POTS Stand Test at Home: NASA Lean Test Step by Step

What Is a Stand Test, and How Is the NASA Lean Test Different?

A stand test compares your blood pressure and heart rate lying down with the same numbers while you're upright. Clinics call it an active stand test or a 10-minute stand test. It comes in 2 versions. In the poor man's tilt, you lie down and then stand straight up without moving. In the modified NASA lean, you stand with your feet about a foot from a wall and rest your hips, back and head against it, which our team sees as closer to a tilt table. Both give useful information about the change from lying to standing. No study has compared a home cuff test with a tilt table, so our team treats the log as a pattern to bring to your doctor.

The published version, from a study of 150 people with ME/CFS and 75 healthy volunteers, reads blood pressure and heart rate "while resting supine and every minute for 10 min while standing with shoulder-blades on the wall for a relaxed stance" (Lee, 2020). The home version our team uses is a modified lean, with hips, back and head on the wall. The home method below follows that shape, with a fixed rest period at the start and a recovery reading at the end. For the lab version, what a tilt table adds and how long it takes, see our tilt table test guide.

What Do You Need Before You Start?

• An automated blood pressure cuff that reads blood pressure and heart rate together, so 1 button press gives you both. A wrist cuff such as an Omron or an upper-arm cuff will both work. Rest the cuffed arm on your chest so the cuff sits level with your heart.
• A flat place to lie down. Use a bed or a clear floor where your whole body lies flat, with nothing bunched up and your legs down. The edge of a couch or a pile of pillows can change the reading.
• A clear stretch of wall if you're doing the lean version, next to the bed if you can.
• A timer and a way to log, on paper or your phone. The log below prints on 1 page.
• A helper. Someone in the room can press the cuff button and write the numbers so you don't have to move. If no one can be there, have someone on a video call.

How Do You Do a Stand Test at Home, Step by Step?

The readings take 17 minutes: 5 lying, 10 standing and 2 lying again, plus a few minutes to set up. Keep the cuffed arm resting on your chest for every reading, lying and standing.

See a filled-in example (illustrative, not a real patient)

Illustrative values, not a real patient. These match the "POTS range" view of the figure below.

Reading	Systolic	Diastolic	Heart rate	What you feel
Lying, 3 min	118	76	72	Fine
Lying, 5 min (baseline)	116	76	72	Fine
Standing, 1 min	114	80	98	Heart pounding
Standing, 2 min	116	81	104
Standing, 3 min	115	80	106	Lightheaded
Standing, 4 min	116	82	107
Standing, 5 min	117	81	108	Legs heavy
Standing, 6 min	116	82	108	Short of breath
Standing, 7 min	115	81	109
Standing, 8 min	116	80	108
Standing, 9 min	117	82	110	Foggy
Standing, 10 min	116	81	109
Recovery, 2 min	117	76	76	Better

In this example, blood pressure holds and the diastolic number rises a little. The heart rate climbs 26 beats in the first minute, passes 30 above baseline by minute 2 and stays there, and the symptoms line up with the climb. A log like this is a reason to see your doctor with the numbers, and the diagnosis is theirs to make.

What Do the Numbers Mean? Read Blood Pressure First

Our team reads blood pressure before heart rate. Compare your baseline, the last lying reading, with each standing reading.

• Diastolic, the bottom number, holding steady or rising a little is what our team likes to see.
• Systolic, the top number, may dip a little or rise a little.
• A drop of 20 or more systolic, or 10 or more diastolic, is the first thing our team flags.

A drop that size within 3 minutes of standing is the standard definition of orthostatic hypotension. For how it differs from POTS, see orthostatic hypotension vs POTS.

The standard definition of POTS requires "an absence of orthostatic hypotension (i.e. no sustained systolic blood pressure [BP] drop of 20 mmHg or more)" (Vernino, 2021). If your pressure can't hold, our team reads that as more than a heart rate response: the body may not be returning enough blood to the heart to supply the system. In the clinic's view, a racing heart on standing is the compensation working to protect brain blood flow, and a falling pressure is that compensation failing. For the why behind the racing heart, see why your heart races when you stand up.

If blood pressure holds, move to heart rate, and start with the baseline. If your lying heart rate is already high, note it, because our team reads that as a different picture from a normal baseline that climbs.

What Does a POTS-Range Result Look Like?

Small rise POTS range

Replay

The definition used by the major autonomic, cardiac and pediatric societies, as restated after a 2019 NIH expert meeting (Vernino, 2021), requires "a sustained HR increment of not less than 30 beats/minute within 10 min of standing or head-up tilt." For people 12 to 19 years old, "the required HR increment is at least 40 beats/minute." The same definition requires no sustained drop in blood pressure, frequent symptoms on standing that improve quickly when you lie back down, symptoms lasting at least 3 months, and no other condition that explains the fast heart rate (Vernino, 2021). The definition asks for a sustained rise, so a single high reading that drops back doesn't meet it on its own. A lab study comparing tilt and standing adds that diagnosis "should consider orthostatic intolerance criteria and not be based solely on orthostatic tachycardia regardless of test used" (Plash, 2013). The symptom column in your log carries that half of the picture.

Our team treats 30 beats as the standard cutoff and also as a somewhat arbitrary line. We look closely at rises that approach it, especially when they line up with the symptoms you wrote down.

In the clinic's view, the shape of the climb matters along with the peak. Our team reads 3 patterns, and each says something different about how your body is responding to standing.

Sketches are illustrative, with no measured values.

A reading that stays under the dashed line doesn't rule POTS out. In the time-of-day study below, only 42% of people with POTS crossed 30 beats in the evening (Brewster, 2012), and in a lab study a 10-minute stand missed about 1 in 8 people with POTS (Plash, 2013). If your symptoms say otherwise, repeat the test in the morning and bring both logs to your doctor.

When Can a Home Stand Test Mislead You?

• Time of day. In a study of 54 adults with POTS and 26 healthy volunteers tested in a hospital research unit, the 30-beat threshold on a 5-minute stand was crossed by 60% of the POTS group in the morning and 42% in the evening, and by 31% of the healthy volunteers in the morning against 4% in the evening (Brewster, 2012). Morning readings ran higher in both groups, so note the time and compare tests done at the same time of day.
• A stand can miss POTS. In a lab study of 15 people with POTS and 15 healthy volunteers, a 10-minute stand picked up 87% of the POTS group at the 30-beat line, so about 1 in 8 didn't cross it (Plash, 2013). That was a lab study, and no study has tested a home cuff version. For how a stand compares with a tilt, see the tilt table test guide.
• Teenagers. In a study of 36 young people with POTS and 39 controls aged 12 to 19, "most subjects were unable to stand for 10 min," and the authors concluded the stand test is "relatively non-specific and imprecise compared to tilt" under age 19 (Stewart, 2025).
• The lean version can read higher. In 80 young adults with long COVID, not a POTS group, the heart rate rise averaged 27.0 bpm on the lean test against 21.5 bpm on a tilt, while systolic changes were similar (Sathaporn, 2025). A lean reading near 30 can run a few beats high.
• Stopping early. In that ME/CFS study, "at least 5 min of the 10-minute NLT were required to detect hemodynamic changes" (Lee, 2020). If you had to lie down early, write down the minute. The readings up to that point still go to your doctor.
• Other reasons for a fast heart. The standard definition of POTS rules out causes such as fever, infection, pain, dehydration, anemia and medicines that speed the heart (Vernino, 2021). Test on a day without a fever, an infection, or a missed meal or drink.
• Moving and talking. Shifting your weight, talking or letting the cuffed arm drop can change the reading. Keep still with the cuff level with your heart.

A cuff measures pressure and heart rate in your arm, so it can't show how much blood is reaching your brain. In our team's view, that's the missing layer in a cuff test. The clinic's version tracks blood flow speed in the brain's arteries and your breathing during the same change in position.

Is It Safe to Do a Stand Test at Home?

• Try not to do it alone. A helper in the room is best, because they can press the cuff button and catch you, and a video call at least gets the numbers written down.
• Lie on a bed or a clear floor, and stand next to the bed or with the wall behind you and nothing hard or sharp nearby.
• If you feel faint, stop. Slide down the wall or onto the bed, lie down flat and raise your legs. Our team would rather have 4 minutes of readings than a fall, and if you feel safe, staying up as long as you can gives your doctor the most to work from.
• If you've fainted and been hurt before, have chest pain, or your readings frighten you, skip the home test and ask your doctor to run it in the office.
• Call 911 for fainting with an injury, chest pain, or trouble breathing that doesn't settle when you lie down.

What Should You Do With Your Results?

Bring the log to your doctor with the symptoms written beside each minute. Measured numbers next to what you felt give you a head start in that visit, and they can point to which kind of doctor you should see next. If the first test was borderline, repeat it on another day at the same time of day, with the same food, drink and medication.

A stand test is a first layer. The clinic's next layer measures blood flow velocity to the brain along with breathing during the same move from lying to standing. For what each clinic test measures, see autonomic testing for POTS.

POTS Stand Test at Home: FAQ