Article 08 · Cardiac Health

Cardiac Health and EDS: Why Your Heart Needs Training Too

Geeta BihariFounder, Rebuilt With Geeta · EDS · rebuiltwithgeeta.com

Your heart is a muscle — and in an EDS body, it can decondition just as fast as any other. Here is what proactive cardiac training actually looks like, and what every person with EDS needs to understand first.

Before anything else: what EDS can do to the heart.

Most conversations about EDS and cardiac health focus on what can go wrong. This one will get to what you can actively do — but not before being completely honest about the structural realities. Understanding the difference between what is fixed and what is trainable is what makes the rest of this article useful rather than dangerous.

EDS is a connective tissue disorder. Connective tissue is not only in the joints. It is in the walls of blood vessels. It is in the heart valves. And in some forms of EDS, that structural involvement carries serious consequences.

Vascular EDS (vEDS)

The most serious subtype. Arterial and organ walls are fragile and prone to spontaneous rupture. Requires specialist cardiac monitoring and significant lifestyle restrictions. Exercise protocols must be developed with a vascular specialist.

Cardiac-Valvular EDS (cvEDS)

A rare subtype characterised by severe cardiac valvular problems — aortic and mitral valve insufficiency — alongside classic EDS features. Requires cardiology involvement and careful management.

hEDS — Aortic Root Dilation

Mild aortic root dilation occurs in a subset of people with hypermobile EDS. It is often asymptomatic and may never progress — but it requires monitoring. An echocardiogram is the standard screening tool.

hEDS — Mitral Valve Prolapse

Mitral valve prolapse occurs more frequently in people with hEDS than in the general population. Most cases are benign. A minority require intervention. Regular cardiac monitoring identifies which category you are in.

Training cannot change the underlying collagen structure of your heart valves or blood vessels. Full stop. If you have vascular EDS, cardiac-valvular EDS, known aortic root dilation, or mitral valve prolapse, your cardiac exercise protocol must be developed with your cardiologist — not derived from general fitness advice, including this article. The information below is written for people who have been cleared for exercise by their medical team and do not have known structural cardiac contraindications.

I get a cardiac echocardiogram every five years as part of routine EDS monitoring. Not because something is wrong. Because I intend to stay ahead of anything that might become wrong. This is not anxiety — it is appropriate medical surveillance for a connective tissue disorder that can affect the heart. If you have not had a cardiac echo, talk to your doctor about whether you should.

The part nobody talks about enough: deconditioning.

People with EDS avoid exercise. The reasons are real and earned. Movement has caused injury. Generic protocols built for other bodies have triggered flares. Fear is a rational response to a body that has repeatedly been hurt by the wrong approach.

But avoidance has a cost — and that cost accumulates faster in an EDS body than most people realise.

EDS bodies decondition quickly. Muscle mass drops. Joint stability — which in a hypermobile body depends entirely on the muscles around the joint — erodes. Proprioception degrades. And the heart? The heart deconditions too. Cardiovascular fitness is not a luxury in EDS. It is structural support.

Dysautonomia and POTS — which co-occur with EDS at significant rates — are both directly worsened by deconditioning and directly improved by structured cardiovascular training. This is not speculative. The research on exercise as a primary intervention in POTS is substantial. Recumbent cycling, swimming, rowing, and progressive cardiovascular conditioning have been documented to meaningfully improve autonomic regulation, reduce symptom burden, and improve quality of life in people with dysautonomia.

Research note: Exercise training — particularly programs developed by Dr. Benjamin Levine and colleagues — has been shown in peer-reviewed research to be among the most effective interventions available for POTS. Structured cardiovascular conditioning improves blood volume, venous return, and autonomic regulation. If you have dysautonomia alongside EDS, exercise is not contraindicated. For most people, it is indicated. Work with a provider who understands the specifics of your presentation.

What proactive cardiac training actually looks like.

I do not train my heart despite EDS. I train it because of it. Here is my current approach — not as a prescription, but as a concrete example of what intelligent cardiovascular conditioning looks like in a hypermobile body.

Session Type	Frequency	Details	Heart Zone
Strength Training	3× per week	Progressively loaded lifting. Power output during compound movements provides significant cardiac stimulus alongside the primary goal of joint stabilisation.	Zone 4
Endurance	1× per week	45 minutes sustained effort. Technically zone 2–3. Staying in pure zone 2 is genuinely difficult — I allow zone 3 on endurance days because I want to train cardiac capacity across a full range, not only in the fat-burning window.	Zone 2Zone 3
Sprint Intervals	1× per week	Short high-intensity bursts followed by full recovery. Builds cardiac resilience — the ability to spike, recover, and spike again. Requires careful joint management in a hypermobile body.	Zone 4+
Daily Walking	Daily	Minimum 8,000 steps. Low-level sustained movement supports circulation, cardiovascular baseline, and autonomic regulation. Non-negotiable regardless of what else happens that day.	Zone 1–2

I also monitor my HRV — heart rate variability. This is one of the most underused tools available to people with EDS. HRV reflects how well your autonomic nervous system is recovering. For a body that runs on a higher baseline stress load — chronic pain, post-exertional malaise, the constant low-level effort of managing an unpredictable system — HRV gives you objective data about when to push and when to pull back. It removes guesswork from decisions that in an EDS body are never straightforward.

From Geeta: I have had seven surgeries and a hip replacement. Between each one, there was a period of deconditioning — unavoidable, medically necessary, but with a real cost. Every time I rebuilt, the cardiovascular work was part of it from early on. Not because I was trying to get fit. Because I knew from experience that a deconditioned heart made everything harder. The fatigue was worse. The recovery was slower. The autonomic symptoms were louder. Building the cardiovascular system back up was not optional — it was part of the foundation everything else stood on.

A note on repetitive motion and hypermobile joints.

Not every hypermobile body tolerates repetitive movement equally. For some people, 45 minutes of sustained cycling or rowing triggers joint pain or a flare response — not from cardiovascular overload, but from the repetitive mechanical stress on unstable joints.

If this is you: split it. Twenty minutes on the bike, twenty minutes on the rower. Or spread endurance work across two shorter sessions in the week. The goal is cardiovascular stimulus — not a specific modality, not a specific duration. Your joints should never be the limiting factor when your heart is what you are training. Find what fits your body. Then do it consistently.

How to get started without making things worse.

01
Get cleared — and get your echoBefore beginning or significantly increasing cardiovascular training, confirm with your doctor that you have no structural cardiac contraindications. If you have not had an echocardiogram as part of your EDS monitoring, ask about whether one is appropriate.
02
Start recumbent or supported if dysautonomia is presentIf you have POTS or dysautonomia, upright exercise is harder to tolerate initially. Recumbent cycling, rowing, and swimming are all effective starting points that reduce the orthostatic challenge while still providing cardiac training stimulus.
03
Start shorter than feels necessaryTen to fifteen minutes of sustained zone 2 effort is a legitimate starting point. The nervous system and the cardiovascular system both adapt to frequency more than volume. Short and consistent outperforms long and sporadic — especially in a body that post-exertional malaise affects.
04
Progress slowly and track your responseAdd duration or intensity only when the current load is well tolerated for two to three consecutive sessions. If HRV drops, if post-exertional malaise worsens, or if joint symptoms increase — hold, do not progress. The 50% rule applies here too: on a good day, do half of what you feel capable of.
05
Pair cardiovascular training with nutrition and sleepCardiovascular adaptation requires recovery. In an EDS body that is already managing inflammation, connective tissue fragility, and autonomic dysregulation, the quality of recovery determines the quality of adaptation. Nutrition, sleep, and hydration are not separate from the training — they are part of it.

vEDS and cvEDS require specialist-guided exercise protocols.

The training principles above are not appropriate for people with vascular or cardiac-valvular subtypes of EDS without explicit cardiology approval and protocol guidance. If you have vEDS or cvEDS, please work with a vascular specialist or cardiologist experienced with these subtypes before undertaking any cardiovascular training program.

The bottom line.

Cardiovascular health in EDS is not one conversation. It is two.

The first is about structural monitoring — knowing what is happening inside the heart and vessels, staying ahead of it with regular imaging, and working with a medical team that understands the connective tissue picture. This part is non-negotiable and cannot be replaced by fitness.

The second is about capacity — building and maintaining the cardiovascular fitness that protects against deconditioning, supports autonomic regulation, and gives the body the best possible foundation for managing a complex chronic condition. This part is trainable. And the research increasingly supports that for most people with EDS, training it is one of the most important things they can do.

Your heart is a muscle. In an EDS body — where deconditioning is fast, where dysautonomia is common, and where the cardiovascular system carries more of the daily load than most people realise — training it is not optional.

It is part of the rebuild.

For informational purposes only. Not medical advice. Always work with qualified healthcare providers — particularly a cardiologist — before beginning or changing any cardiovascular exercise program. If you have vascular EDS, cardiac-valvular EDS, known aortic root dilation, or mitral valve prolapse, please seek specialist guidance before undertaking exercise beyond daily walking. If you are navigating EDS and looking for a structured approach to rebuilding, rebuiltwithgeeta.com is a good place to start.