Pre-Existing Anxiety and Vestibular Symptoms: The Relationship to Coordination, Balance, and Reaction Time in College Athletes

Abstract

A growing body of literature suggests that certain pre-existing physical and mental health conditions can contribute to significant differences in important areas of performance among athletes, such as reaction time and balance. These findings have important implications for concussion testing protocols, as factors that potentially skew performance could place the health of athletes at risk by resulting in inaccurate diagnosis or premature return to play following a head injury. Symptoms of both anxiety and vestibular dysfunction, such as dizziness and vertigo, are frequently reported problems in the adult population, and research has documented notable symptom overlap between these two conditions. However, there is little research examining how anxiety and vestibular dysfunction may impact the performance of college athletes on measures of balance and reaction time. The present study seeks to explore the relationships amongst these variables. Specifically, it was hypothesized that athletes who endorsed symptoms of both anxiety and vestibular dysfunction would have slower reaction time and worse balance than athletes who only endorsed symptoms of one of these conditions, who in turn would have slower reaction time and worse balance than athletes who endorsed no symptoms of either condition. Using an accelerometer-based measurement of postural stability called Sway, athletes who endorsed no symptoms of anxiety were shown to have better balance than athletes who endorsed at least one symptom of anxiety, t(237) = 2.73, p= .007, d = .31. Similarly, athletes who endorsed no vestibular symptoms were shown to have better balance than those who endorsed at least one vestibular symptom, t(359)= 2.14, p= .03, d = .27. Meanwhile, a statistically significant difference in average balance scores was observed between individuals with No Symptoms, symptoms of only One Condition (anxiety or vestibular), and symptoms of Both Conditions (anxiety and vestibular) F(2, 358) = 5.023, p=.007, ηp2= .027. Specifically, the Single Condition group had lower scores and thus worse balance than the No Symptom group (p = .009). Correlational results further demonstrated that as symptoms of anxiety (r = -.209, n = 361, p = .000) or vestibular dysfunction (r = -.145, n = 361, p = .006) increase, balance performance on Sway decreases. On the other hand, no significant differences in reaction time were observed among any of these groups. Overall findings from this study suggest that pre-existing anxiety and vestibular symptoms have a negative impact on balance, supporting the inclusion of measures related to these symptoms in concussion testing protocols with college athletes.