Frontiers in Rehabilitation Sciences · Oct 31, 2026
Simulated driving is impaired by inspiratory loading with dyspnea in older adults
By Eric Choi, Peter Rassam, Anson He et al.
Introduction: Age-related breathlessness can interfere with complex cognitive-motor function. This study aimed to determine if computer-based driving with inspiratory threshold loading (Drv+ITL) compared to driving (Drv) in older adults increased driving errors and neural activity of the prefrontal cortex (PFC); and if negative affect was related to driving error. Methods: Using a repeated measures design, fifteen older adults (63±12 years, 8M:7F) performed three tasks in a randomized, counterbalanced sequence: Drv, inspiratory threshold loading (ITL) against a 20 cmH2O load, and combined Drv+ITL. Simulated computer-based driving was conducted on two routes matched for length and difficulty. Outcome measures were: weighted driving errors; change in oxygenated hemoglobin (ΔO2Hb) of the PFC evaluated by near-infrared spectroscopy; dyspnea; Depression Anxiety Stress Scale-21 (DASS-21); and cardiopulmonary measures. Results: Drv+ITL compared to Drv resulted in a 79% increase in vehicle control error (15.5±7.1 versus 10.4±5.8; p=0.016) and 32% increase in total errors (26.5±9.8 versus 20.4±7.9, p=0.015). Drv+ITL versus Drv induced apparent differences in ΔO2Hb but none differed between tasks. Heart rate and mean arterial pressure did not differ but minute ventilation was more variable during Drv+ITL than Drv. Dyspnea increased during Drv+ITL compared to Drv and baseline (p≤0.022). During Drv+ITL, DASS-21 Anxiety was associated with total driving errors (ρ=0.620, p=0.021) and during Drv, total ΔO2Hb was related to total errors (ρ=.721, p=0.008) Conclusions: Inspiratory loading with dyspnea in older adults impaired simulated driving performance and induced changes in PFC hemodynamic activity, an indication of neural activation. Anxiety was related to driving errors during inspiratory loading.