Normative data for the 10-min lean test in adults without orthostatic intolerance, 2025, Iftekhar et al.

[ME/CFS Science Blog]

Background: Orthostatic intolerance syndromes such as Orthostatic Hypotension (OH) and Postural Orthostatic Tachycardia Syndrome (PoTS) are common symptoms seen in post-infection conditions and other neurological conditions with autonomic dysfunction. The 10-min Lean Test (LT) is an objective clinical test used to assess these symptoms and direct management. There is, however, no robust literature on normative data for this test, particularly from a younger population.

Aims: The aim of this study was to produce a healthy control data set for LT, which can be used for comparison with the patient population with health conditions.

Methods: Individuals recruited into the study had no history or symptoms of orthostatic intolerance; autonomic dysfunction; post-infection conditions (such as long COVID); or other neurological conditions with hemodynamic instability. Participants were primarily recruited from the general population in a metropolitan city. All participants underwent a standardized LT. Lying Blood Pressure (BP) and Heart Rate (HR) after 2 min of lying down supine was recorded, followed by BP and HR recordings at every minute of standing (leaning against a wall) up to 10 min, along with recording subject-reported symptoms at each time point.

Results: A complete dataset was available for 112 individuals (60.7% Female, 39.3% Male). The population was 61.6% Caucasian, 8.0% Asian, 3.6% Black/Caribbean, 9.8% Mixed, and 17.0% Other; the mean age was 35.3 ± 15.1, with a BMI of 24.8 ± 4.0; 30.6% of individuals had a background medical condition, but none of the exclusion criteria. During LT, upon standing, the average change of HR was an increase of 9.89 ± 8.15 bpm. The sustained HR increase (HR increase sustained at two consecutive readings) was an average of 6.23 ± 6.94 bpm. The predominant response with BP was an increase of systolic BP, with the average initial increase being 7.55 ± 10.88 mmHg. None of the participants met the diagnostic criteria for symptomatic OH or PoTS during LT.

Conclusion: For the first time in the current literature, 10-min LT data from a relatively younger population without orthostatic intolerance have been gathered. This normative data will help interpret LT findings in younger patients with orthostatic Intolerance better and be useful in managing dysautonomia in specific conditions.

Link:

Frontiers | Normative data for the 10-min lean test in adults without orthostatic intolerance

BackgroundOrthostatic intolerance syndromes such as Orthostatic Hypotension (OH) and Postural Orthostatic Tachycardia Syndrome (PoTS) are common symptoms see...

www.frontiersin.org

 

[ME/CFS Science Blog]

EDIT: this is not a new study, the preprint came out in may 2025.

There is an interesting new study with normative data for the 10-min lean test in adults without orthostatic intolerance. The data came from 112 participants of the LOCOMOTION study. The average heart rate change was an increase of 9.89 ± 8.15 bpm. The sustained HR increase was only 6.23 ± 6.94 bpm.

These HR increases are quite low. We previously wrote a blog article that discussed the problems with tilt table testing, which tends to show high HR increase, even in healthy people. This study seems to show that the lean test may be a more specific (and easier) way to test for orthostatic tachycardia.

 

[ME/CFS Science Blog]

The paper writes:

The normative data from our study can be compared with LT data collected in the study by Isaac et al. (1) from 100 LC patients. The mean HR changes in that study was 18.45 ± 9.93 bpm which was significantly different from data collected in this study (unpaired t-test, p < 0.0001). This also provides further support for clinical use of LTs in screening for OI (including neurally mediated syncope)

 

[ME/CFS Science Blog]

Some comments about the study here:

 

[Utsikt]

Background: Orthostatic intolerance syndromes such as Orthostatic Hypotension (OH) and Postural Orthostatic Tachycardia Syndrome (PoTS) are common symptoms seen in post-infection conditions and other neurological conditions with autonomic dysfunction.

The wording here is weird. POTS is not a symptom, it’s a syndrome. And «OI syndrome» is new to me.

Introduction​

Orthostatic Intolerance (OI) (1) refers to symptoms arising from the inability to maintain normal blood pressure or heart rate when standing upright, which is then alleviated by reclining or lying down (2). OI can cause symptoms such as myalgia (3), dizziness, syncope (4), fatigue, headache, nausea, and palpitations (5, 6).

I don’t buy this definition. OI is experiencing symptoms when not horisontal. The cause of those symptoms is irrelevant. In POTS it’s speculated that it’s caused by abnormal changes in HR and BP.

Our study shows that the LT is a useful tool to detect OI in LC patients, as it is easy and safe to do either at home or in a clinic. Orthostatic Intolerance and dysautonomia can be missed in those with multiple health conditions and can cause serious problems if left untreated, hence early diagnosis and treatment are important. More research is needed to understand how OI affects LC patients over time. Health professionals who work with LC patients should learn how to assess, interpret, and manage OI and dysautonomia, and have clear guidelines for further care.

I think this goes way beyond the evidence. There is substantial overlap between the HC and OI groups, so how this can be relevant for clinical use is very unclear to me.

As far as I can tell, the link between POT and OI is also unclear.

The data might be useful, but my impression is that the article is sloppily written with unclear terminology. They also make several unsubstantiated claims, e.g. about correlation between HR and OI symptoms:

When comparing the normative values in a healthy population seen in this study to that of a LC population, we can see that there is significant difference in HR and BP changes in LC that correlates to symptoms during the test. This provides further validation of the presence of dysautonomia in LC and other medical conditions.

And what is «dysautonomia» supposed to mean?