The 10-Minute NASA Lean Test: How to Do It Step by Step and What Your Numbers Mean

TL;DR

• What This Test Does: Routine clinic visits and ER trips check your heart while you sit or lie flat, which misses POTS and upright blood pooling. The 10-minute NASA Lean Test checks your blood pressure and pulse while you lean against a wall with only your shoulder blades touching and your heels 6 inches out, turning off your leg muscles so gravity pooling shows up clearly.
• The 5 Simple Steps: Test in the morning before coffee with a helper standing nearby. (1) Take off shoes, socks, and compression tights. (2) Lie flat and quiet for 5 to 10 minutes and record two baseline readings 1 minute apart (Supine 1 min and Supine 2 min). (3) Stand up, put your heels 6 inches from the wall, rest only your shoulder blades on the wall, and check right away (Standing 0 min). (4) Record BP, pulse, and symptoms every minute from Standing 1 min to Standing 10 min. (5) Stop and lie flat right away if you feel close to fainting.
• What the Numbers Mean: A sustained pulse jump of 30+ beats per minute in adults (40+ bpm at ages 12 to 19) without a blood pressure drop points to POTS. A squeezed gap between top and bottom blood pressure (under 25% of the top number, like 105/93) shows blood pooling in your lower body, while a 20/10 mmHg blood pressure drop shows orthostatic hypotension.

When your heart races in the shower, your vision darkens when you stand up, or standing in line leaves you exhausted and shaky, a 10-second resting EKG on a flat exam table will almost always come back "normal." To catch an upright circulation problem, we have to test your body against gravity for a full 10 minutes. The 10-minute NASA Lean Test is the simplest way to measure standing heart rate and blood pressure in our Philadelphia clinic or at home with a partner.

Positioning photographs and 10-minute lean test instructions courtesy of the Bateman Horne Center (NASA 10-Minute Lean Test PDF).

What is the 10-minute NASA Lean Test, and why do only your shoulder blades touch the wall?

The 10-minute NASA Lean Test is a passive standing test where resting only your shoulder blades on a wall with your heels 6 inches forward turns off your calf muscles, showing POTS and blood pooling without a tilt table.

When you stand in the middle of a room without support, your lower legs sway and clench to keep your balance. Every time your calf muscles tighten, they squeeze leg veins and pump blood back up toward your heart. That reflex is called the skeletal muscle pump. If you fidget or tense your legs to keep from feeling dizzy, that calf pumping can hide a circulation drop during a short check.

NASA doctors first solved this problem in astronauts returning from space. They had astronauts lean against a wall with their feet set forward (Bungo et al., Aviat Space Environ Med 1985). Researchers at the Bateman Horne Center in Salt Lake City built the modern 10-minute clinical protocol for patients with POTS, ME/CFS, Long COVID, and fibromyalgia (Lee & Vernon et al., J Transl Med 2020).

In a study of 112 healthy adults who completed the 10-minute NASA Lean Test (Iftekhar et al., Front Neurol 2025), the average sustained heart-rate rise was only 6.2 ± 6.9 beats per minute, and 0% of healthy participants had a false-positive POTS result.

What do you need before starting the NASA Lean Test at home?

You need an automatic upper-arm blood pressure cuff, a fingertip pulse monitor (or the pulse readout on your cuff), a flat wall, a timer, a recording sheet, and a helper to press the cuff button and write down your numbers while standing within arm's reach.

Setting up everything before you lie down keeps you from scrambling once the timer starts:

1. An automatic upper-arm blood pressure cuff: Use a standard upper-arm cuff fitted snugly on your bare upper arm. Skip wrist cuffs because they drift whenever your hand moves above or below heart level.
2. A fingertip pulse oximeter (optional): While your upper-arm cuff gives both blood pressure and pulse, clipping a simple fingertip pulse monitor onto your other hand lets your helper read your heart rate smoothly between cuff inflations.
3. A helper (spotter): Do not run a home lean test alone if you get dizzy or have ever come close to fainting. Your helper has three jobs: pressing the cuff button each minute, writing down your numbers and symptoms so your arms stay relaxed, and helping you lie down if you feel faint.
4. Morning timing before coffee or tea: Blood pooling is strongest in the morning after overnight sleep (Bryarly & Levine, JACC 2019). Test before caffeine or a big meal.
5. Bare feet and loose clothing: Take off shoes, socks, and compression stockings or abdominal binders before lying down.
6. Medication and salt safety rule: In research studies, clinics sometimes pause heart-rate or blood-pressure medications, extra sodium, and high fluid intake before a baseline test (Bateman Horne Center PDF). At home, stay on your beta-blockers, ivabradine, midodrine, fludrocortisone, and daily salt and water plan unless your doctor specifically asks you to hold them. If your test is already positive while you are taking high salt and electrolytes, that makes the result even stronger.

How do you do the 10-minute NASA Lean Test step by step?

You lie flat and quiet for 5 to 10 minutes to take two baseline readings 1 minute apart (Supine 1 min and Supine 2 min), then stand barefoot with your heels 6 inches from the wall and only your shoulder blades touching the wall while your helper records blood pressure, pulse, and symptoms at Standing 0 min and every minute through Standing 10 min.

The Three Positioning Photos (Courtesy of the Bateman Horne Center)

A. Barefoot, Heels 6 Inches From Wall	B. Only Shoulder Blades Touch the Wall	C. Arms Loose at Sides With Pulse Monitor
Photo A: Stand barefoot with heels ~6 inches (15 cm) in front of the wall and legs relaxed.	Photo B: Rest only your shoulder blades against the wall. Keep your lower back and butt off the wall.	Photo C: Let both arms hang loosely at your sides while your helper logs vitals every 1 minute.

Photographs courtesy of the Bateman Horne Center (NASA 10-Minute Lean Test Instructions).

The 5 Steps from Start to Finish

1. Step 1 - Lie flat and still for 5 to 10 minutes: Put the blood pressure cuff on your upper arm, take off your shoes and socks, and lie flat on your back on a bed or couch with a thin pillow under your head. Rest in silence for 5 to 10 minutes without talking, crossing your legs, or looking at your phone. That lets your heart rate settle to a resting baseline.
2. Step 2 - Take two flat baseline readings (Supine 1 min and Supine 2 min): While you are still lying flat, have your helper press the cuff button and write down your blood pressure and pulse as Supine 1 min. Wait 1 full minute, then check again and write it down as Supine 2 min. Average those two numbers for your resting baseline. (If one reading was thrown off by a cough or movement, wait 1 more minute and take a third flat reading.)
3. Step 3 - Stand up smoothly, set your heels 6 inches out, and lean (Standing 0 min): Walk a step or two to the wall, place your bare heels about 6 inches (15 cm) in front of the wall, and lean back so only your shoulder blades touch the wall (keep a clear gap behind your lower back and butt). Let both arms hang loosely at your sides. As soon as your shoulder blades touch the wall, start the 10-minute timer and have your helper take your first upright reading right away (Standing 0 min).
4. Step 4 - Check blood pressure, pulse, and symptoms every 1 minute (Standing 1 min to Standing 10 min): Stay in that wall lean for 10 minutes. At the start of every minute (1, 2, 3, 4, 5, 6, 7, 8, 9, and 10), have your helper press the cuff button and write down your blood pressure and heart rate. Have them note any symptoms you feel or signs they see (dizziness, dark or blurry vision, hot flash, sweating, extra saliva, tingling or purple feet, shaky knees, pounding heart, chest tightness, brain fog, or nausea). Do not chat between readings, and resist shifting your weight or wiggling your toes.
5. Step 5 - Stop and lie flat right away if you feel close to fainting: If your vision starts going black, your knees start to buckle, or you feel like you might pass out, tell your helper, stop the test right away, and lie flat on the floor or bed with your legs propped up. Have your helper take one final reading if safe and note the minute you stopped ("Stopped at Minute 6 due to vision blacking out"). Stopping early because of near-fainting is an important finding. Do not try to push through a blackout to reach Minute 10.

How do you record your 10-minute NASA Lean Test results?

Use a 12-row log sheet with two flat baseline rows (Supine 1 min and Supine 2 min) followed by 11 upright rows (Standing 0 min through Standing 10 min), recording blood pressure, pulse, and symptoms on every line.

You can copy the blank table below into a notebook or notes app before you start, and compare it against the positive POTS example right underneath it.

Blank 10-Minute NASA Lean Test Recording Sheet

Sample Positive POTS & Venous Pooling Log

A positive home NASA Lean Test in a patient with POTS and lower-body blood pooling shows a clear jump in pulse and a narrowed blood pressure gap:

Three findings in that log stand out right away:

1. Immediate and sustained 50 to 70 bpm pulse surge: Resting pulse was 77 to 80 bpm lying flat, jumped to 133 bpm within seconds of leaning, and stayed between 126 and 148 bpm for all 10 minutes (far above the >= 30 bpm POTS cutoff).
2. Top blood pressure held steady (104 to 115 mmHg), ruling out orthostatic hypotension: Because the top number never dropped by 20 points, a clinician looking only at top blood pressure might miss the problem.
3. Narrowed pulse pressure at Minute 2 (105/93 mmHg, only a 12-point gap): When blood pools in the legs and belly, less blood returns to the heart on each beat, so the top number softens while the body squeezes lower arteries hard, pushing the bottom number up (75 -> 93 mmHg). That squeezed 12 mmHg gap right when the patient's vision went black shows lower-body blood pooling.

What do your NASA Lean Test numbers mean?

Your 10-minute log separates six distinct patterns: a normal response (pulse rise under 30 bpm), POTS (sustained 30+ bpm pulse rise without a BP drop), narrowed pulse pressure (top-to-bottom BP gap under 25% of systolic from low heart filling), hyperadrenergic BP surges, classic orthostatic hypotension (BP drop within 3 minutes), and delayed orthostatic or neurally mediated hypotension (BP drop between minutes 4 and 10).

In the Bateman Horne Center's study of 150 ME/CFS patients and 75 healthy controls using the 10-minute NASA Lean Test (Lee & Vernon et al., J Transl Med 2020), at least 5 minutes of quiet leaning were required to catch the drop in pulse pressure and circulation. A 1-minute or 3-minute clinic stand check misses many cases.

How does the NASA Lean Test compare to an active stand test and a hospital tilt-table test?

The 10-minute NASA Lean Test gives you the passive leg relaxation of a tilt-table study with far fewer false alarms (0% false-positive POTS in healthy adults vs. up to 77% false-positive rates on 70-degree tilt tables) and zero hospital facility fees.

When your 10-minute NASA Lean Test already shows a sustained 30+ bpm heart-rate jump (such as 79 bpm flat -> 133 to 148 bpm leaning) with classic upright symptoms, you do not need a hospital tilt-table test to prove you have POTS. We save hospital autonomic lab referrals (at Penn or Jefferson) for patients whose lean tests are borderline or who need small-fiber sweat testing (QSART).

What should you do after a positive NASA Lean Test?

After a positive NASA Lean Test, share your 12-row log with your doctor to rule out reversible mimics (low ferritin, thyroid, cortisol, B12, and resting EKG) and start the 4-part POTS plan: morning water and 2.5 to 3+ liters of fluid, 8 to 12 grams of salt (NaCl), 30 to 40 mmHg waist-high or belly compression, and recumbent exercise.

A positive lean test is the starting line for a targeted recovery plan:

1. Send your complete 12-row log (Supine 1-2 and Standing 0-10) to your doctor: Having the minute-by-minute numbers on paper gives you objective proof in your medical chart, which also supports work accommodations or disability paperwork when needed.
2. Check the blood panel and resting EKG that rule out mimics: Before blaming everything on autonomic nerves, we check serum ferritin (repleting to >= 50 ng/mL, since half of young POTS patients have ferritin <= 25 ng/mL, Jarjour 2013), CBC, CMP, TSH and free T4, morning cortisol, vitamin B12, vitamin D, and a 12-lead ECG (racing heart when standing workup).
3. Fill the blood-volume tank first (water + sodium): When resting blood pressure is normal, a 500 mL (16 oz) morning water bolus before getting out of bed lowers standing heart rate by 15 bpm (Shannon 2002). Taking 8 to 12 grams of salt (NaCl) daily (~4 to 6 g sodium) with 2.5 to 3+ liters of fluid restores blood volume and lowers standing heart rate by 10 bpm (Garland JACC 2021). On crash days or when table salt upsets your stomach, 1 packet of unflavored TriOral WHO Oral Rehydration Salts mixed into 1 liter of water delivers 1,695 mg sodium via the gut's SGLT1 pump without MCAS-triggering dyes or citric acid (see our hydration and electrolytes guide).
4. Cover the abdomen and thighs with compression: Because 2 to 3 times more blood pools in the belly and pelvis than in the calves, waist-high compression tights (30 to 40 mmHg) or an abdominal binder cut the standing heart-rate jump by 17 bpm and halve upright symptoms (Bourne JACC 2021).
5. Layer horizontal movement and matched medication when needed: Recumbent-first exercise (rowing, swimming, recumbent cycling - paced gently at 5 to 10 minutes if you have ME/CFS post-exertional crashes) puts 53% to 71% of POTS patients into remission at 3 months (Fu 2010, George 2016). When medications are needed, we match low-dose propranolol (10-20 mg), ivabradine (2.5-7.5 mg BID, -18.5 bpm without beta-blocker fatigue), midodrine, fludrocortisone, or pyridostigmine to your standing vitals (POTS treatment guide).

Related at Fishtown Medicine

• Dizziness and a Racing Heart When Standing (POTS Case Walkthrough) - how a 10-minute stand test, mimic labs, and the 4-part POTS foundation work together
• POTS Treatment in Philadelphia - our 90-minute diagnostic visit, volume and compression math, and matched medications
• The POTS & Dysautonomia Playbook - deep clinical roadmap across hypovolemic, neuropathic, and hyperadrenergic POTS
• ME/CFS Pacing and the Energy Envelope - how orthostatic intolerance and post-exertional crashes interact
• Hydration and Electrolytes Guide - sodium math, WHO Oral Rehydration Salts (TriOral), and daily fluid targets
• Getting Answers from a Heart Monitor (Zio Patch) - when we pair standing vitals with continuous rhythm monitoring

Scientific References

1. Bateman Horne Center. 10-Minute NASA Lean Test: Instructions for Providers and Patients. Salt Lake City, UT: Bateman Horne Center. PDF Instructions
2. Lee J, Vernon SD, Jeys P, et al. Hemodynamics during the 10-minute NASA lean test: evidence of circulatory decompensation in a subset of ME/CFS patients. J Transl Med. 2020;18(1):314. PubMed
3. Iftekhar N, Wilson A, Nguty L, et al. Normative Data for the 10-Min Lean Test in Adults Without Orthostatic Intolerance. Front Neurol. 2025. PubMed
4. Bungo MW, Charles JB, Johnson PC Jr. Cardiovascular deconditioning during space flight and the use of saline as a countermeasure to orthostatic intolerance. Aviat Space Environ Med. 1985;56(10):985-990. PubMed
5. Chung TH, Raj SR. Postural Orthostatic Tachycardia Syndrome (POTS): A Review. JAMA. 2026. JAMA
6. Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12(6):e41-e63. PMC
7. Raj SR, Guzman JC, Harvey P, et al. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Can J Cardiol. 2020;36(3):357-372. PubMed
8. Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar. J Am Coll Cardiol. 2019;73(10):1207-1228. PubMed
9. Garland EM, Gamboa A, Nwazue VC, et al. Effect of High Dietary Sodium Intake in Patients With Postural Tachycardia Syndrome. J Am Coll Cardiol. 2021;77(17):2174-2184. PubMed
10. Bourne KM, Sheldon RS, Hall J, et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. J Am Coll Cardiol. 2021;77(3):285-296. PubMed
11. Natelson BH, Lin JM, Blate M, Khan S, Chen Y, Unger ER. Physiological assessment of orthostatic intolerance in chronic fatigue syndrome. J Transl Med. 2022;20(1):95. PubMed
12. van Campen CLMC, Verheugt FWA, Rowe PC, Visser FC. Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography. Clin Neurophysiol Pract. 2020;5:50-58. PubMed
13. Rowe PC, Bou-Holaigah I, Kan JS, Calkins H. Is neurally mediated hypotension an unrecognised cause of chronic fatigue? Lancet. 1995;345(8950):623-624. PubMed