The Effectiveness of Physical and Sports Exercises in Cochlear Implant Users: A Systematic Review

Background and Aims Cochlear implantation is an effective intervention for auditory rehabilitation in individuals with severe to profound hearing loss. However, it may lead to balance and vestibular disorders or worsen existing symptoms. Physical, motor, and vestibular rehabilitation exercises, especially balance-focused interventions, are considered essential to improve motor function and quality of life. This systematic review aimed to assess scientific evidence regarding the effectiveness of such exercises among cochlear implant users. Methods This systematic review was conducted following PRISMA guidelines and the PICO framework. A comprehensive search was performed in international databases (MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, SCOPUS, SPORTDiscus, Embase, and Taylor & Francis) and Persian databases (SID and Magiran) for studies published between January 2015 and August 2025, with no language restrictions. Eligible studies included randomized controlled trials, quasi-experimental studies, pre-test–post-test studies, case–control studies, and case reports involving cochlear implant recipients with outcomes related to balance, gait pattern, or motor performance. Study quality was assessed using the GRADE framework and standard evaluation tools. Results Out of 4,920 records, eleven studies met the inclusion criteria. Participants ranged from children to adults with severe-to-profound hearing loss from diverse cultural backgrounds. The most common interventions included static/dynamic balance training (20.9%), gait/mobility exercises (16.3%), and eye–hand/visual–motor training (14%), as well as multisensory–vestibular exercises, specialized skill training, and fine motor occupational therapy. Most studies reported significant improvements in balance, reduced vestibular symptoms, and enhanced quality of life. The main limitations were small sample sizes and short follow-up durations. Conclusion Current evidence supports the effectiveness of physical, motor, and vestibular rehabilitation programs in improving motor performance, balance, and quality of life in cochlear implant users. Future high-quality studies with larger samples and longer follow-up are recommended to provide more robust clinical guidelines.