How to do a stand test at home properly

Short answer

A home stand test measures how much your heart rate rises when you go from lying down to standing still for 10 minutes. You lie flat for 5–10 minutes, record heart rate and blood pressure, stand up with your shoulders resting against a wall, and record again at minutes 1, 2, 3, 5 and 10. For adults, a sustained rise of 30 beats per minute or more within those 10 minutes — 40 or more for ages 12–19 — without a significant drop in blood pressure is the heart-rate part of the POTS criteria. (doi.org)

And the reason you're doing this is legitimate. If you have been told your racing heart and lightheadedness are anxiety, or that your resting heart rate is normal so nothing is wrong, you were not imagining the problem — you were being measured in the wrong position. POTS is defined by what happens when you stand. A heart rate taken while you sit in a clinic chair can look entirely ordinary. Our own data below shows how small the resting difference really is.

Done properly, the active stand is a respectable test, not a folk remedy. In a head-to-head study against tilt-table testing, a 10-minute active stand detected POTS with 87% sensitivity and 67% specificity using the 30 bpm threshold — while 10 minutes on the tilt table was less specific, at 40%, because tilting pushes healthy people's heart rates higher too. (doi.org) The best cut-off for a 10-minute stand in that study was 29 bpm, almost exactly the standard 30.

Done badly — after coffee, after a big lunch, holding onto furniture, stopping at minute three — it tells you very little. Most of this article is about the difference.

What is a stand test actually measuring?

When you stand up, gravity pulls roughly half a litre to a litre of blood down into your legs and abdomen. Your nervous system has seconds to respond: blood vessels in the lower body tighten, and heart rate rises a little to keep blood pressure and brain blood flow steady. In most people heart rate goes up by 10–20 bpm and settles within a minute or two.

In POTS, that compensation is exaggerated. Heart rate keeps climbing and stays high while you remain upright, and it comes with symptoms: lightheadedness, palpitations, shakiness, brain fog, fatigue, nausea, blurred vision. The formal criteria from the Heart Rhythm Society's expert consensus are:

• A sustained heart rate increase of ≥30 bpm within 10 minutes of standing (or head-up tilt) — ≥40 bpm in people aged 12–19

• Without orthostatic hypotension — no sustained drop of 20 mmHg or more in systolic, or 10 mmHg in diastolic, blood pressure

• Frequent symptoms of orthostatic intolerance that ease on lying down

• Symptoms present for at least 3 months

• No other obvious cause, such as dehydration, medication, bleeding, or prolonged bed rest (doi.org)

The blood pressure part matters as much as the heart rate part. If your pressure drops substantially when you stand, that points toward orthostatic hypotension, which is a different problem with different causes. That is why a home test that measures only heart rate gives you half the picture.

What do you need before you start?

• An upper-arm blood pressure cuff. Wrist cuffs are less reliable, and positioning them while standing is hard to keep consistent. Ask for an arm cuff if you're buying one.

• Something that reads heart rate quickly. The cuff itself will show heart rate. A chest-strap heart rate monitor or a fingertip pulse oximeter updates faster than most wrist wearables, which often smooth their readings over several seconds.

• A clear stretch of wall and a bed or mat right next to it, so you go from lying to standing in a few seconds.

• A timer — a phone is fine.

• A second person. Strongly recommended, and not optional if you have ever fainted. They can take readings, write them down, and catch you.

• A notebook or the table below, printed or on screen.

How do you do the stand test step by step?

This follows the structure of the NASA Lean Test, the version most widely used for home and clinic assessment of orthostatic intolerance.

1. Pick the right time. Morning, ideally within an hour or two of getting up, before caffeine, before a large meal, and not after exercise. Drink normally beforehand — don't preload with extra fluid or salt, or you'll measure your intervention rather than your baseline. Note whether you've taken any medication that affects heart rate or blood pressure.

2. Lie down for 5–10 minutes. Flat on your back, still, not talking, cuff already on your upper arm. The goal is a true resting baseline, and a heart rate that's still settling from walking to the bed will shrink your apparent rise. Ten minutes is better than five if you can manage it.

3. Take your lying measurement. At the end of the rest period, record heart rate and blood pressure. This is your baseline — everything that follows is compared against it.

4. Stand up and lean. Get up smoothly and stand with your heels about 15 cm (6 inches) out from the wall and your shoulder blades resting against it. Feet about shoulder-width apart. Arms relaxed by your sides. No holding onto furniture, no shifting weight from foot to foot, no tensing your legs, no talking. Those movements act like a muscle pump that pushes blood back up and blunts the heart rate rise — which is exactly why the lean position exists.

5. Record at minutes 1, 2, 3, 5 and 10. Heart rate and blood pressure each time, plus a one-line note of any symptoms: lightheaded, palpitations, nausea, sweaty, blurry, legs discoloured, need to sit. If your helper can manage it, recording every minute is even better.

6. Stay up the full 10 minutes — unless you need to stop. POTS responses often build. In a study of the 10-minute NASA Lean Test in people with ME/CFS, at least 5 minutes of standing were needed before the circulatory changes became detectable. (doi.org) Stopping at minute three because you feel fine can miss the rise entirely.

7. Lie back down. Record heart rate once more after a couple of minutes lying down. In POTS it usually falls back quickly — that recovery is part of the pattern too.

8. Repeat on two or three different days. Heart rate responses vary with hydration, sleep, heat, hormonal cycle and illness. One test is a data point. Three tests are a pattern a clinician can use.

How do you read your results?

Calculate peak standing heart rate minus lying heart rate. Use the highest sustained value — one that appears at more than one reading or holds for at least a minute — rather than a single spike in the first 30 seconds, which is a normal response to standing up.

Two readings that are easy to overlook. Narrowing pulse pressure — the gap between systolic and diastolic shrinking while you stand — was the hallmark of circulatory decompensation in a subgroup of people with ME/CFS in the NASA Lean Test study, alongside the higher heart rate. (doi.org) And acrocyanosis — feet and lower legs turning red-purple while standing — is common in POTS and worth photographing.

Why can't a home test diagnose POTS?

Because a positive heart-rate result is necessary but not sufficient, and several other things can produce the same number.

Dehydration, a recent viral illness, weeks of reduced activity, anaemia, an overactive thyroid, some medications, and anxiety in the moment can all push standing heart rate up. So can the test conditions themselves. A clinician's job is to rule those out and put the number in context.

The size of the overdiagnosis problem is sobering. In a 2025 series of 36 patients referred to an autonomic lab with a presumptive clinical diagnosis of POTS, formal testing confirmed it in only 11% — four people. 61% had normal autonomic tests, and 27% turned out to have a different condition, most often orthostatic hypotension or vasovagal syncope. (doi.org) That is a small, single-centre abstract, and referral populations are skewed. But it is a strong reason to treat a home result as the start of a conversation rather than the end of one.

And the numerical criterion itself isn't the whole diagnosis. The authors of the tilt-versus-stand comparison concluded that POTS diagnosis "should consider orthostatic intolerance criteria and not be based solely on orthostatic tachycardia regardless of test used." (doi.org)

What are the most common mistakes?

Not resting long enough first. A heart rate still coming down from walking to the bed inflates your baseline and shrinks the rise. Five minutes minimum, ten better.

Standing and moving. Shifting your weight, rising onto your toes, crossing your legs, or clenching your thighs activates the muscle pump and pushes blood back to the heart. It can hide a genuine POTS response. Lean, stay still, stay quiet.

Stopping early. If you feel fine at minute three and sit down, you may have missed the rise that comes at minute seven.

Testing after caffeine, a big meal, a hot shower, or exercise. Each changes your cardiovascular state before you start. Some of them — heat and large carbohydrate meals — can make a POTS response look worse than usual. Standardise, then vary one thing at a time if you want to learn what worsens it.

Trusting a single spike. Heart rate normally jumps in the first 15–30 seconds after standing and then settles. Use the sustained value.

Relying on a wrist wearable alone. Many smoothing algorithms lag by several seconds and can underestimate a fast rise. Use a chest strap, a fingertip oximeter, or the cuff's own reading.

Doing it once. Your response on your best day and your worst day can differ by 20 bpm or more. Three tests on three days gives a much fairer picture.

When should you stop the test?

Stop immediately and lie down if you feel you are about to faint, your vision greys or tunnels, you develop chest pain, you become confused, or your helper sees you go pale and sway. Raise your legs once you are lying down.

Seek urgent care if you actually faint and injure yourself, if chest pain doesn't settle promptly on lying down, if your heartbeat feels genuinely irregular rather than just fast, or if you have new weakness, numbness, or difficulty speaking.

Don't repeat the test alone after any of these. The information you already have — the minute you had to stop and what you felt — is useful to a clinician on its own.

When should you see a doctor?

See a clinician if your standing heart rate consistently rises by 30 bpm or more with symptoms, if your blood pressure drops substantially when you stand, if you have fainted or nearly fainted more than once, or if orthostatic symptoms are limiting your work, study, or daily life. Also see someone if your results are normal but your symptoms clearly aren't — a normal home test doesn't rule out orthostatic intolerance.

How to bring this up with your doctor — and what to ask for

Bring the table, not the story. Three tests on three days, each with lying and standing heart rate and blood pressure at every time point, plus symptoms and the time of day. One page. A clinician can read that in thirty seconds.

Say the sentence that opens the door. "I've done a 10-minute stand test at home on three mornings. My heart rate rose by 34, 38 and 31 beats per minute with symptoms, and my blood pressure didn't drop. Could we test for POTS formally?" Precise numbers are much harder to wave away than "my heart races when I stand."

Ask these specifically. Can we repeat an active stand test in clinic, or refer me for tilt-table or full autonomic testing? Should we check full blood count, ferritin, thyroid function and electrolytes to rule out other causes? Could any of my medications be contributing? If it isn't POTS, what explains a rise like this?

Mention what else you've noticed. Symptoms worse in heat, after meals, around your period, after illness, or after long periods of standing. Discoloured legs when standing. Any history of joint hypermobility. These all help place the picture.

If you are dismissed. "I understand. Can you note in my record that I brought home stand test readings showing a rise of over 30 bpm, and that we decided not to investigate further for now?" A request on the record is revisited more often. And ask about a referral to a cardiologist or neurologist with an interest in autonomic disorders — the difference in experience between clinics is large.

How Welltory helps

Welltory does not know your posture and does not run or interpret a stand test. Our data section says exactly what we can and can't see.

What the app does provide is the context around your test days: resting heart rate and heart rate variability measured the same way every day against your baseline, plus sleep and daily load. That matters because your stand test result on a morning after a bad night, or three days after a viral illness, may look very different from a normal morning — and having the surrounding days recorded makes it easier to tell whether a result is typical for you or an outlier. It also helps you see which days are harder, which can guide when you repeat the test.

How we made it

Protocol and criteria come from autonomic literature: the Heart Rhythm Society expert consensus statement on POTS (Sheldon et al. 2015), the tilt-versus-active-stand comparison (Plash et al.), and the 10-minute NASA Lean Test study in ME/CFS (Lee et al. 2020). We included a caution against over-reading home results: a 2025 autonomic-lab series in which formal testing confirmed only a minority of presumed POTS diagnoses.

The data section uses Welltory's own curated cohort: 4,145 users with wearable-quality data, of whom 359 report POTS and 1,355 report no conditions in an onboarding survey. The resting heart rate difference was tested against a verification gate — it had to hold within strata of how many other conditions a person reports, and it did. We have no posture data, so no stand test was measured and no claim about one is made.

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