Swallow strength training exercise for elderly: A health maintenance need

Abstract

Background: Recent studies have shown high prevalence of oropharyngeal dysphagia associated with frailty- and age-related muscle weakness. Strength training exercises have been advocated for locomotive health maintenance in the elderly and have shown positive outcomes. As muscles involved in oropharyngeal phase of swallowing are also comprised of striated muscles, the aim of this study was to determine biomechanical effect of a novel resistance exercise program, Swallowing Against Laryngeal Restriction (SALR), on pharyngeal phase swallowing in the healthy elderly.

Methods: A total of 28 volunteers (75 + 7 years; 17 females) with no complaint of dysphagia were studied using video fluoroscopy before and after 6 weeks of the swallow strength training exercise. Eighteen of these volunteers also underwent high-resolution pharyngeal manometry non-concurrent with fluoroscopy. Ten additional volunteers (81 + 6 years; 9 females) were studied by videofluoroscopy before and after 6 weeks of a sham exercise.

Key results: Swallow resistance exercise but not the sham exercise resulted in a significant increase in maximum upper esophageal sphincter opening (P < .01), superior and anterior laryngeal excursion (P < .01) as well as posterior pharyngeal wall thickness (P < .01). Resistance exercise but not sham exercise also resulted in a significant increase in deglutitive pharyngeal contractile integral (P < .01).

Conclusions & inferences: Strength training of muscles involved in the pharyngeal phase of swallowing using the swallowing against laryngeal restriction technique is feasible and significantly improves key physiologic features of the pharyngeal phase of swallowing. These findings provide the basis for consideration of developing an exercise-based swallow health maintenance program for the elderly swallow health maintenance program for the elderly.

Keywords: aging; dysphagia; elderly; exercise; swallow health maintenance; swallowing disorders.

Figure 1

Swallow Resistance Exercise Device (sRED) consists of an inflatable bag housed in a rigid shell. The concave surface of the inflated bag rests on the thyroid cartilage and conforms to the surface of the larynx, restricting the antero-superior excursion of the hyolaryngeal complex

Figure 2

Comparison between maximum deglutitive anteroposterior opening of the UES (UESDmax) during 1, 3 and 5ml swallows at enrollment and completion of the six-week study. Significant volume effect in UESDmax at enrollment persisted and remained significant after six weeks of exercise (p<0.01).

Figure 3

Deglutitive laryngeal excursions increased significantly following the six weeks of exercise for all tested volumes (*p< 0.05). Individual subject average data are shown as connected scattergrams and group average is shown as a horizontal line.

Figure 4

For the eighteen subjects who had both manometry and fluoroscopic studies, there was significant increase in average pharyngeal contractile integral after six weeks of exercise compared to pre-exercise values (* p<0.05). Bars represent mean values and error bars represent standard error.

Figure 5

Posterior pharyngeal wall (PPW) thickness before the initiation of swallow (PPW-Hold) and during swallow (PPW-Max) measurements showed six weeks of exercise was associated with significant increase in both measures for all tested volumes (*p<0.01). Connected dots represent individual mean values before and after the exercise period. Group means are shown as horizontal lines.