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Characteristically, syncope may occur while the individual is '''standing motionless''' during the first five to ten minutes after exercise <cite>Bjurstedt</cite>. Especially athletes in the (ultra) endurance sports are at risk for post exercise vasovagal syncope e.g. after marathon swimming <cite>Finlay</cite> or marathon running <cite>Tsutsumi</cite>;<cite>Holtzhausen95</cite><cite>Holtzhausen97</cite>.

Vasovagal episodes are the most common in-flight medical events, and may affect patients of all ages (Gendreau & DeJohn, 2002). In addition to prolonged motionless sitting, the use of alcohol, anxiety  and mild hypoxia during air travel all may predispose to vasovagal faints (Sutton, 1999). Cabin pressure in commercial aircraft is usually adjusted to the equivalent of an altitude of 1500 to 2500 m above sea level. It appears that hypoxic syncope results from the super-imposed vasodilator effects of hypoxia on the cardiovascular system (Halliwill & Minson, 2005).  

Patients, who otherwise never experienced a (severe) vasovagal episode may suffer from convulsive syncope during air travel (Wieling et al., 2006). These patients should be advised to have a high salt intake in the days prior to travelling by plane, reducing anti-hypertensive medication –if feasible- and drinking non-alcoholic beverages galore during the trip. Especially during long flights (> 2 hours) they should perform in-chair muscle tensing and relaxing exercise and have a regular walk through the isle. In recurrent cases midodrine prior to flying or supportive stockings can be considered.

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