Summary
| Direction in ME/CFS | ↑ Elevated — higher than in the comparison group |
|---|---|
| Category | Autonomic |
| Also described as | Tilt/stand test |
| Compared against | HC (healthy controls) |
| Associated symptoms | POTS, orthostatic intolerance |
| Test type | Clinical or physiological test |
| Source | Nelson et al. 2019 — doi:10.1186/s12967-019-02100-4 |
| Condition atlas | ME/CFS Biomarker Atlas |
Other conditions where Orthostatic heart rate increment is reported
- Orthostatic heart rate increment in Gulf War Illness — ↑ elevated vs HGV
- Orthostatic heart rate increment in PACVS — ↑ elevated vs HC
See the cross-condition hub: Orthostatic heart rate increment across conditions.
Trials, interventions and tests
In clinical-trial registrations this marker maps to the outcome term Active Stand Test (25 registered trials use a matching outcome measure).
Clinical trials using Orthostatic heart rate increment as an outcome
- NCT06231238: Balance Acceptance and Commitment Therapy for Long COVID (Active Not Recruiting)
Outcome measure: 1 minute sit-to-stand test - NCT07621588: Diaphragmatic Breathing Exercises With KOTS Currents in Patients With Long COVID (Not Yet Recruiting)
Outcome measure: Physical Function - NCT06305793: RECOVER-AUTONOMIC: Platform Protocol, Appendix A (IVIG) (Active Not Recruiting)
Outcome measure: Change in Active Stand Test - NCT06871293: Evaluating the Impact of a Functional and Cognitive Strategy in Patients With Long Covid-19 (Recruiting)
Outcome measure: Change in Functional Capacity - NCT06766825: Study to Evaluate the Efficacy and Safety of Plitidepsin in Adults With Post-COVID-19 Condition (PCC) (Recruiting)
Outcome measure: To compare changes in terms of fatigue (Five times sit to stant test) in patients with PCC among the three treatment arms. - NCT06161688: Ensitrelvir for Viral Persistence and Inflammation in People Experiencing Long COVID (Active Not Recruiting)
Outcome measure: Active Stand Test - NCT05965726: RECOVER-VITAL: Platform Protocol, Appendix to Measure the Effects of Paxlovid on Long COVID Symptoms (Completed)
Outcome measure: Percentage of Participants Who Improved in Autonomic Dysfunction Symptom Cluster, as Measured by the Active Stand Test - NCT06305806: RECOVER-AUTONOMIC: Platform Protocol, Appendix B (Ivabradine) (Completed)
Outcome measure: Change in heart rate (HR)
17 more trials reference this marker.
Interventions studied alongside this marker
Hypothesis-generating links from trial outcome usage and literature co-occurrence. Not treatment recommendations.
- Exercise therapy — 4 trials, 6 PubMed co-citations
e.g. Sit-to-stand test as a complementary assessment in patients with cardiovascular disease. - Acceptance and commitment therapy — 3 trials, 2 PubMed co-citations
e.g. Acceptance and commitment therapy for adults with advanced cancer (CanACT): study protocol for a feasibility… - Cognitive rehabilitation — 2 trials, 3 PubMed co-citations
e.g. Impact of Chemotherapy on Motor-Cognitive Dual-Task Performance in Strength and Mobility Tests. - Ritonavir — 2 trials, 1 PubMed co-citations
e.g. Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 Infection: The STOP-PASC… - Ivabradine — 1 trial, 2 PubMed co-citations
e.g. Dysautonomia: a common comorbidity of systemic disease. - Physiotherapy — 1 trial, 6 PubMed co-citations
e.g. Comparative Effects of Land-Based and Aquatic Physiotherapy on Functional and Neuromuscular Outcomes in the… - Rehabilitation — 1 trial, 6 PubMed co-citations
e.g. Comparative Effects of Land-Based and Aquatic Physiotherapy on Functional and Neuromuscular Outcomes in the…
Related Autonomic markers in ME/CFS
- LF/HF ratio ↕
- Blood pressure variability ↑
- Heart rate variability (SDNN) ↓
- Baroreflex sensitivity ↓
- Heart rate variability (RMSSD) ↓
Full list: ME/CFS Biomarker Atlas.
Frequently asked questions
Is Orthostatic heart rate increment high or low in ME/CFS?
Elevated. Studies summarised in the OSMF atlas report higher Orthostatic heart rate increment in ME/CFS than in healthy controls. Source: Nelson et al. 2019.
What symptoms is Orthostatic heart rate increment associated with in ME/CFS?
The cited literature associates this marker with POTS, orthostatic intolerance. These are population-level associations and do not mean the marker causes the symptoms.
Which test measures Orthostatic heart rate increment?
It is measured as a clinical or physiological test. Many of the cited studies used research-grade assays, so clinical availability may vary.
Is one abnormal Orthostatic heart rate increment result diagnostic of ME/CFS?
No. No single biomarker is diagnostic of ME/CFS. Orthostatic heart rate increment findings come from group comparisons, overlap considerably between patients and controls, and vary with study design, timing and comparison group. A result should be interpreted by a clinician alongside symptoms, history and other tests.
Is Orthostatic heart rate increment specific to ME/CFS?
No. The same marker is also reported in Gulf War Illness, PACVS in this atlas, so it reflects shared biology (for example inflammation or vascular stress) rather than a condition-specific signature.
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Last reviewed: 2026-06-29 · Page generated from me-cfs.json · Browse: ME/CFS atlas · Biomarker Index · All marker pages
Disclaimer: This page is an educational synthesis of published, peer-reviewed research and is not medical advice. Biomarker findings vary across studies with case definitions, comparison groups, timing and assay methods. Direction of change reflects the predominant finding in the cited source and does not establish a diagnostic threshold. Discuss any test result with a qualified clinician.