Welcome to the Interactive Poor Man's Tilt Table and NASA Lean Test. This educational tool is designed to help you explore how your body responds to positional shifts, like standing up from lying down. By tracking blood pressure and heart rate changes during these shifts, you can uncover patterns about how your body adapts. While not a diagnostic test, your results can be shared with your healthcare provider and can be a helpful way to gather insights for personal understanding.
Changes in position can sometimes reveal signs of orthostatic intolerance, which is difficulty in regulating blood flow and heart rate when standing upright. This is often seen in conditions like Postural Orthostatic Tachycardia Syndrome (POTS), Orthostatic Hypotension (OH), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Long COVID.
Jump to:
- How to do the Poor Man’s Tilt Table and NASA Lean Tests
- Interpreting Tilt Table Test Results
- Frequently Asked Questions
- POTS and Dysautonomia Resources
How to do the Poor Man’s Tilt Table and NASA Lean Tests
Explore the detailed guide below, or try the interactive experience by pressing "Start Test" on the tool above.
Here’s what you’ll need:- 20 minutes of uninterrupted time
- A flat surface to lie down on
- A wall to lean your back against
- Another person with you to monitor and help record
- A blood pressure cuff that can also measure heart rate
If your blood pressure cuff takes multiple measurements, change it to only record single measurements for the test.
Optional: A pulse oximeter can measure heart rate more accurately if you have one.
Overview of the test:
- Lie down for 10 minutes
- Measure your heart rate and blood pressure while lying down
- Stand and lean against the wall at a slight angle (your feet ~6 inches or 15cm away from the wall) for 10 minutes.
- Measure your heart rate and blood pressure at 1, 3, 5, 7 and 10 minutes.
1. Lie down for 10 minutes
Stay relaxed and ensure you’re in a quiet, calm environment.
Keep your blood pressure cuff and heart rate monitor on or within easy reach to take measurements conveniently before standing up. If your blood pressure cuff also takes your heart rate, a separate heart rate monitoring device is not required.
Start a timer for 10 minutes.
2. Measure your heart rate and blood pressure while still lying down
After 10 minutes of lying down, measure your blood pressure using a blood pressure cuff.
Measure your heart rate in beats per minute (bpm). You can use your blood pressure cuff for this if it has a heart rate functionality, however a pulse oximeter can provide a more accurate measurement. You can also take your heart rate manually or with a smart device, although these methods may be less accurate.
3. Prepare to stand up
Next, you'll stand up normally. No need to rush. Place your back against the wall, move your feet out ~6 inches (15cm), and ensure that only your shoulders are making contact with the wall.
Keep your blood pressure cuff on, and be ready to record at the 1-minute mark.
4. Stand and lean on wall
Stay relaxed. After 1 minute of standing, record your heart rate and blood pressure. Repeat this step again at minutes 3, 5, 7, and 10.
5. Record if you've experienced any of the following symptoms as a result of this test:
- Dizziness
- Lightheadedness
- Nausea
- Blurred vision
- Fainting
Interpreting Tilt Table Test Results
If within the first three minutes of standing, your:
- Systolic blood pressure decreased by more than 20 mmHg
- Or diastolic blood pressure decreased by more than 10 mmHg
This may be associated with orthostatic hypotension, which describes an abnormal and sudden drop in blood pressure after standing or sitting up, regardless of heart rate changes.
If after three minutes of standing, your:
- Systolic blood pressure decreased by more than 20 mmHg
- Or diastolic blood pressure decreased by more than 10 mmHg
This may be associated with delayed orthostatic hypotension. This is characterized by a delayed ability for the body to regulate blood pressure when moving to an upright position from sitting or lying down.
If you experienced a sustained heart rate increase of 30 bpm or more, without a significant change in blood pressure (no more than 20/10 mmHg):
Your doctor may consider additional testing for Postural Orthostatic Tachycardia Syndrome (POTS). These criteria match those set by clinical tilt table tests to test for POTS, which is a form of orthostatic intolerance and dysautonomia.
If you experienced symptoms of dizziness, lightheadedness, nausea, blurred vision, or fainting, without significant changes in your heart rate or blood pressure:
It's best to consult with your provider. There are a number of reasons why these symptoms can occur, and your physician can take you through formal testing and evaluation.
If you didn't experience any symptoms nor a significant change in your heart rate and blood pressure:
This suggests that your body is maintaining blood pressure and heart rate appropriately when transitioning to a standing position. If you have any concerns about your health, however, it’s best to consult with a physician.
Frequently Asked Questions
What is the 10-minute NASA Lean Test?
The 10-minute NASA Lean Test is a screening method for orthostatic intolerance (OI), including conditions like Postural Orthostatic Tachycardia Syndrome (POTS) and orthostatic hypotension (OH). By assessing OI, the NASA 10-minute lean test can also serve as a useful indicator for associated conditions like ME/CFS, fibromyalgia, and long COVID.
Originally developed by NASA for experimental purposes, it provides a practical way to evaluate how the body responds to standing upright after a period of lying down. This test can be performed in clinical and non-clinical settings, but its methods have yet to be repeated by sufficient studies for it to be considered ‘gold standard’ for diagnosing OI.
How is the 10-minute NASA Lean Test different from the Poor Man’s Tilt Table Test?
The 10-minute NASA Lean Test and Poor Man’s Tilt Table Test both assess orthostatic intolerance (OI) but differ in their protocols:
Measurement Frequency:
- The NASA Lean Test records blood pressure and heart rate every minute for 10 minutes while standing, providing detailed data on the body's response to prolonged standing.
- In contrast, the Poor Man's Tilt Table Test typically only involves three measurements, recording once after lying down, then twice after 5 and 10 minutes of standing.
Posture:
- During the NASA Lean Test, individuals stand with their shoulder blades against a wall and heels approximately 6 inches away, minimizing muscle involvement to reduce its effect on blood flow.
- The Poor Man's Tilt Table Test generally requires standing still without specific posture guidelines.
Clinical Validation:
- The NASA Lean Test is a standardized method developed for clinical assessment of orthostatic intolerance, although it still requires more thorough validation through repetition in future studies.
- The Poor Man's Tilt Table Test is a simplified, home-based approach that offers preliminary insights but lacks formal clinical validation.
How accurate are the Poor Man’s Tilt Table and NASA Lean Tests?
The Poor Man’s Tilt Table Test and NASA Lean Test follow similar criteria to a clinical tilt table test, helping to provide insights into heart rate and blood pressure changes when standing. However, they are at-home tools to help with screening, not diagnostic tests.
A clinical tilt table test offers greater accuracy by using continuous monitoring, controlled tilt angles, and medical supervision to rule out external factors like muscle engagement or dehydration. The NASA Lean Test is a more structured version of the Poor Man’s Tilt Table Test, with stricter positioning and more frequent measurements, making it slightly more standardized.
While not as precise as a formal tilt table test, these at-home tests can provide data for a healthcare provider to evaluate further. For best accuracy, use a high-quality blood pressure cuff and heart rate monitor, follow testing guidelines carefully, and repeat the test to confirm patterns.
What’s a tilt table test?
A tilt table test is a clinical procedure used to evaluate the causes of unexplained fainting (syncope), dizziness, or lightheadedness. During the test, the patient lies on a special table that transitions from a horizontal to an upright position while healthcare providers monitor heart rate and blood pressure responses to changes in posture. This test helps identify conditions like orthostatic hypotension, where blood pressure drops significantly upon standing, and postural orthostatic tachycardia syndrome (POTS), characterized by an excessive heart rate increase upon standing.
What’s the difference between the NASA Lean Test / Poor Man’s Tilt Table Test and a clinical tilt table test?
The Poor Man’s Tilt Table Test and NASA Lean Test are simplified, home-based versions of the clinical tilt table test. In a formal clinical setting, the patient lies on a motorized table that tilts them to different angles while continuous monitoring of heart rate, blood pressure, and symptoms occurs. The test may include interventions like medications or nitroglycerin to provoke responses.
What is orthostatic intolerance (OI)?
Orthostatic intolerance (OI) is a condition in which the body has difficulty regulating blood flow and blood pressure when transitioning to an upright position, such as standing or sitting up. This leads to symptoms like dizziness, lightheadedness, fainting, rapid heartbeat, fatigue, nausea, and difficulty concentrating (often called "brain fog").
OI occurs because the cardiovascular system struggles to maintain proper blood circulation against gravity. It’s often associated with conditions like Postural Orthostatic Tachycardia Syndrome (POTS), orthostatic hypotension (OH), vasovagal syncope, ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), and long COVID.
What’s the difference between POTS and orthostatic hypotension (OH)?
Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by a sustained increase in heart rate without a significant drop in blood pressure upon standing or sitting upright. In contrast, orthostatic hypotension (OH) describes an abnormal and sudden drop in blood pressure after standing or sitting up, regardless of heart rate changes.
Although both conditions include the term “orthostatic,” referring to an upright posture, they are distinct and mutually exclusive diagnoses. Both conditions fall under the umbrella term, orthostatic intolerance (OI), which describes the onset of symptoms that happen upon standing or sitting up.
Can I do the NASA Lean Test or Poor Man’s Tilt Table Test at home?
Yes, you can perform the NASA Lean Test and Poor Man’s Tilt Table Test at home by following the steps to Guava’s interactive guide, however, you must have an additional person in the room to observe and help you record. People with orthostatic intolerance (OI) are at a higher risk of fainting, so be sure to stop if you experience symptoms of lightheadedness, nausea, blurred vision, etc.
Can I use a fitness tracker for this test?
If possible, you should use an at-home blood pressure monitoring cuff that also measures heart rate. For increased heart rate accuracy, you can also use a pulse oximeter. You may also use a fitness tracker or take your heart rate manually, although this data may be less accurate.
Read more: How Accurate Are Fitness Trackers?
How do I measure my resting heart rate manually?
- Locate your pulse: Use your index and middle fingers to find your pulse on your wrist (radial artery) or neck (carotid artery).
- Count your heartbeats: Once you feel your pulse, use a timer or clock to count the beats for 60 seconds. Alternatively, count for 15 seconds and multiply the number by 4 to estimate your beats per minute (bpm).
What heart rate or blood pressure changes indicate orthostatic hypotension (OH)?
Orthostatic hypertension (OH) is associated with a drop in systolic blood pressure (SBP) of 20 mmHg or more upon standing within the first three minutes of standing. A drop in diastolic blood pressure (DBP) of 10 mmHg or more within three minutes also suggests OH, although this measure is often considered secondary to the more significant drop in systolic pressure. It can provide additional evidence, especially if the systolic drop is borderline.
What heart rate or blood pressure changes indicate POTS?
POTS is defined by a sustained heart rate increase of 30 bpm or more after 3 minutes of standing, without a significant drop in blood pressure (≤20/10 mmHg). These changes must not be attributable to OH, since OH must first be ruled out in order to make a POTS diagnosis.
Poor Man’s Tilt Table Tests typically use broader, less standardized criteria, often considering any heart rate increase of 30 bpm or more after 10 minutes as indicative of POTS. However, these criteria are not clinically validated and should not be used for diagnosis.