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 (or exceeds 120 bpm) without a significant drop in blood pressure.

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.

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.