Exercise Considerations for hEDS, HSD, POTS, and MCAS
Many people with hypermobility, dysautonomia, or mast cell disorders struggle in traditional group exercise settings. Being told to “just modify” or “do what you can” often leaves people feeling singled out, unsafe, or unsure how to progress.
When movement patterns look different or symptoms fluctuate, the problem is not motivation or effort. It is that standard fitness environments are rarely designed to account for the physiologic realities of these conditions.
Why standard group fitness often falls short
Most group exercise classes prioritize flow, uniformity, and pace. While this works for many bodies, it can create challenges for individuals with connective tissue or autonomic differences.
Common issues include:
Exercise selection or intensity that exceeds joint or nervous system tolerance
Insufficient attention to motor control and proprioception
Unintended stress placed on secondary joints during compound movements
Rapid postural changes that increase dizziness or fainting risk
The emotional burden of constantly self-modifying or opting out
Over time, these experiences can lead people to avoid exercise altogether, not because movement is harmful, but because the environment does not support them.
Why “just modify” is not enough
Modifications are not the same as programming. Asking someone to independently adapt exercises within a class designed for a different physiology places the burden of safety and effectiveness on the participant.
People with hEDS, HSD, POTS, or MCAS should not have to design their own training while also managing symptoms. Appropriate exercise requires intention, structure, and an understanding of how these systems interact.
Key needs to consider when exercising with zebra conditions
Effective training for hypermobility and dysautonomia often requires attention to factors that are not emphasized in general fitness settings, including:
Cervical spine stability to support head and neck control
Thoracic spine mobility and strength to improve posture and breathing mechanics
Targeted flexibility work, recognizing that some areas may be stiff despite overall hypermobility
Body awareness and proprioceptive training, given the increased range of possible joint positions
Careful management of postural changes to reduce orthostatic symptoms
Psychological safety, addressing the fear of symptom flares or injury based on prior experience
These considerations are not niche preferences. They are foundational requirements for safe and sustainable participation.
What supportive exercise environments provide
A supportive training environment prioritizes:
Individualized pacing rather than uniform intensity
Clear instruction and feedback for joint control and movement quality
Predictable transitions and rest opportunities
Education that builds confidence, not dependence
When these elements are present, exercise becomes a tool for building capacity rather than a source of stress.
Moving forward with intention
Exercise can be beneficial for people with hEDS, HSD, POTS, and MCAS when it is thoughtfully designed and appropriately supported. The goal is not to fit into existing fitness models, but to build strength, coordination, and tolerance in a way that respects variability and lived experience.
Movement should help people feel safer in their bodies over time, not more defeated.