By Jennifer Green, MS

It is estimated that 31.5 million U.S. citizens have some form of hearing loss, including an estimated 738,000 with hearing loss at the severe to profound level. There are two frequent terms used to characterize a hearing impairment: hard of hearing and deaf. Hard of hearing is a mild to severe level of hearing loss in which individuals have some range of useful hearing, and possibly use a communication device. Individuals who are deaf have complete hearing loss and are unable to use residual hearing for processing information or communicative purposes, even with the use of amplification devices.

Hearing loss commonly does not modify the exercise response to any form of physical activity, as there are no physical limitations directly associated with hearing impairments. In fact, most individuals can take part at a high intensity of exercise or sport without any special considerations. While evidence has revealed that people with hearing impairments do not differ radically from others with respect to exercise, it has also shown that both children and adults who are hard of hearing or deaf tend to report a higher incidence of overweight and obesity when compared to their counterparts.

There are four different types of hearing loss: conductive, sensorineural, mixed, and central hearing loss. While it may not be imperative for fitness professionals to fully understand the fine points of each category of hearing impairment; it is, however, important to understand that some of these types may affect dynamic balance and spatial orientation – specifically sensorineural. This may in turn affect the clients’ cardiorespiratory efficiency in exercises or activities requiring high levels of balance. Particular consideration should be given to these clients, if the fitness professional is performing an exercise test using protocols, such as those involving the treadmill or step test. It is also essential to note that the amplified cardiorespiratory efficiency required to compensate for balance and spatial awareness deficiencies, while exercising on these modalities may negatively affect the client’s test results. Beyond altered test results, these protocols also put your client at an increased risk of falling.

In addition to balance and spatial awareness concerns, the extent of exercise familiarity, as well as the ability for full involvement, including communication and understanding are important considerations when working with a client who has a hearing impairment. A client with profound hearing loss may not be able to hear music at an acceptable level for participation; however, he or she may feel the vibrations either through the floor or by holding a vibration-transmitting object (such as a balloon) while completing exercise movements. Spoken communication is also a concern for people with severe to profound hearing loss. Research shows that this barrier can lead to fewer social opportunities, lower self-concept, decreased self-esteem, lack of self-confidence, and isolation. It is the job of the fitness professional to ensure that clients can participate fully and adapt exercise programs or group fitness classes to meet the needs of these individuals.

While regular exercise produces the same positive physiological, psychological, and skill benefits for people with hearing impairments as their counterparts; additional benefits may also include improved socialization skills in group activities, improvements in balance and spatial orientation, increased communication proficiency among trainers or group leaders and other participants, as well as improved self-image, confidence, and self-concept and reduced social isolation.

If you are conducting exercise testing on an individual with a hearing impairment, and they do not have any signs or symptoms or other comorbidities or balance or spatial orientation deficiency, no additional special considerations need to be taken to ensure a safe exercise test. However, a number of adaptations in terms of presenting the test may be necessary so that the client fully understands the test, and to guarantee that effective communication can be maintained between the fitness professional and client. Adaptations include:

• Presenting all instructions in writing or picture form via signing, or on a video with closed captioning.
• Allowing the person to describe or demonstrate the test protocol before the test begins.
• Giving visual or tactile reinforcement to increase motivation.

In terms of exercise programming, individuals with hearing loss can generally partake in all types of physical activity, and programming should be based on other signs, symptoms or comorbidities that may be present, as well as any medications the client may currently be taking. However, an important concern for individuals who are deaf or hard of hearing is to ensure effective communication during exercise training sessions. While individuals with hearing loss may use a variety of communication strategies, those who are hard of hearing typically rely on hearing aids and other assistive listening devices in order to maximize use of residual hearing. Individuals who are deaf may also use modalities ranging from verbal communication to manual sign language systems, to a combination of the two. In some cases, the use of interpreters may be required to aid in facilitating communication.

Care is warranted when one is speaking directly to an individual with a hearing loss, as even the most superlative speech readers are able to pick up only about 30% of spoken language. If difficulty in communication persists, use illustrative means, such as paper and pencil or whiteboards. The aim is effective communication, regardless of how it is achieved.

The subsequent are additional strategies that can enhance communication effectiveness:

• Always face the person so that he or she can see your face, lips, eyes, and body.
• Maintain eye contact and speak directly to the person, not to the interpreter if one is present.
• Demonstrate exactly what is required from start to finish, as many people who are deaf or hard of hearing are very visual learners.
• Use as many visual cues and concrete examples as possible.

Below are a handful of supplementary considerations to ensure exercise programming and communication is safe and effective for clients with hearing impairments as suggested by the American College of Sports Medicine:

• The speaker should stay near the individual and maintain eye contact to enable speech reading.
• The speaker should use facial expression, body language, gestures, and common signs or cues, such as thumbs up or down to communicate emotions and meanings.
• The speaker should avoid chewing gum or food, covering the mouth, or having an untrimmed mustache, as each of these hinders clear view of the lips and mouth, and affects speech reading.
• The speaker should use normal enunciation and loudness, regardless of whether the person is deaf or hard of hearing or uses a hearing aid, cochlear implant, or no assistive listening device.
• Visual and tactile cues should be used to enhance understanding; this includes having a black-or whiteboard available to use when necessary.
• A demonstration of the routine or activity is helpful, and could be done in person or via a video demonstration.
• If an individual’s speech is unclear or difficult to understand, the listener should not pretend that he or she understands, but rather ask for clarification.
• Avoid loud, constant background noise as such sounds may cause headaches (from echoes or vibration) or reduce the effective use of hearing aids.
• Unnecessary or extra physical or visual movements in the area behind the speaker (aka “visual noise”) should be avoided.
• The individual should be orientated to all aspects of the facility, and environment with special attention to emergency aspects, such as exits and fire evacuation procedures.
• Facilities should be equipped with strobe or visual fire alarms or other alerting devices or strategies. Alerting devices or strategies include use of the buddy or tapping system, very loud sounds, vibrations, colorful flags, or flashing lights.
• Normal speech enunciation and volume should be used for speaking to an individual who has a hearing aid or cochlear implant.
• Some basic cue or feedback signs, for words such as “ready,” “start,” “faster,” “ok,” “stop,” or whatever words are necessary for activity should be established and used consistently.
• Hearing aids and external cochlear implant devices should be removed before participation in activities involving contact and in water activities.
• Fitness professional should familiarize themselves with the support devices and resources (e.g. amplified phones, sound wizards, interpreters) available.

Sources:

2010 ADA Standards for Accessible Design (2010). Department of Justice.

Dair, J., Ellis, M. K., & Lieberman, L. J. (2006). Prevalence of overweight among deaf children. American Annals of the Deaf, 151 (3), 318-326.

Longmuir, P. E., & Bar-Or, O. (2000). Factors influencing the physical activity levels of youths with physical and sensory disabilities. Adapted Physical Activity Quarterly, 17, 40-53.

Sherrill, C. (2004). Adapted physical activity, recreation and sport. New York: McGraw Hill.

Schirmer, B. R. (2001). Psychological, social, and educational dimensions of deafness. Massachusetts: Allyn and Bacon.

Simmonds, M. J., Ph.D., PT., MCSP., & Derghazarian, T. P. (2009). Muscular dystrophy. In J. L. e. a. Durstine (Ed.), ACSM’s exercise management for persons with chronic diseases and disabilities (3rd ed., p. 306). Champaign, IL: Human Kinetics.

Stewart, D. A. & Ellis, M. K. (2005). Sports and the deaf child. American Annals of the Deaf, 150(1), 59-66.

Thompson, W. R., PhD, FACSM, Gordon, N. F., MD, PhD, MPH, FACSM, & Pescatello, L. S., PhD, FACSM (Eds.). (2010). ACSM’s guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.