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Int J Sports Med
DOI: 10.1055/a-2760-6902
Clinical Sciences

Cardiorespiratory Fitness Prediction in Vestibular Hypofunction: Does One Size Fit All?

Authors

  • Maitane Ruiz-Rios

    1   Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
    2   Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Basque Country, Spain

  • Sara Maldonado-Martin 

    1   Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
    2   Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Basque Country, Spain

  • Asier Lekue

    3   Otorrinolaringology Services of OSI Araba-Osakidetza, University Hospital from Álava, Vitoria-Gasteiz, Spain

  • Julene Argaluza-Escudero

    4   Epidemiology and Public Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain

  • Pablo Corres

    1   Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
    2   Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Basque Country, Spain

  • Mikel Tous-Espelosin

    1   Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
    2   Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Basque Country, Spain

  • Lucas Tojal-Sierra

    5   Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
    6   Carlos III Health Institute (ISCIII), CIBER Physiopathology of Obesity and Nutrition (CIEROBN), Madrid, Spain

  • Ibai Garcia-Tabar 

    1   Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
    2   Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Basque Country, Spain

Supported by: University of the Basque Country (UPV/EHU) PIF21/160
Supported by: Vital Fundazioa-Bioaraba BAFV22-012
Supported by: Vital Fundazioa VITAL21/14

Clinical Trial:

Registration number (trial ID): NCT05192564, Trial registry: Chinese Clinical Trial Registry (http://www.chictr.org/), Type of Study: controlled, randomized, prospective, single-blinded, two-arm, parallel intervention study


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Abstract

Cardiorespiratory fitness is a strong predictor of health and mortality. However, its gold-standard assessment, peak oxygen uptake via cardiopulmonary exercise testing, is not always feasible in clinical practice. This study aimed to (1) develop exercise-based cardiorespiratory fitness prediction models for people with vestibular hypofunction and (2) evaluate the applicability of existing models to this population. Fifty-four adults with unilateral or bilateral vestibular hypofunction (56% women) completed maximal cardiopulmonary exercise testing for peak oxygen uptake determination. Cardiorespiratory fitness prediction models were developed using maximal vestibular hypofunction and submaximal vestibular hypofunction (vestibular hypofunction-specific submaximal prediction model with gas-based analysis and vestibular hypofunction-specific submaximal prediction model without gas-based analysis) test characteristics. A 100-fold repeated cross-validation assessed model accuracy, maximal vestibular hypofunction (r=0.90 and standard error of the estimate=3.0), vestibular hypofunction-specific submaximal prediction model with gas-based analysis (r=0.86 and standard error of the estimate=3.6), and vestibular hypofunction-specific submaximal prediction model without gas-based analysis (r=0.79 and standard error of the estimate=4.3) showed high predictive accuracy, with minimal bias (< 1%). Existing equations misestimated cardiorespiratory fitness (effect size=0.56–0.68, large). Predictions within one or more metabolic equivalent of task were higher for vestibular hypofunction models, reaching up to 8–9 out of 10 individual cases. The newly developed vestibular hypofunction-specific models offer more accurate, clinically applicable tools for cardiorespiratory fitness estimation across various clinical scenarios, including settings where maximal testing is not feasible. An automated calculator was developed to support clinical implementation in vestibular hypofunction management.

Keywords

Cycle ergometry - cardiorespiratory optimal point - predicted fitness - person-specific medicine - dizziness - vestibular system

Supplementary Material



Publication History

Received: 04 August 2025

Accepted after revision: 01 December 2025

Accepted Manuscript online:
02 December 2025

Article published online:
20 February 2026

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