Physical Activity and Frailty Are Impaired in Older Adults with Benign Paroxysmal Positional Vertigo

<b>Background/Objectives</b>: Benign Paroxysmal Positioning Vertigo (BPPV), diagnosed in 46% of older adults with complaints of dizziness, causes movement-related vertigo. This case-control study compared physical activity, frailty and subjective well-being between older adults with BPPV (oaBPPV) and controls. <b>Methods</b>: Thirty-seven oaBPPV (mean age 73.13 (4.8)) were compared to 22 matched controls (mean age 73.5 (4.5)). Physical activity was measured using the MOX accelerometer and the International Physical Activity Questionnaire. Modified Fried criteria assessed frailty. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed subjective well-being. A post-hoc sub-analysis compared all variables compared between frail oaBPPV, robust oaBPPV and robust controls. Significance level was set at α = 0.05. <b>Results</b>: oaBPPV were significantly less physically active and were more (pre-)frail (<i>p</i> < 0.001) compared to controls. They performed significantly less active bouts (<i>p</i> = 0.002) and more sedentary bouts (<i>p</i> = 0.002), and a significantly different pattern of physical activity during the day. OaBPPV reported significantly less time in transportation activities (<i>p</i> = 0.003), leisure (<i>p</i> < 0.001), walking (<i>p</i> < 0.001) and moderate-intensity activities (<i>p</i> = 0.004) compared to controls. Frail oaBPPV were even less active (<i>p</i> = 0.01) and experienced more fear of falling (<i>p</i> < 0.001) and feelings of depression (<i>p</i> < 0.001) than robust oaBPPV and controls. <b>Conclusions</b>: BPPV can induce a vicious cycle of fear of provoking symptoms, decreased physical activity, well-being and consequently frailty. It is also possible that frail and less physically active older adults have an increased prevalence of BPPV. Post-treatment follow-up should assess BPPV, frailty and physical activity to determine if further rehabilitation is needed.