Aerobic Training for Patients Living with POTS

Instructions
Your doctor or health care provider has decided that you may benefit from unique exercise training program that is based on a program developed
and researched done by Dr. Benjamin Levine for patients primarily suffering from Postural Orthostatic Tachycardia Syndrome (POTS). Trying this
program is a decision that you need to be 100% committed to for yourself and your health. This program includes using the following techniques to
remedy the physiologic conditions that may be causing your suffering from this syndrome: increased water and salt intake, raising the head of your
bed, (both covered in a separate handout) performing cardiovascular aerobic exercise 3-5 days a week, and strength training 2 days a week (see
separate handout for exercises). You will need access to a wide variety of gym equipment and therefore it is recommended that you join an exercise
facility. Many patients follow this program without help, or have a friend, family member, personal trainer or physical therapist oversee your
progress. We believe it is imperative for POTS patients to begin with cardio and strength training exercise in a more horizontal position and progress
over many weeks to upright activity (each patient does this at their own rate, but we give a specific outline in the Monthly Training Calendars).

The major challenge with implementing exercise therapy is being regular and consistent with the program for at least 3 months. Patients often
complain that they feel more fatigued in the first few weeks of exercise and may abandon the program before any benefits are realized; this
possibility must be anticipated, and we encourage you to persevere with the program, because tolerance does improve as you become more fit. In
order to preserve symptomatic improvement, you are encouraged to continue a lifelong habit of regular exercise.

The Structure of the Training Calendars

Your healthcare provider may choose to have you begin with Month 1, Month 2, or Month 3 of training. This is up to them based upon your
condition. Training during these first months should only utilize the following horizontal modes: recumbent biking, rowing, and/or swimming laps or
kicking laps with a kickboard. Month 4 is when people can usually begin to use the upright bike, and Month 5 or 6 is when people can generally
incorporate the more upright modes (elliptical and treadmill walking).

Think about the calendars as a week-by-week guide. You need to complete all the training for that week within each week. You may shift training
sessions on the calendar a day or so before or after it is scheduled. However, it is important that all sessions for that week then are shifted so the order
they are performed is maintained as prescribed (and you complete all workouts for that week within a week). One requirement is that after ‘Moderate
Steady State’ workouts you must always complete a ‘Recovery’ workout the next day. A ‘Recovery’ workout can actually be doing anything active
as long as your effort stays below the zone prescribed. Recovery workouts can be done by slowly cycling at a low level on the recumbent bike, using
a kickboard to leisurely kick laps in the pool, taking a walk outdoors, playing in the yard with your kids, anything active that gets you moving
continuously for the prescribed amount of time.
Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
There are a few other points to keep in mind. If for some reason you miss a period of workouts (illness, injury, etc.) it is best to back up in the
calendar and repeat cardio workouts. For example, if you miss several cardio workouts, back up and repeat a full week. If you miss a week, back up
and at least repeat 1 ½ -2 weeks. If you’ve stopped for more than 2 weeks, you may want to consider beginning all over again. The program gets
progressively more difficult, and when you take time off you lose some of your hard-earned conditioning, therefore it is important to back up and
repeat some workouts. You may also need to return to training with the first more horizontal modes of training (i.e. recumbent bike, swimming,
rowing only) before moving forward in the program again.
TIPS:
• Use what you have access to and can tolerate training but starting with one horizontal mode of training is key!
• Keep the workouts spread out throughout the week. This is more beneficial than bunching them up and then taking several days off from
exercising. Try not to take more than 2 days off from exercising. This is KEY!!
• If you cannot complete all the sessions for that week, you need to repeat that entire week again before moving forward.

Basics of Horizontal to Upright Aerobic Training

In the beginning, for this program you need to use equipment that keep you seated or horizontal: the recumbent bike, a rowing ergometer (such as
the Concept II rower), and swimming (or kicking with just a kickboard) because they will not exacerbate any symptoms you have by being in the
upright position. Use these modes until you feel you are ready to try moving on to the upright bike (incorporate this for a few weeks), the elliptical
(incorporate this for a few weeks—no arm motion at first) and then some treadmill walking (no incline at first). Lastly, you can increase speed and
grade on the treadmill as is necessary to keep your heart rate in the correct heart rate zone for your workouts. You may not be able to add an incline
on the treadmill until after you have completed Months 5 of training. It may be hard to imagine walking on the treadmill for exercise right now, but
most POTS patients that have done this program have been able to utilize a treadmill for walking workouts by the end of Months 5 or 6. In general,
your monthly aerobic exercise plan includes:
Months 1-3 = Horizontal, recumbent or seated training
- When beginning this exercise program, you need to use equipment where you are seated or horizontal in position because upright
positions will likely make your symptoms worse. Examples include:
o Recumbent bike
o Rowing ergometer
o Swimming (or kicking with a kickboard)
o Seated stepper or peddler machine
Month 4 = Upright bike

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 Month 5 = Upright exercise
- Elliptical (begin without arm motion and then add after a few weeks)
- Treadmill walking (no incline at first)
Month 6-8 = Upright Training
- Add arm motions on the elliptical and incline on the treadmill
- Make more challenging during this time as tolerated.
o Jogging and stair stepping can be tried only after you have performed either elliptical with use of arms or treadmill walking on
an incline and did not have an increase in symptoms. You do not ever have to jog if you do not want to.
TIPS:
• Begin with the upright bike, rower, or elliptical as these are safer than the treadmill for interval training. Try to treadmill only when
you are ready.
• You can add any strength training you want, and try other things like yoga, aerobics classes, returning to competitive sports as you feel
able (we do not recommend any exercise in the heat).
• Consider yourself on a path to wellness and do what you feel you can do! We often hear that symptoms continue to decrease with long
term training.
• Remember each patient progresses through the program to upright exercise at a different pace and that is okay!
• Please note exercise in the heat is not recommended for patients with POTS.

Long Term Aerobic Training

Months 6-8 of training is different for each person. Some people choose to maintain the level of training laid out in Month 5 forever, but we
recommend trying to push forward. After you have completed the program, you should continue to exercise to maintain what you have
worked for. During this time you can use whatever modes you enjoy most.

High intensity interval training is a name for the training that begins in calendar Month 6. It has been shown to provide great benefits to the
heart and lung’s response to exercise for healthy individuals and several patient populations. We have found it to be beneficial to patients with
POTS when it is introduced at a time when they are ready for it and responding well to their training. Here is an example of how to perform this
training:
- Step 1: 10 minute- warm up to get your effort (RPE) up to Light Pace zone
- Step 2: 1 minute- go “all out”, hard and fast, increasing the resistance and speed on the mode you are using, and trying to get your
effort (RPE) up to your Hard Pace zone
Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 - Step 3: 1 minute- remove all resistance, slow down, and actively recover.
o Take this time to get a drink but keep moving on the piece of equipment. It doesn’t matter what your HR gets down to.
- Step 4: Repeat steps 2 and 3 for two to three more trials.
- Step 5: 5-10 minute cool down
- Step 6: 20-minute Recovery workout. Recovery workouts should feel light and easy.

Exercise Training Principles

Warm Up and Cool Down:
- Can be done on any piece of equipment and should NEVER be skipped.
- At the end of your warm-up you should have your level of effort approaching the appropriate level of effort for your prescribed
workout, so you can simply begin your workout time then.
- For the cool down, simply remove all resistance from the piece of equipment you are using and slow down.
• In the beginning, your level of effort and heart rate will take a long time to recover (and may not fully recover until after you
leave the gym), but as you become more trained it will lower more quickly during your cool down
- Try performing stretching during or after your 5-10 minute cool down is complete. You should hold each stretch for 30 seconds and
repeat 3-4 times on each side. Only stretch to the point where you begin to feel resistance. It should feel a little uncomfortable, but it
should not hurt.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 Monitoring Your Exercise Intensity - Monitoring Your
Perceived Effort
The RPE scale (Rating of Perceived Exertion) runs from 0 – 10. The numbers below relate to how easy
or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a
chair or lying down; 10 (very, very heavy) is how you feel at the end of an exercise test or after a very
difficult activity or max effort.
Each aerobic workout is prescribed to be within a specific RPE range, and it is important that you
complete the workout in that RPE range.

Do not concern yourself with any one factor such as leg pain or shortness of breath, but try to
focus on your total feeling of exertion. Look at the rating scale while you exercising. Choose the
number that best describes your level of exertion. Try to evaluate your feeling of exertion as
honestly as possible. It is your own feeling of effort and exertion, not how it compares to other
people's scores.

• The specific exercise intensity zones have been prescribed for you and your condition. The
workout zones are defined below.

Expected RPE
Training Zone
(Rating of Perceived Exertion)
Light Pace (LP) 2-4
Moderate Steady State (MSS) 5-7
Hard Pace (HP)/Interval Pace 8-9
Recovery 0-2

If these exercise zones feel too easy or difficult, please let us know. Please keep in mind that in the beginning most of the workouts may feel
tough. As you become trained, more work will be required to maintain your RPE!

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 What to Expect Getting Started
This program is not an easy fix to having POTS, and if exercise made everyone feel better in a matter of weeks, everyone would be doing it. The
real results will be seen after several committed months of training. The first month may be very difficult, and you may feel increased fatigue
during this month. This is not surprising, so do not give up! You are challenging your system to do things it CAN do but is not USED TO doing.
The second month may still be tough. The hope is that you’ll feel less fatigue, begin to sleep better, and suffer from fewer POTS symptoms in your
daily life than you did before beginning the training. This is the goal!!!
TIPS:
• Your commitment and mental toughness are key.
• When you begin with a new mode of training, it is not uncommon to feel increased fatigue. Listen to your body. Push forward when
you can or repeat a week if you feel you need to.
• If you are anything like the individuals we’ve met with POTS, you probably do not feel good most of the time, and have tried several
other things to make your condition better, here is the question we are proposing to you: Why not give this program your utmost effort
for 3-5 full months before deciding if it helps you or not? Remember the benefits of training occur after months of training and not just
days or weeks.

• Write down a list of things you want to resume in your life, tape it to your bathroom mirror, and read it every day. Read it especially
on the days you do not feel like going to the gym— allow it to help motivate you to get your quality of life back.
• Get a workout buddy if you need one! They might not be able to follow your training zones, but they can work out with you!
• Ensure your family is on board supporting you on this journey. Help them understand you may feel more tired in the beginning, but
the hope will be to feel better in the long run.
• Family support is important, but YOU need to be the one to take the responsibility to make this change happen.

Exercise as Your Lifelong Therapy

If you feel that exercise is helpful for you in any way, maintaining exercise will then be important for you to keep the benefits and continue to
see further improvements in your health and quality of life. Furthermore, you will experience the benefits of regular exercise in many other
areas of your life and health, as well. Many patients successfully resume caring for their children, full-time work, full-time school, or enter
college when previously they thought that these things might be impossible. We hope that this is the case with you as well. Keep in mind that
according to the Canadian Guidelines every healthy adult should perform 30-60 minutes of exercise more days than not. Think of exercise as
part of your daily personal hygiene program. Some patients feel that daily exercise is needed to avoid developing symptoms again.
Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 If you have an illness, setback, or quit exercise, and realize that you felt better while training, this is a good sign! Do not be discouraged. You
have a good response to exercise, and you know that it makes you feel better! Just start again. You need to begin with horizontal modes of
training, but you will know how to progress through the program again.

YOU CAN DO IT!!

Please remember!!!
We are available for questions or concerns; however, we ask that should there be a sudden change in your symptoms or sudden beginning of a
new symptom that you contact your primary care provider first. We want them to be able to help you assess whether there is an emergency
problem, and you should go to the Emergency Department, be seen in the office, or if the issue can be handled through a call made to us by you
or your primary care provider.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 1
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1
5-10 min Warm Up 5-10 min Warm Up 5-10 min Warm Up
3 min Light Pace 3 min Light Pace 3 min Light Pace
2 min Recovery 2 min Recovery 2 min Recovery
3 min Light Pace 3 min Light Pace 3 min Light Pace
5-10 min Cool down 5-10 min Cool down 5-10 min Cool down

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1
5-10 min Warm Up 5-10 min Warm Up 5-10 min Warm Up
4 min Light Pace 4 min Light Pace 5 min Light Pace
3 min Recovery 3 min Recovery 3 min Recovery
4 min Light Pace 4 min Light Pace 5 min Light Pace
5-10 min Cool Down 5-10 min Cool Down 5-10 min Cool Down

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1
5-10 min Warm Up 5-10 min Warm Up 5-10 min Warm Up
5 min Light Pace 6 min Light Pace 6 min Light Pace
3 min Recovery 3 min Recovery 3 min Recovery
5 min Light Pace 6 min Light Pace 6 min Light Pace
5-10 min Cool Down 5-10 min Cool Down 5-10 min Cool Down

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1
5-10 min Warm Up 5-10 min Warm Up 5-10 min Warm Up
6 min Light Pace 7 min Light Pace 7 min Light Pace
3 min Recovery 3 min Recovery 3 min Recovery
5 min Light Pace 5 min Light Pace 5 min Light Pace
5-10 min Cool Down 5-10 min Cool Down 5-10 min Cool Down
Training Mode 1 = any of supine cycling, recumbent bike, swimming laps with a kick board, rowing, seated stepper
Recovery = slow down, reduce resistance, get a drink, but don’t stop moving.
Warm ups and cool downs are done starting very slowly with little or no resistance and leading up to and out of your Light Pace RPE = 2-4 zone.
Weight training can be done on the same days as cardio workouts if necessary.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 2
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Training Mode 1 Training Mode 1 Training Mode 1
10 min Warm Up Strength Training 10 min Warm Up Strength Training 10 min Warm Up
5 min Light Pace 5 min Light Pace 5 min Light Pace
2 min Recovery 2 min Recovery 2 min Recovery
5 min Light Pace 5 min Light Pace 5 min Light Pace
2 min Recovery 2 min Recovery 2 min Recovery
5 min Light Pace 5 min Light Pace 5 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down
Training Mode 1 Training Mode 1 Training Mode 1
10 min Warm Up Strength Training 10 min Warm Up Strength Training 10 min Warm Up
6 min Light Pace 7 min Light Pace 8 min Light Pace
2 min Recovery 2 min Recovery 2 min Recovery
6 min Light Pace 7 min Light Pace 8 min Light Pace
2 min Recovery 2 min Recovery 2 min Recovery
6 min Light Pace 7 min Light Pace 8 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down
Training Mode 1 Training Mode 1 Training Mode 1
10 min Warm Up Strength Training 10 min Warm Up Strength Training 10 min Warm Up
10 min Light Pace 11 min Light Pace 12 min Light Pace
3 min Recovery 3 min Recovery 3 min Recovery
10 min Light Pace 11 min Light Pace 12 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down
Training Mode 1 Training Mode 1 Training Mode 1
10 min Warm Up Strength Training 10 min Warm Up Strength Training 10 min Warm Up
13 min Light Pace 14 min Light Pace 15 min Light Pace
4 min Recovery 5 min Recovery 5 min Recovery
13 min Light Pace 14 min Light Pace 15 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down
Training Mode 1 Training Mode 1 Training Mode 1
10 min Warm Up Strength Training 10 min Warm Up Strength Training 10 min Warm Up
20 min Light Pace 24 min Light Pace 27 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 3
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1
5-10 min Warm Up 5-10 min Warm Up 5-10 min Warm Up
30 min Light Pace 30 min Light Pace 30 min Light Pace
5-10 min Cool Down 5-10 min Cool Down 5-10 min Cool Down

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1 Training Mode
5 min Warm Up 5 min Warm Up 5 min Warm Up 40 min Recovery
30 min Light Pace 30 min Light Pace 20 min MSS
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 1 Strength Training Training Mode 1 Strength Training Training Mode 1
5 min Warm Up 5 min Warm Up 5 min Warm Up
30 min Light Pace 30 min Light Pace 30 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 1 Strength Training Training Mode 1 Training Mode 1 Strength Training Training Mode 1
5 min Warm Up 5 min Warm Up 40 min Recovery 5 min Warm Up
30 min Light Pace 25 min MSS 30 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 1 = any of Recumbent Biking, Swimming, Rowing, seated stepper

Weight Training can be done on the same days as Cardio workouts if necessary.
MSS = Maximal Steady State (RPE= 5-7)

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 4
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Training Mode 1 Strength Training Training Mode 2 Strength Training Training Mode 2
5 min Warm Up 5 min Warm Up 5 min Warm Up
30 min Light Pace 20 min Light Pace 20 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 1 or 2 Strength Training Training Mode 2 Strength Training Training Mode 1 or 2 Training Mode 1
5 min Warm Up 5 min Warm Up 5 min Warm Up 40 min Recovery
30 min Light Pace 30 min Light Pace 25 min MSS
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 1 or 2 Strength Training Training Mode 1 or 2 Training Mode 1 Strength Training Training Mode 1 or 2
5 min Warm Up 5 min Warm Up 40 min Recovery 5 min Warm Up
40 min Light Pace 30 min MSS 35 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down

Strength Training Training Mode 1 or 2 Training Mode 1 Training Mode 2 or 3 Strength Training Training Mode 1 or 2
5 min Warm Up 40 min Recovery 5 min Warm Up 5 min Warm Up
35 min MSS 30 min Light Pace 40 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 1 = Any of: Recumbent Biking, Swimming, Rowing

Training Mode 1 or 2 = Either Upright Bike or Rowing
Training Mode 2 = Upright Bike
Training Mode 2 or 3 = Any of: Upright Bike, Treadmill walking (flat grade), Elliptical (stationary arms)
Weight Training can be done on the same days as Cardio workouts if necessary.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 5
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Training Mode 2 or 3 Strength Training Training Mode 2 or 3 Strength Training Training Mode 2 or 3
5 min Warm Up 5 min Warm Up 5 min Warm Up
35 min Light Pace 35 min Light Pace 35 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down

Training Mode 2 or 3 Strength Training Training Mode 3 Training Mode 2 or 3 Training Mode 2 or 3
5 min Warm Up 5 min Warm Up 40 min Recovery 5 min Warm Up
40 min Light Pace 30 min MSS 35 min Light Pace
5 min Cool Down 5 min Cool Down Strength Training 5 min Cool Down

Training Mode 2 or 3 Strength Training Training Mode 2 or 3 Training Mode 3 Training Mode 2 or 3 Training Mode 2 or 3
5 min Warm Up 5 min Warm Up 5 min Warm Up 25 min Recovery 5 min Warm Up
60 min Light Pace 30 min Light Pace 35 min MSS 50 min Light Pace
5 min Cool Down 5 min Cool Down 5 min Cool Down Strength Training 5 min Cool Down

Training Mode 3 Strength Training Training Mode 2 or 3 Training Mode 3 Training Mode 2 or 3
5 min Warm Up 5 min Warm Up 5 min Warm Up 25 min Recovery
35 min Light Pace 45 min Light Pace 40 min MSS
5 min Cool Down 5 min Cool Down 5 min Cool Down Strength Training

Training Mode 2 or 3 = Any of: Rowing, Upright Bike, Treadmill walking (flat grade), Elliptical (stationary arms) – MIX IT UP when ready to do more upright modes!
Training Mode 3 = If you are ready: Treadmill walking (with incline), Elliptical (arms and legs) (if not, stick with Rowing and Upright Bike)
Weight Training can be done on the same days as Cardio workouts if necessary.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 6
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up

45 min Light Pace Strength Training 40 min Light Pace 60 min Light Pace Strength Training 45 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down

10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up

Strength Training 30 min Light Pace 3x1 min Intervals 45 min Light Pace Strength Training 30 min MSS
10 min Cool Down 5 min Cool Down 10 min Cool Down 10 min Cool Down
20 min Recovery

25 min Recovery
10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up
Strength Training 35 min Light Pace 35 min MSS Strength Training 4x1 min Intervals 40 min Light Pace
10 min Cool Down 10 min Cool Down 5 min Cool Down 10 min Cool Down
20 min Recovery

10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up
60 min Light Pace Strength Training 5x1 min Intervals 45 min Light Pace Strength Training 30 min Light Pace 30 min MSS
10 min Cool Down 5 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down
20 min Recovery

Training modes are not listed because individuals should continue to progress to upright modes as tolerated.
We recommend beginning Interval training on the rower, upright bike or elliptical. Can progress to jogging as able.
Weight Training can be done on the same day as Cardio if necessary.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 7
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

10 min Warm Up Strength Training 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
60 min Light Pace 45 min Light Pace 45 min Light Pace 60 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down

Strength Training 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
5x2 min Intervals 45 min Light Pace 40 min Light Pace 40 min MSS
5 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down
20 min Recovery

10 min Warm Up Strength Training 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
60 min Light Pace 5x2 min Intervals 45 min Light Pace 5x2 min Intervals 40 min MSS
10 min Cool Down 5 min Cool Down 10 min Cool Down 5 min Cool Down 10 min Cool Down
20 min Recovery 20 min Recovery

10 min Warm Up Strength Training 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
60 min Light Pace 40 min MSS 45 min Light Pace 5x2 min Intervals 60 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down 5 min Cool Down 10 min Cool Down
20 min Recovery

Training modes are not listed because individuals should continue to progress to upright modes as tolerated.
We recommend beginning Interval training on the rower, upright bike or elliptical. Can progress to jogging as able.
Weight Training can be done on the same day as Cardio if necessary.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020
 MONTH 8
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Strength Training 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
45 min Light Pace 45 min Light Pace 45 min Light Pace 10 40 min MSS
10 min Cool Down 10 min Cool Down min Cool Down 10 min cool Down

10 min Warm Up Strength Training 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
60 min Light Pace 45 min Light Pace 45 min MSS 45 min Light Pace 7x2 min Intervals
10 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down 5 min Cool Down
20 min Recovery

Strength Training 10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training
5x3 min Intervals 45 min Light Pace 45 min MSS 45 min Light Pace 5x3 min Intervals
5 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down 5 min Cool Down
20 min Recovery 20 min Recovery

10 min Warm Up Weight Training 10 min Warm Up 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up
60 min Light Pace 10x2 min Intervals 45 min Light Pace 45 min MSS 60 min Light Pace
10 min Cool Down 5 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down
20 min recovery

Strength Training 10 min Warm Up 10 min Warm Up Strength Training 10 min Warm Up 10 min Warm Up
45 min MSS 45 min Light Pace 45 min Light Pace 45 min Light Pace
10 min Cool Down 10 min Cool Down 10 min Cool Down 10 min Cool Down

Training modes are not listed because individuals should continue to progress to upright modes as tolerated.
We recommend beginning Interval training on the rower, upright bike or elliptical. Can progress to jogging as able.
Weight Training can be done on the same day as Cardio if necessary.

Adapted from Children Hospital of Philadelphia (CHOP), Dr. Levine protocol (Texas)
Revised May 2020