Fitness for Individuals Who Are Visually Impaired or Deafblind

Lauren J. Lieberman

RE:view,Fitness for individuals who are visually impaired or deafblind. Lieberman, Lauren J.. 34(1),13-8023. 2002. Reprinted with permission of the Helen Dwight Reid Educational Foundation. Published by Heldref Publications, 1319 18th Street, NW, Washington, DC 20036-1802. www.heldref.org. Copyright © 2002.

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Regular physical activity benefits both physical and psychological health and reduces risk for heart disease, diabetes, high blood pressure, obesity, and stress-related illnesses (U.S. Department of Health and Human Services, 1996). Although many people believe that children are naturally active, children in the United States do not engage in levels of activity sufficient to maintain adequate fitness (U.S. Department of Health and Human Services, 1996), and the percentage of overweight children is at an all-time high (Nicklas, Webber, Johnson, Srinivasan, & Berenson, 1995; Sallis & Patrick, 1994). The literature clearly shows that regular physical activity and related lifestyle changes can significantly reduce premature death and disability, improve the quality of life, and increase the chances for longevity in the population at large (U.S. Department of Health and Human Services, 1995). Children who are visually impaired can gain those same benefits from physical activity.

Children who are visually impaired consistently exhibited lower levels of fitness than their sighted peers (Blessing, McCrimmon, Stovall, & Williford, 1993; Lieberman & McHugh, 2001; Skaggs & Hopper, 1996; Winnick & Short, 1985, 1999). The need for fitness in children who are blind might be greater because of the increased energy required to complete activities of daily living (Buell, 1982). Children who are visually impaired and blind can improve their levels of physical activity, thereby improving comfort and success of movement (Lancioni, Oliva, Bracalente, ten Hoopen, 1996; Lieberman, Butcher, & Moak, 2001). The improved comfort and success of movement facilitates the completion of activities of daily living.

The following are five major components of health-related fitness:

Muscular strength-the maximum amount of force that a muscle or group of muscles can generate.
Muscular endurance-the ability of muscle to avoid fatigue.
Cardiovascular endurance-how long or at what intensity a person can sustain aerobic activity. The term aerobics literally means "with oxygen" or the "steady state transport of oxygen to the working muscles" (Shephard, 1990 p. 5). The fitness activity called aerobics involves sustained physical activity to a point at which the body is utilizing oxygen.
Body composition-an indication of the degree of leanness or fatness of the body.
Flexibility-the range of motion an individual has around the joints.

Through activities such as running, bicycling, swimming, aerobics, or using equipment at health clubs or in the home, individuals can address these components of healthrelated fitness.

The activities I discuss in this article are examples of how individuals who are visually impaired or deafblind can access fitness, By trying a variety of activities they can determine which ones they would prefer to pursue on a consistent basis.

Running Techniques¹

Guidewire System

A guidewire system can be set up on a track, in a gym, or along a child’s backyard or driveway. The rope must be pulled taut and attached to an eyehook in a gym; to short poles outside; or to any stationary, permanent structure. A carabiner, key ring, or 4-in. PVC tube can be placed around the rope so the child does not have to hold directly onto the rope. There must be a warning knot at least 2 ft from the end of the rope and a difference in floor texture so the child does not run into the wall or the end poles.

Using a guide wire, a child can run whenever she or he desires, and the running gait can be efficient with almost a full arm swing with both arms. The child can run in relays and perform locomotor skills independently beside sighted peers. The guidewire system is one of the most preferred methods to use with children with visual impairments (Lieberman, Butcher, & Moak, 2001).

Sighted Guide

In the sighted guide technique the child holds the guide runner’s elbow with the thumb placed laterally on the elbow or may choose to hold onto the runner’s shoulder. The pair also can hold hands, or the child with low vision can follow the runner if the guide wears a bright shirt. The sighted guide should be trained in guiding, communication techniques, and the appropriate terrain for running. In addition, the guide runner
should be able to run faster than the runner who is blind so the guide does not hold back the runner.

Having a guide decreases fear. The running gait can be efficient with almost full arm swing with both arms. Running with a peer or another individual increases socialization. This technique can be transferred to other individuals, and the runner can use it anywhere.

Tether

The tether is a short rope, a towel, or a shoelace held between the guide and the individual with a visual impairment. Wrapping the tether around each person’s hand secures it from slipping. If a dangerous area appears, the guide pulls the runner closer to avoid injury. With this technique also, the guide must be able to run faster than the runner who is blind.

In addition to the advantages of running with a sighted guide. the runner who is using a tether has some space and feels more independent than with other guiding techniques (Lieberman. Butcher, & Moak. 2001).

Caller

In this technique the runner who is blind runs toward a voice, running free, not restricted by holding on to anything. The caller can stand at the other end of the gymnasium or track for a short run or for distances can run behind, beside, or in front of the runner holding a bell, keys, or using verbal instruction.

This technique does not restrict the runner. He or she has the feeling of being independent and able to move as fast as desired without worrying about running into anything. The arm motion can be full and natural.

Running With No Assistance on a Track

A child with low vision can run on a track that is dark with bright lines. This technique works best when the track is not crowded, and adults should monitor students who are running unassisted to ensure that they do so safely. The child can run independently or side-by-side with a friend, using full arm swing and potentially an efficient biomechanical gait.

Running on a Treadmill

Treadmills are common and accessible to children with visual impairments. For safety, individuals with visual impairments or deafblindness should use treadmills with handrails. Runners need not hold on to the handrails, but the rails ensure that they know when they have moved too far to the right or left. Runners should start out slowly to get a feel for the motion.

Treadmills are found in gyms and fitness centers around the country; on them a child can run independently, with no guide. The child can run with full arm swing and can keep a record of speed and distance. Children can learn age-appropriate and functional skills enabling them to make a lifetime commitment to an active lifestyle.

Bicycling¹

Riding Independently

Individuals who have low vision may be able to ride a bicycle independently in a quiet park, cul de sac, or around a track. It is always safer if someone with sight is present to ensure safety.

The participant has a feeling of independence. Even when an individual can ride independently, caregivers and teachers should watch them but will have some freedom to assist other students or family members.

Tandem Bicycles

Tandem bikes allow the sighted participant to ride in the front of the bike, while the participant who is visually impaired rides in the back. The person in front is responsible for steering, peddling, and stopping. The person in the back is responsible for peddling. Tandem bikes cost between $400 and $2,000 and are sold in most bicycle stores. Contacting a local bicycling club, university, or deaf club may help a potential tandem biker find someone to ride with. Before riding together, the participants should develop specific signals for turning, stopping, or emergencies. It is important that individuals who are deafblind create with the guide rider a method of communicating a wish to turn and to stop.

Surrey or Duo Bicycles

On surrey or duo bikes, the participants ride side-by-side, a style that is more conducive to communication. The sighted participant is responsible for steering and stopping. Local bike stores do not usually sell these bikes, but they can direct a customer to specialty stores or catalogues that do.

On duo bicycles, riders sit side-by-side and can talk to each other during the ride. This arrangement permits any child who is deafblind and can sign to communicate effectively during the ride. The stability of a three- or four-wheeled bike helps with the comfort level of the participant and offers support to riders who may have poor balance or other disabilities.

Stationary Bicycles

Anyone who has some functional use of his or her legs can use these bikes independently. Many display the distances pedaled and amount of time ridden. Most sporting goods stores sell these for $500 to $1,000. The participant can easily record the distance traveled or the time ridden if it is of interest. Stationary bikes are found in health clubs, at schools, and in the home. The participant does not have to worry about weather or having a sighted guide.

The benefits of riding a stationary bike are improved aerobic endurance, muscular strength, and muscular endurance. One can ride a stationary bike at home without modifications.

Bicycle Stand

Bicycle stands can turn an ordinary 10-speed bike into a stationary bike. They are now similar to stationary bicycles and can be purchased for under $100 from any sporting good stores.

Swimming¹

Swimming is an excellent fitness activity for individuals who are visually impaired or deafblind, if they swim laps or participate in aqua aerobics or similar activities. There are few barriers, and the swimmer can move freely without worrying about obstacles, especially when lines clearly mark lane widths. Water aids in range of motion, muscle strength, balance, stability, locomotion, cardiovascular endurance, and socialization.

Beginning Swimmers

Flotation devices. Beginners can use a variety of flotation devices when needed. They can receive an aerobic workout while using a flotation device and can swim laps with the flotation device if this makes them more comfortable. Kickboards are helpful because the board hits the side of the pool before the swimmer’s head (Lieberman & Taule, 1998).

Treading water. Treading water is a good aerobic workout for individuals who do not feel comfortable swimming laps. The participant can tread for a stated period of time or for a given distance. Putting a radio on the deck to signal the shallow end of the pool may be helpful.

When treading water, people do not have to worry about bumping their heads on the wall of the pool. It is easy to communicate with individuals who are deafblind when they are treading water.

Lap Swimmers

Turning. Individuals who are visually impaired or deafblind may have a difficult time swimming laps because they may not know the location of the wall and be at risk for hitting their heads. The following are three ways to signal a swimmer when to stop and turn or to do a flip turn.

An instructor or friend can take a kickboard and tap the swimmer’s shoulder with a kickboard when the swimmer is 3-4 ft from the wall.
The same person can tap the swimmer on the head with a "bonker" (a long pole with a tennis ball or 1 ft of a swimming noodle attached to the end) when he or she is 3-4 ft from the end of the pool (Lepore, Gayle, & Stevens, 1998). Bonkers are used in international competition for athletes who are blind.
For a swimmer with low vision, a sprinkler placed at either end of the pool to disturb the water 3-4 ft from the wall warns the swimmer when to turn.

Trailing. Trailing involves using the wall and lane lines as guides for swimming laps the length of the pool, thus ensuring that the swimmer will stay in her or his lane and swim the straightest line to the end of the pool (Lepore. Gayle, & Stevens, 1998). Trailing may slow the speed of new lap swimmers, but with practice it becomes natural.

Recording distance. Counting devices such as flip cards, counters, or rings can tell swimmers the distance or number of laps they have covered. For example. a basket of 10 plastic pool rings is located at the shallow end of the pool where swimmers start. Swimmer pick one ring and swim to the other end, drop the ring into another basket, and swim back, completing a 2-lap cycle. Swimmers who have dropped off all the rings at the other end of the pool know that they have completed 20 laps. Because holding a ring while swimming is difficult, some swimmers choose to use flip cards. Swimmers start at one end of the pool, swim to the opposite wall and back, and then flip over two cards, which have large-print or Braille numbers. Having flipped two cards each time, swimmers know how many laps they have swum.

Whether swimmers use counting devices, count their own laps, or swim for time, their goal remains to keep track of performance and to maintain or improve fitness levels.

Exercise Training in a Health Club

In this section I discuss exercise training, which focuses on muscular strength and endurance training. Weight training improves bone density, muscular strength, and flexibility. The safest way to perform muscular strength and endurance training is by using a circuit of stationary machines. The machines may consist of free weights or weight machines. The following are some strategies for introducing and teaching the use of stationary machines:

Allowing time for exploration. When introducing individuals to a machine allow them time for tactile or visual exploration.
Demonstrating. The instructor should demonstrate the movement and identify the exercise and the muscle involved. The instructor may ask participants to repeat some of the skills to ensure understanding and safe performance.
Offering the option to perform. Encourage individuals to try everything, but let them understand that declining to perform is an option.

The following are some adaptations to the physical environment:

Providing pictures or instructions in appropriate reading media. Allow the person time to look at performance pictures and to have an opportunity to read about the exercise. Explain the muscles used and why there is a proper and safe way to lift.
Creating a visual and a tactual perimeter. For safety, mark the perimeter of the exercise machines on the floor with rope covered with tape or with contrasting colored tape. The tape helps the participant with low vision to locate the perimeter of the weight machines and the rope with tape signals the perimeter to the person who is blind or deafblind.
Numbering the stations. Label each piece of equipment with a designated number, using large print, hi-mark paint, or Braille. A rope, tape, or tactile guide can lead from one piece of equipment to the next one.
Recording performance. Participants should have some way to record the number of repetitions and weight for each exercise to document improvement.
Adapting equipment. Many fitness gyms have aerobic equipment such as treadmills, step-masters, or stationary bicycles with electronic switches. Identify on-off switches by marking them with large print, hi-mark paint, or Braille. Participants can keep track of time on machines with ringing or vibrating timers worn around their necks or in their pockets.

Weight training also can take place at home-in the living room, garage, television room, or the back yard-as well as at a health club. Weight training can be done with family and friends, and practice improves performance. The participant can use light hand-weights (2-5 lbs) or heavy barbells and a weight bench. She or he can also purchase a chin-up bar to hang in the doorway.

Aerobics¹

To "do" aerobics is to perform with or without music certain moves that increase one’s heart rate. It is much easier to practice the movements initially without music and to add it later.

I recommend teaching the moves needed for many aerobics classes by the teaching style of physical assistance or brailling (Lieberman & Cowart, 1996; O’Connell, 2000). The instructor would use physical assistance with individuals who do not have enough vision or hearing to understand verbal instructions about the movement. The instructor then explains the move and moves the participant’s limb through the desired movement pattern, either by a light tap or by fully assisted support. In brailling, the participant feels the instructor or another participant execute the move or skill. Physical assistance and brailling need to be coupled with explanations so that the participant knows what to do. The instructor can then simplify all of the moves to one touch cue or a sign cue that the participant will understand. For example, the instructor wants the participant to march in place for eight counts as part of a low-impact aerobics routine. Once the participant understands the concept, the instructor can do the sign for soldier or tap the individual’s knee to signal marching. The participant then knows to march for eight counts, and then the instructor will give a new cue for the next move. The instructor can also set up routines so that one eight-count move is always followed by the next eight-count move, and so on. That procedure depends on the ability and condition of the participant. Once the participant understands the moves, the instructor should promote independence by trying to fade out the touch cues for physical assistance and brailling.

Aerobics can be done at home with a video or with music and with family and friends of all ages. Probably. the initial routine may have to be taught or described by a helper, but the participant then can exercise independently, performing eight-count or four-count routines and combining different moves.

Low-Impact Aerobics

In this type of aerobics the participant keeps one foot on the ground at all times. An individual can march with high knees; kick to the front; bring a knee up and clap under the leg; march in place and bring arms up and down; do toe touches to the front, right, and left; or just walk briskly around the room. As long as the individual moves and keeps his or her heart rate elevated, anyone who is ambulatory can successfully execute this activity.

Step Aerobics

The participant in step aerobics does sustained stepping on and off a platform 4-, 6-, or 8 in. high at varying tempos and in different directions. The participant imitates the movements made by the instructor. It helps if the instructor repeats moves often and in the same order until the participant learns them. This activity is adaptable to any level of ability. An individual who cannot step onto a step can do these activities without a step.

High-Impact Aerobics

In high-impact aerobics both feet leave the floor at some point during the movement. An individual can do jumping jacks, kicks to the front, jog in place, bring the knees up and clap under the leg with a jump with the other leg, pendulum leg swings out to the sides, side jumps and front jumps in alternating directions, and other such movements. An individual must be in condition to sustain this activity for a long period of time. With this activity it is also helpful if the instructor does the moves in the same order and repeats them often.

Wheelchair Aerobics

The individuals who do aerobics in a wheelchair move their arms up in the air, out to the sides, punch down, or twist at the hips for eight counts or more to elevate their heart rate. If possible, they move their legs and arms at the same time. Any amount of movement can elevate the heart rate, and if it is continued for more than 5 min, it is considered aerobic. The point is to elevate the heart rate and have fun.

Fitness at Home

Many individuals who are visually impaired or deafblind have difficulty getting out into the community for recreation and fitness activities. They also often cannot find a sighted guide to help them in running. walking. or tandem bicycling. Participating in fitness and recreation activities in the home can be an easy, safe, and rewarding endeavor for the participant and the family.

Jumping Rope

Jumping rope aids in agility, balance, and aerobic and muscular endurance. It can be done slowly with no impact or quickly with high impact; it can be done to favorite music or to no music. Individuals can jump rope in a driveway, a yard, or in a clear garage. To remain in a safe area, the jumper can mark off the area with bright cones, a rope on the floor with tape over it, mats, or towels. It can be done with family and friends, and practice improves one’s skill.

Yoga

Life is often stressful for an individual with a visual impairment or deafblindness. Probably the most important advantage of Yoga is its teaching of relaxation, although it produces weight loss and improves muscular strength and flexibility. Yoga can be learned in a class, by reading a book, or from a video. Yoga instruction, like aerobics, can use the techniques of physical assistance and brailling coupled with explanation. Once having learned the moves of yoga, the participant can train in the home or yard, alone or with friends and family. Yoga is an inexpensive way to improve fitness and to gain relaxation.

Basketball

Participants can use regulation women’s or men’s balls, balls with bells, or beach balls. Participants by themselves can practice bouncing while sitting, walking, or running. They can practice shooting by following the sound of the ball when it rebounds. They can locate the basket (a) with a bell on the basket (a string is tied to a bell on basket and pulled by participant), (b) by a friend or family member banging a cane or a broom on the rim of the basket, or (c) by placing a metronome behind the basket. Participants who are deafblind may need a partner to point to the basket and give feedback about performance. Participants need not have a basket to enjoy the game. If they have a family member or peer to play with, they can practice bounce passes, chest passes, and catching. Bounce passes are easiest to catch.²

Summary

Daily physical activity is important for physical and psychological health and to reduce the risk of heart disease, diabetes, high blood pressure, obesity, and stress-related illnesses. A person who is visually impaired or deafblind can access physical activity in many ways. My purpose in writing this article was to provide ideas about how to promote physical activity and lifetime fitness for individuals who are visually impaired or deafblind. I hope this information can be shared with all people working with this population, including physicians. The more physically active individuals are, the more easily they can move through activities of daily living. As the activities of daily life become easier to manage, the quality of a person’s life improves.

Notes

This section is adapted from Lieberman (in press).
See Lieberman and Cowart (1996) for more ideas about basketball and other sports and games.

References

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Buell, C. E. (1982). Physical education and recreation for the visually handicapped. Reston, VA: American Alliance for Health, Physical Education, Recreation, & Dance.

Craft, D., & Lieberman, L. J. (2000). Visual impairments and deafness. In J. Winnick (Ed.), Adapted physical education and sport (3rd ed. pp. 159-169). Champaign, IL: Human Kinetics.

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