The purpose of this study is to report on a series of patients who were referred for evaluation of syncope that occurred during or immediately after exercise and in whom a diagnosis of vasodepressor syncope was established (9 women and 8 men; mean age of 28 +/- 17 years). The approach to management was individualized in each patient. All patients were monitored to determine the frequency and type of recurrent symptoms. The mean age at onset of symptoms was 23 +/- 16 years. In 10 patients syncope occurred only in association with exercise. Pharmacologic therapy was successful in normalizing the patients' response to upright tilt in each of the 10 patients in whom it was attempted. During a mean follow-up period of 35 +/- 9 months, none of the patients placed on pharmacologic therapy has had recurrent syncope. Seventeen (88%) of 19 patients have resumed participation in athletics. The results of this study demonstrate that vasodepressor syncope is a cause of syncope in athletes and that patients with exercise-related vasodepressor syncope can safely continue to participate in athletics.