What SLPs Should Know About Physical Activity and Hearing Loss

A 2026 University of South Carolina Arnold School of Public Health study links physical activity to hearing protection in older adults. The research, led by Neils Strunjas in the Department of Communication Sciences and Disorders, moves exercise from general wellness advice into a clinical variable for speech-language pathology.

Older adults with hearing loss often reduce physical activity, and that withdrawal compounds communication and balance risks. For SLPs, this makes activity history a practical part of aural rehabilitation rather than a separate wellness topic.

For many SLPs, asking about movement is becoming as routine as asking about hearing aid use.

What the Research Says About Physical Activity and Hearing Loss

The conversation in geriatric speech therapy has shifted from treating hearing loss as an isolated ear problem to seeing it as one piece of an older adult's overall physical health. A 2026 University of South Carolina Arnold School of Public Health study, led by Neils Strunjas in the Department of Communication Sciences and Disorders, found that older adults with higher everyday physical function were less likely to have hearing loss. Each 10-point increase in physical function was associated with a 1.35 dB better hearing threshold, independent of systolic blood pressure.¹

What the 2026 USC study found

The USC findings add to a consistent pattern in recent research: adequate exercise, cardiorespiratory endurance, and muscle strength are each associated with reduced hearing loss risk and better pure-tone thresholds.² But the authors are careful to say well-designed randomized controlled trials are still needed to establish cause and effect.

Pure-tone data and functional hearing gaps

Most of the current evidence tracks pure-tone thresholds, not everyday communication. That matters for SLP evaluation and treatment planning because pure-tone averages do not fully capture speech-in-noise performance, listening effort, or aural rehabilitation needs. The available research does not yet give a clear quantitative link between physical activity and better speech-in-noise scores, so it would be premature to tell clients that exercise will improve their ability to follow conversation in a noisy restaurant.

Association, not yet causation

The relationship appears to run both ways. In one representative U.S. sample, every 10 dB increase in better-ear pure-tone average was associated with 69,580 fewer total activity counts per day and 16.01 fewer active minutes per day.² Moderate or greater hearing loss also raised the odds of no vigorous activity (OR 2.16) and no walking (OR 1.96) in the past month.² In ACHIEVE trial participants aged 70 and older, moderate or greater hearing impairment was linked to poorer balance (OR 2.17).³ Secondary ACHIEVE analyses found that hearing intervention did not clearly change physical activity trajectories⁵: total activity counts declined 2.7% per year and active minutes declined 2.1% per year in both groups.⁴ So physical activity may protect hearing, but the evidence is not yet strong enough to say it prevents hearing loss.

How Physical Activity Influences Communication and Auditory Function

Think of hearing as an isolated ear problem, and physical activity looks irrelevant. Think of hearing as a whole-body system, and movement becomes part of the SLP case history. That broader view, rooted in speech pathology and public health, helps explain why University of South Carolina researchers found physical activity may protect older adults from hearing loss, without promising dramatic audiometric change.

Why Blood Flow and Inflammation Matter

The cochlea depends on steady blood flow to deliver oxygen and clear waste. Regular physical activity supports cardiovascular health, which may preserve that cochlear circulation. Movement also reduces chronic inflammation, a factor tied to age-related damage in many systems, including hearing. Over time, exercise can improve neural processing, helping the brain make faster use of auditory signals even when the inner ear is not perfect.

From Ears to Everyday Communication

For SLPs providing speech therapy for older adults, the practical payoff is not a better pure-tone threshold. It is reduced listening effort, more stable speech-in-noise perception, and greater willingness to stay socially active. Older adults who stay physically active may report less fatigue during conversations in restaurants or group fitness classes and more confidence joining activities where hearing demands are high.

Keep the Focus Functional

Position physical activity as a whole-health support, not a hearing-cure claim. It strengthens the cardiovascular and neural systems that make communication feel easier, even when pure-tone results look unchanged.

SLP Assessment Implications: Adding Physical Activity to the Case History

What physical activity screening questions should SLPs add to a case history? Start with a few focused prompts that connect movement to hearing and communication.

• "How many minutes of moderate activity do you get in a typical week?"
• "What activities do you enjoy that involve movement?"
• "Do you avoid group exercise because of hearing or balance concerns?"

These questions surface participation restrictions that may not appear during speech and language testing. Because physical activity may protect older adults from hearing loss, asking about it alongside hearing and communication concerns makes the history more complete.

Red flags that may warrant follow-up

Look for less than 150 minutes of moderate activity per week, social isolation, or fear of falling. These signs can overlap with untreated hearing loss, vestibular issues, and reduced confidence in communication-heavy settings. If a client reports skipping group classes because of trouble hearing, treat that as a participation signal, not just a fitness preference.

Documenting activity within the ICF

Record low activity as a potential participation restriction, not simply a lifestyle detail. This framing links movement to a person's ability to engage in group conversations, follow exercise instructions, and self-advocate during activity.

Referral pathways

When the history suggests sedentary behavior, mention audiology for hearing and balance assessment (including otoacoustic emissions screening), physical therapy for safe movement planning, and community-based exercise programs that offer communication-friendly options.

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Counseling Older Adults: Physical Activity Recommendations for Hearing Health

Generic exercise advice often stops at "move more." SLP-informed counseling for older adults with hearing loss starts with WHO 2020 guidelines and adapts them to communication access and safety.

WHO 2020 Baseline for Adults 65 and Older

The WHO 2020 guidelines on physical activity and sedentary behaviour recommend at least 150-300 minutes of moderate-intensity aerobic activity per week, 75-150 minutes of vigorous activity, or an equivalent combination spread across the week. Add muscle-strengthening on 2 or more days and multicomponent balance and strength training on 3 or more days at moderate or greater intensity. These guidelines apply across abilities, including adults with sensory impairments, as detailed in physical activity information for sensory impairments.

Start Small and Build Communication-Friendly Habits

A realistic first goal matters more than an ambitious plan. Try a script like: "Let's start with a 10-minute walk after lunch three times this week and build from there." Break up prolonged sitting with 2-minute movement breaks every 30 minutes. The NCBI physical activity recommendations note that WHO advises limiting total sedentary time and replacing it with any-intensity movement; WHO does not set a specific threshold for sitting breaks, so use the 30-minute cue as a practical prompt.

Motivation and Hearing Access

Adults with hearing loss stay active when activities feel enjoyable and socially safe. Suggest walking groups with clear sightlines, fitness classes with captioned or written instructions, and exercise buddies who face the person when speaking. Pair movement reminders with visual or non-auditory cues, such as phone alarms or printed schedules, rather than relying on spoken prompts. Social accountability plus communication accommodations often outweighs intensity as a starting motivator.

Making Group Exercise and Fitness Classes Communication-Friendly

A communication-friendly exercise class lets an adult with hearing loss follow the flow without constantly asking for repeats. For SLPs, recommending these accommodations helps extend aural rehabilitation into community settings.

Instructor habits that reduce listening effort

• Face the class when speaking and avoid giving cues while turned away.
• Keep music at or below 85 dB when possible and reduce background noise.¹³
• Demonstrate each movement while explaining, and pair cues with written outlines, slides, or large-print handouts.²⁴⁶
• Use visual timers for intervals and caption any class videos.³⁴
• Use a microphone that connects to an FM, loop, infrared, or sound field assistive listening system.²

Environment and communication access

• Keep classes small, or arrange participants in a circle or shallow arc so mouths are visible, away from fans and doorways.⁵
• Increase lighting so facial cues and demonstrations are easy to see.⁴
• Offer real-time captioning for classes with a teaching component, and arrange sign language interpreters when requested.³
• Suggest high-fidelity or musician's earplugs for louder music, which can protect hearing while still allowing speech through.⁷

Script to share with fitness instructors

"Welcome. I want everyone to be able to follow along. I will face you when I speak, keep the music at or below 85 dB, and demonstrate each move. If you use hearing aids or have hearing loss, tell me how I can help you see my cues or connect to the microphone system." This language keeps the focus on shared access rather than singling anyone out, and instructors can use it easily at the start of class.

Hearing Aids and Cochlear Implants During Exercise: Wear, Moisture, and Maintenance

The daily tradeoff for many adults with hearing loss is staying connected during exercise versus protecting expensive devices from sweat, moisture, and impact. The good news: most modern hearing aids are sweat-resistant, not waterproof, and can be worn for most workouts with a few precautions.

Moisture: IP Ratings and Sweat Protection

An IP rating has two digits: the first covers dust, the second covers liquid. IPX4 is splash-resistant and suitable for light workouts, while IPX5 handles heavier sweating and more intense activity. Many current hearing aids carry IP67 or IP68 ratings. IP68 is the highest common rating, but it does not mean fully waterproof; devices are typically tested in fresh water, and depth and time vary by manufacturer. Sweat covers, moisture guards, sweatbands, and caps add protection. Retention clips and sports locks keep behind-the-ear and receiver-in-canal styles from shifting or falling. These accessories supplement the IP rating; they do not replace it.

Cochlear Implant Processors: Manage the External Device

The internal implant is surgically placed and never removed. It is the external processor that needs care. Use waterproofing options, headbands, or accessory clips where available, and check the specific processor manual for exercise guidance. Rechargeable battery care applies here too.

After Workout and When to Remove

Wipe hearing aids or processors immediately with a dry cloth and let them air dry completely before storage or charging. Keep charging contacts dry. Remove devices for swimming, water sports, and showering unless they are explicitly designed for water use. For high-impact activities, secure retention is essential to prevent loss or dislodgement.

Balance, Vestibular Function, and Fall Risk: Choosing Safe Exercise

Which exercises are safe for an older adult who has both hearing loss and balance problems? For many, the safest starting point is low-impact aerobic work and supervised balance training, but exercise choices should match the person's vestibular symptoms and fall history.

Safe Starting Points

Walking on level surfaces, tai chi, standing yoga, heel-to-toe walking, and supervised strength training are often reasonable options. For balance drills, encourage a stable support such as a wall, counter, or sturdy chair. Short, repeated sessions usually work better than one long session when dizziness is present. For someone new to balance work, begin with seated or wall-supported variations and build duration gradually. The key is choosing movements that build confidence without triggering symptoms.

Movements to Modify or Avoid

Steer older adults away from rapid head movements, uneven surfaces without support, and complex choreography that requires quick changes in direction. Avoid balance challenges near stairs, glass, or unstable furniture. If an exercise causes dizziness, pain, or overexertion, modify or stop it. Balance training itself is probably safe and at least moderately effective for improving balance outcomes, which supports a conservative, progressive approach.

SLP Screening and Next Steps

Ask about dizziness, unsteadiness, and falls during the case history. Hearing loss is linked with balance issues, and co-occurring vestibular disorders are common. Document any reported falls or near-falls and note whether vestibular symptoms are provoked by specific head movements. If an older adult reports dizziness or falls, refer to physical therapy or an ENT before recommending a new exercise program. Current evidence does not show that general physical activity alone robustly improves physical function or psychosocial wellbeing in adults with hearing loss, so professional vestibular or balance therapy may be the better first step.

Physical activity is a modifiable factor that speech-language pathologists can address as part of aural rehabilitation for older adults with hearing loss.

Future Directions for SLP Practice and Research

The next phase of this work is about moving from early findings and expert opinion to evidence that speech-language pathologists can act on with confidence.

For older adults, the 2026 University of South Carolina study adds momentum, but most current guidance for younger people with hearing loss stops at device safety. Pediatric and adolescent sports recommendations for cochlear implant users tell families which activities carry elevated risk for cochlear implant damage (judo, rugby, tackle football) and suggest helmets or removable processors¹, but they rarely address speech-in-noise communication during practices, coach and teammate interaction, or how early sports experiences shape long-term physical activity habits. No controlled SLP studies have tested communication outcomes in youth sports, a gap noted in physical activity and youth with hearing impairments research.

Where SLPs can build partnerships

SLPs are positioned to collaborate with audiologists, physical therapists, fitness instructors, and public health researchers. Together, they can develop communication-friendly exercise protocols, coach training tools, and shared case history questions that bridge hearing, balance, and activity.

Intervention research needed

SLP-led studies could test physical activity counseling inside aural rehabilitation programs. The key question is whether adding activity discussions changes not only hearing-related habits but also social participation and communication confidence. Outcome measures could include reported activity frequency, participation in group settings, and self-rated communication comfort during exercise.

One step this month

A practical first move is to add one physical activity question to every older adult case history: "What physical activity do you do in a typical week?" Record it alongside hearing concerns and revisit it during counseling.