Relative Device-Output Music Intensity and Virtual-Reality-Based Postural Control in Trained Athletes.

BACKGROUND/OBJECTIVES: Postural control depends on the integration and reweighting of visual, somatosensory, vestibular, and contextual sensory information. Stable auditory cues may support balance, whereas complex musical stimulation may impose additional sensory-cognitive demand during multisensory conflict. This study examined the acute effects of relative device-output music intensity on virtual-reality-based postural control in trained athletes and explored whether responses differed by sport background. METHODS: Forty-eight athletes from tennis, combat sports, swimming, football, and volleyball completed the Clinical Test of Sensory Interaction in Balance delivered through virtual reality (CTSIB-VR) and Limits of Stability (LOS) assessments under four auditory conditions: routine/no sound and low (+10 dB), moderate (+20 dB), and high (+30 dB) relative device-output increments. Linear mixed-effects models included sport, auditory condition, and their interaction as fixed effects and participant-specific random intercepts and random linear condition slopes. Model-based estimated marginal means, Bonferroni-adjusted contrasts, 1.5×IQR sensitivity analyses, and robust generalized estimating equations were calculated. RESULTS: Auditory condition affected all five CTSIB-VR outcomes (Wald χ2(3) = 16.773-94.404, all p < 0.001). The routine condition exceeded the high-intensity condition for composite score (adjusted mean difference = 6.05, 95% CI 3.99-8.10; Bonferroni-adjusted p < 0.001) and somatosensory score (8.62, 95% CI 6.78-10.46; adjusted p < 0.001). Sport × condition interactions were significant for all CTSIB-VR outcomes (χ2(12) = 54.869-98.953, all p < 0.001), but sport-stratified findings were exploratory. For LOS, auditory-condition effects were detected for endpoint excursion (p = 0.004), maximum excursion (p < 0.001), and directional control (p = 0.002), whereas reaction time (p = 0.648) and movement velocity (p = 0.056) did not show clear main effects. Sensitivity analyses supported the endpoint-excursion, maximum-excursion, and directional-control findings; movement-velocity inference was method-sensitive. CONCLUSIONS: Relative device-output music intensity was associated with consistent changes in CTSIB-VR sensory-organization measures and outcome-specific changes in LOS performance. Sport-related patterns require confirmation in adequately powered, balanced samples.