REFERENCE · RECOVERY TECHNIQUE

Making Sitting, Standing and Walking More Manageable

When this may fit: When upright activity worsens an established PPPD pattern, with faintness and other causes assessed separately. [Individualized rehabilitation guidance; component efficacy uncertain]

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For the Person With FND

Standing in a queue can be harder than it looks from the outside. This page is about adjusting upright activity so that it becomes more manageable, with a safe place to stop. It does not ask you to remain standing when you feel you may faint.

What does graded upright practice mean?

“Graded” means changing the demand in small, planned steps. Upright practice might involve supported sitting, standing for a task or walking a short familiar route. It need not follow a fixed ladder, and walking is not a required goal for everyone.

PPPD can become worse upright, but dizziness on standing can also involve blood pressure, heart rate, dehydration, medicines or another condition. Blacking out or near-fainting needs its own assessment. One diagnosis does not cancel another. [1]

Choose a useful starting point

With the therapist, choose an already assessed position or activity and the support it needs.
Make the environment easy to manage: clear the route, put a chair within reach and use the prescribed aid.
Agree an amount you can evaluate without sacrificing the rest of the day. Include recovery and any delayed worsening.
If this is repeatable, discuss one change, such as a little more time or a different task. More time is not automatically better.

For example, preparing one part of a meal while seated may be the current goal. Later you might explore a short supported standing task if that suits your condition. Both versions let you take part. This is an illustrative adaptation, not a studied dosing schedule. [2]

When another approach is needed

Stop for near-fainting, collapse, unsafe balance or a substantially different symptom. A clinician should review repeated upright intolerance. If activity causes delayed, prolonged worsening, tell the team; a standard exposure progression may need changing. Keep wheelchairs, seats and other accommodations when they help you participate safely.

During a familiar flare

Return to the position or support that is currently manageable. If even that is not safe, pause practice and seek advice. No minimum standing time applies to everybody.

When to stop and seek assessment

Stop unsafe activity. Sudden or distinctly different dizziness with new weakness, double vision, speech trouble, inability to walk, severe headache, fainting or chest pain needs urgent assessment. Sudden hearing loss, head injury or persistent vomiting also needs prompt medical attention. Increasing falls or progressive loss of function warrants reassessment. Existing PPPD does not explain every new symptom. See the diagnostic and differential-assessment page.

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For Family, Friends, and Other Supporters

Plan seating and an easy exit before leaving home. Ask before offering physical help, and use only assistance you have been taught. Do not remove a chair or aid because the person stood longer yesterday.

During a familiar flare, follow the agreed support and safety plan. Ask before taking over. New or substantially different symptoms need their own assessment; an exercise should never delay that care.

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For Clinicians and the Care Team

Evaluate orthostatic and cardiovascular symptoms alongside the PPPD history. Document transfers, fall risk, fatigue, pain and delayed exertional effects before progression. Separate a rehabilitation goal from essential mobility access. Agree functional endpoints and review criteria rather than automatic weekly increases.

Agree an accessible next step and review point. Consider meaningful activity, safety, access, effort and delayed effects alongside dizziness severity. Limited improvement is not grounds to withdraw assistance or infer lack of effort.

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Research and Sources

This page expands original entry 3, Graded upright exposure. Examples and practical prompts are educational adaptations, not patient quotations or a reproduced treatment protocol. Original-entry numbering does not imply thirteen independently validated treatments.

Graded activity has been included in PPPD rehabilitation, but evidence does not establish a universal upright-exposure schedule. Orthostatic disorders require their own management; response to standing practice is not diagnostic evidence.

Citation	Source	What it supports and its limits	Figure
1	FND-CIT-0027 — Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191–208. DOI.	Diagnostic consensus; defines PPPD and differential assessment, not treatment efficacy.	—
2	FND-CIT-0192 — Herdman D, Norton S, Murdin L, Frost K, Pavlou M, Moss-Morris R. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. Journal of Neurology. 2022;269:4753–4763. DOI.	Small feasibility comparison of treatment packages; does not establish component efficacy or ACT benefit.	—

Sources checked: September 22, 2026 · Vestibular, neurological, lived-experience and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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