Tools

NASA Lean Test

Orthostatic Intolerance Protocol

This is not a diagnostic tool. The NASA Lean Test can provide useful information to discuss with your doctor, but it cannot diagnose POTS, orthostatic hypotension, or any other condition. Stop the test immediately if you feel faint, unwell, or develop worsening symptoms. All results should be discussed with a clinician.

What this test does

The NASA lean test is a simplified version of a tilt table test that you can perform at home with just a heart rate monitor or a finger on your pulse. It is sometimes called the “poor man’s tilt table test” and is widely used in POTS and dysautonomia communities as a practical screening method for orthostatic intolerance.

The test involves lying flat for a period, then standing up and leaning against a wall with your heels a few inches from the wall and your back supported. Your heart rate is recorded at intervals while lying and while standing. The key finding that suggests POTS is whether heart rate rises by 30 or more beats per minute within 10 minutes of standing (40 or more at ages 12 to 19) without a significant drop in blood pressure. Some definitions also accept a standing heart rate above 120 bpm.

A formal tilt table test involves being strapped to a motorised table in a clinical setting, which can be difficult to access, especially through the NHS where waiting times for autonomic testing are often long. The NASA lean test is not a replacement for formal testing, but it gives you a structured way to gather objective data at home that you can bring to appointments. Many patients find that presenting lean test results helps move conversations forward with clinicians who may not otherwise consider autonomic testing.

This guide walks you through the test step by step, with an interactive timer for each stage and fields to log your heart rate readings. You can repeat it on different days to build up a picture of your orthostatic heart rate response. To put a number on symptoms as well as heart rate, complete the Vanderbilt Orthostatic Symptom Score in the final minute of standing; it is the symptom score POTS trials use at exactly that point.

What you need

  • Heart rate monitor: a pulse oximeter, smartwatch, or heart rate monitor. You need to be able to read your heart rate quickly at the prompt.
  • Blood pressure cuff (optional but useful): a standard upper-arm cuff. If you don't have one, simply leave the BP fields blank.
  • A smooth wall to lean against.
  • Somewhere comfortable to lie flat: a bed, sofa, or mat.
  • Your device propped up so you can see the screen while lying down and while standing.

How to position yourself

Supine phase
Lie flat on your back. Arms at your sides or resting gently on your abdomen. Stay still and as relaxed as possible. Avoid a pillow if you can manage without one.
Standing/leaning phase
Stand with your back flat against a smooth wall. Move your feet forward until they are approximately 15–20 cm (6–8 inches) from the wall. Your legs should be straight and your weight through your heels. Keep your arms loose at your sides. This removes active leg-muscle use from the test, making it a closer approximation to passive tilt.

Before you start

  • Avoid a large meal, caffeine, or exercise for at least 2 hours beforehand.
  • Make sure someone is nearby or can check on you if you have a history of fainting.
  • Have water to hand.
  • You will be prompted for readings at 1, 3, 5, and 10 minutes in each phase. An audio chime and visual cue will alert you; you do not need to watch the screen continuously.
  • A Stop test button is always visible. Use it if you feel unwell, then sit or lie down immediately.

Understanding your NASA lean test result

What the score measures

A simple test of how heart rate and blood pressure respond to being upright. You lie flat for 10 minutes, then lean with your shoulder blades against a wall, heels about 15 cm out, for 10 minutes. Your result here is the rise in heart rate: the peak while leaning minus the last reading lying down.

This page takes readings at 1, 3, 5 and 10 minutes. Research versions take one every minute, so a brief peak can be missed (Lee et al. 2020).

Score bands

The consensus definitions of POTS use a sustained rise of 30 bpm or more within 10 minutes of standing or tilt (40 bpm or more at ages 12 to 19), without a sustained drop in systolic blood pressure of 20 mmHg or more, with symptoms on standing for at least 3 months. Some definitions also accept a standing heart rate above 120 bpm. These criteria were set for standing and tilt tests, not the lean test.

Sources: Sheldon et al. 2015 and Vernino et al. 2021. The 120 bpm alternative is from European Society of Cardiology criteria (as summarised by Spahic et al.). See the 30 bpm threshold explainer.

In 112 UK adults without orthostatic symptoms, heart rate rose by about 10 bpm on average and none met POTS criteria. Other studies differ: in one US study a third of healthy controls met its POTS heart rate criteria by the tenth minute. So a rise over 30 is not, on its own, a diagnosis.

How often a 10-minute lean test met POTS heart rate criteria
GroupPeopleMet criteriaSource
Healthy adults (UK)112NoneIftekhar et al. 2025
Healthy controls (US, MCAM)131 tested4.8%Issa et al. 2025
Healthy controls (US, Lee)7533% by 10 minutesLee et al. 2020
ME/CFS (US, MCAM)258 tested10.6%Issa et al. 2025
ME/CFS (US, Lee)15040% by 10 minutesLee et al. 2020

The studies used slightly different rules, which partly explains the spread.

What a change in score means

Clinical tests control things that affect heart rate, such as recent meals and heart rate medication, and home tests usually cannot. We found no published figure for how much a home lean test varies between days, so look for a pattern across several tests done the same way.

Repeat it at the same time of day with the same device. Rating the Vanderbilt score in the last minute adds a symptom number.

What it does not measure

No. Autonomic specialists point out that the lean test has not been validated against tilt-table or standard standing tests, and that home readings can be inaccurate. A diagnosis also needs symptoms over time and other causes ruled out. A home result is a reason to ask for proper testing.

It does not separate POTS from other causes of a fast heart rate (see POTS vs IST). A normal result does not rule POTS out: the Heart Rhythm Society suggests a tilt test when standing readings are normal but suspicion is high. Leaning is neither a true stand nor a tilt; in a small 1975 NASA experiment it raised heart rate more than tilting did (Teuschl et al. 2025).

Taking this to your GP or consultant

Bring the full readings (“Copy results as text” or print), the date, time and device, any heart rate medication, your symptoms and earlier results. A rise of 30 bpm or more with symptoms supports asking for a clinic stand test or an autonomic referral. It cannot confirm POTS. See preparing for a GP appointment.

Sources