Prevention and rehabilitation of chronic tinnitus through sports activities.

Abstract

Tinnitus, defined as the perception of sound in the absence of an external acoustic source, affects around 14% of adults and can become a debilitating disorder when accompanied by emotional distress, cognitive dysfunction, and autonomic arousal. Despite extensive research into its pathophysiology, effective preventive and rehabilitation strategies remain limited. Given the well-documented benefits of physical activity for cardiovascular and mental health, this thesis investigates whether and how exercise may prevent, alleviate, or transiently modulate tinnitus and its perceived severity. The thesis comprises six studies. The first study explored whether regular physical activity reduces the risk of having tinnitus. Using data from over 3000 adults, results revealed that engaging in more than 2.5 hours of moderate-to-vigorous leisure-time physical activity per week was associated with a substantially lower risk of having tinnitus, whereas sitting for more than seven hours per day increased this risk. These findings point to a preventive role of an active lifestyle and highlight sedentary behavior as a modifiable risk factor. The second study examined the relationship between physical activity and tinnitus loudness and severity among 2751 individuals with tinnitus. Participants who performed more moderate or vigorous leisure-time activities reported significantly quieter and less severe tinnitus, even after adjustment for confounders such as hearing loss, noise trauma, and psychological symptoms. This cross-sectional evidence suggested that physical activity may attenuate tinnitus perception. Building on this, a three-year longitudinal study demonstrated that increments in physical activity relate to reductions in tinnitus severity over time. Individuals who increased their physical activity to meet World Health Organization recommendations had a 64% higher chance of reporting lower tinnitus severity, while those who became inactive were more likely to experience worsening of their tinnitus complaints. These results support a long-term beneficial role of maintaining vigorous physical activity for tinnitus self-management. The fourth study investigated which patients are more likely to experience tinnitus changes during exercise. In over 6000 participants, about one-third reported such changes, which were predicted by younger age, fluctuating tinnitus, stress sensitivity, and somatosensory modulation (e.g., tinnitus changing with jaw or head movements). These findings underscored the heterogeneity of tinnitus reactivity to exercise. The fifth study examined experimentally how exercise modality and intensity influence tinnitus loudness. In a randomized crossover design, 39 patients performed aerobic and resistance exercises of low and high intensity. Significant changes in tinnitus loudness occurred only during aerobic exercise, particularly at high intensity. Interestingly, one third of the participants perceived a decrease in tinnitus loudness during aerobic exercise, one third an increase, and one third experienced no change. In contrast, resistance exercise did not affect tinnitus loudness. The sixth study built on the fifth and aimed to explore physiological and inflammatory mechanisms underlying tinnitus loudness changes during exercise. Increases in heart rate and systolic blood pressure mediated both decreases and increases in tinnitus loudness, while aerobic fitness moderated these effects—participants with higher VO₂peak were more likely to experience tinnitus reductions. Blood analyses focused on inflammatory markers (IL-6, IL-10, TNF-α) showed that despite the increase of biomarkers during HIAE, there was no mediating effect present, but these results should be interpreted with caution due to the limited availability of data because of technical issues. Collectively, these studies show that physical activity should not be seen merely as an adjunct to tinnitus therapy but as a potentially important component in prevention and rehabilitation strategies. By fostering cardiovascular fitness, emotional well-being, and neuroplastic adaptability, exercise offers a low-cost, accessible, and health-promoting avenue for individuals at risk of or living with tinnitus. The studies presented here provide the foundation for future longitudinal and interventional research that can refine these findings and ultimately translate them into clinical practice.