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Introduction: Several studies have shown an association between panic disorder (PD) and reduced balance abilities, mainly based on functional balance scales. This pilot study aims to demonstrate the feasibility of studying balance abilities of persons with PD (PwPD) using computerized static and, for the first time, dynamic balance measurements in order to characterize balance control strategies employed by PwPD.Methods: Twelve PwPD and 11 healthy controls were recruited. PD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the severity of symptoms was evaluated using the Hamilton Anxiety Scale (HAM-A), PD Severity Scales (PDSS), and Panic and Agoraphobia Scale (PAS).Balance was clinically assessed using the Activities-Specific Balance Confidence (ABC) scale and physically by the Mini-Balance Evaluation Systems Test (Mini-BESTest).Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) scale. Postural control was evaluated statically by measuring body sway and dynamically by measuring body responses to rapid unexpected physical perturbations.Results: PwPD had higher scores on the HAM-A (17.6 ± 10.3 vs. 3.0 ± 2.9; p < .001), PDSS (11.3 ± 5.1 vs. 0; p < .001), and PAS (20.3 ± 8.7 vs. 0; p < .001) questionnaires and lower scores on the balance scales compared to the controls (ABC scale: 156.2 ± 5.9 vs. 160 ± 0.0, p = .016; Mini-BESTest: 29.4 ± 2.1 vs. 31.4 ± 0.9, p = .014; DHI: 5.3 ± 4.4 vs. 0.09 ± 0.3, p < .001). In the static balance tests, PwPD showed a not-significantly smaller ellipse area of center of pressure trajectory (p = .36) and higher body sway velocity (p = .46), whereas in the dynamic balance tests, PwPD had shorter recovery time from physical perturbations in comparison to controls (2.1 ± 1.2s vs. 1.6 ± 0.9 s, p = .018). Conclusion:The computerized balance tests results point to an adoption of a ''postural rigidity'' strategy by the PwPD, that is, reduced dynamic adaptations in the face of postural challenges. This may reflect a nonsecure compensatory behavior. Further research is needed to delineate this strategy.

Background Athletes, soldiers, and rescue personnel must often perform intense, prolonged, and physically demanding activities while maintaining cognitive focus. As cognitive and physical functions are believed to share central nervous system resources, their simultaneous activation can cause reciprocal disruptions in the performance of both. Methods In the current study, we aimed to develop and validate a virtual reality-based experimental protocol enabling rigorous exploration of the effects of prolonged high-load physical and cognitive efforts, by comparing novel cognitive tasks presented in the context of a simulated loaded march to a battery of established neurocognitive tests. We then used this protocol in a pre-post pilot study exploring the effects of high-load physical and cognitive activity on physical and cognitive performance. Twelve participants underwent a simulated 10-km loaded march on a treadmill in our virtual reality environment, with or without integrated cognitive tasks (VR-COG). At each of three experimental visits, participants underwent pre-activity and post-activity evaluations, including the Color Trail Test, the Synthetic Work Environment (SYNWIN) battery for multitasking evaluation, and physical tests (i.e., ‘time to exhaustion’). Results In general, strong or moderate correlations (r ≥ 0.58 p ≤ 0.048) were found between VR-COG scores and scores on the validated cognitive tests. Together, VR-COG and CTT measures were able to successfully predict the effects of the combined physical and cognitive load on multitasking performance, as assessed by SYNWIN score. Conclusions As virtual environments are ideal for studying high performance professional activity in realistic but controlled settings, the novel protocol is optimal for measuring the effects of prolonged, high-load physical and cognitive activity, and can therefore contribute to our knowledge on physical-cognitive interactions.

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