe exercise intolerance, reaching their metabolic limit much earlier than expected during physical activity. The specialized exercise with oxygen therapy used at the Hope Brain and Body Recovery Center provides valuable real-time data about how a patient's autonomic system responds to physical exertion. Joseph Quirk describes observing unusual patterns, such as heart rates dropping when they should increase—a sign that metabolism has hit its threshold and the body is essentially shutting down.

Dr. Schneider shares his experience training for a marathon using the "180 minus your age" formula to establish his maximum aerobic heart rate. Initially frustrated by the limitation, he persisted with the approach, finding that after about two months, he could run uphill at the same heart rate but significantly faster. This demonstrated how training within appropriate metabolic zones actually improves performance over time—a principle particularly relevant for dysautonomia patients who often push too hard too quickly.

The hosts emphasize that recovery requires gradual, progressive training of the nervous system through properly calibrated exercise intensities. They use the analogy of a diving platform: their treatment program gets patients to the edge of the platform, but patients must then continue "diving" repeatedly—practicing the skills and building capacity through consistent effort. This approach directly counters the common misconception that patients can simply complete a therapy program and be "cured." Instead, rehabilitation requires ongoing lifestyle changes and appropriate exercise intensities tailored to each patient's metabolic threshold.

Keys to Successful Exercise for POTS and Dysautonomia Patients:  

• Start with extremely short durations (even just 1-2 minutes) if severely deconditioned

• Keep heart rate within the appropriate range (often calculated as 180 minus your age)

• Monitor oxygen levels during activity

• Pay attention to recovery time between sessions

• Increase intensity and duration gradually based on objective measurements

• Include both cardiovascular and strength training when appropriate

• Prioritize consistency over intensity

• Stop immediately if experiencing lightheadedness or unusual symptoms

Taking the First Step Toward Recovery  

Living with POTS or dysautonomia can feel like being an astronaut stranded in a hostile environment—your body no longer responds appropriately to everyday challenges. However, as Dr. Schneider and Joseph Quirk demonstrate through their work at the Hope Brain and Body Recovery Center, recovery is possible with the right approach. By understanding dysautonomia as a whole-body condition affecting multiple systems, patients can move beyond simply managing symptoms to actually rebuilding their body's adaptive capacities.

The path forward begins with recognition that these conditions affect more than just heart rate—they impact everything from digestion and energy production to cognitive function and emotional regulation. Recovery requires addressing the central nervous system connections often overlooked in conventional treatment, along with making consistent lifestyle changes that support autonomic function.

If you're struggling with symptoms of POTS or dysautonomia, take the first step today by establishing a daily movement practice, even if it's just 10 minutes of gentle activity. Focus on consistency rather than intensity, and gradually build your capacity over time. Consider seeking out practitioners experienced in functional neurology who understand these conditions from a whole-body perspective. Remember that like an astronaut returning to Earth, your body needs time to readapt—but with the right approach, you can gradually reclaim your life and expand your capabilities beyond what currently seems possible.

Connect with Dr. Joseph Schneider:

Website: Hope Brain and Body Recovery Center

LinkedIn: Joseph Schneider

YouTube: @hopebrainbodyrecoverycenter

Instagram: @hopebraincenter_

Facebook: Hope Brain and Body Recovery Center