Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial

Abstract

Tongue-strengthening exercises (TSE) are based on the principles of exercise and motor learning, including intensity. Intensity is manipulated by gradually adjusting the resistive load. This randomized controlled trial (RCT) investigates the effect of three different values resistive load during TSE in healthy older adults. Sixty subjects completed 8 weeks of TSE while exercising with Iowa Oral Performance Instrument (IOPI). They were randomly distributed to 4 different treatment arms: 3 exercise groups (EG1: n = 15; EG2: n = 16, EG3: n = 16) and 1 control group performing lip-strengthening exercises (CG: n = 13). Values of resistive load for EG1, EG2, and EG3 were 100, 80, and 60% 1RM, respectively. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, after 4 and 8 weeks of training and 4 weeks post-training. MIPA and MIPP in the EG were significantly higher than in the CG at all time points, except baseline. No significant differences between EG were found, but some trends were observable. Anteriorly, the higher the resistive load, the higher the increase in MIP. Posteriorly, 100% 1RM caused the highest values, followed by 60% and 80% 1RM. No detraining effects were measured. The degree of exercise load had a significant negative effect on the registered success rate. This RCT confirms the efficacy of TSE in healthy older adults. For MIPA and MIPP, TSE at a resistive load of 100% 1RM are the most efficient choice in this population, while lowering the resistive load will lead to an increased success rate. No detraining effects were registered.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Murphy BA. Clinical and economic consequences of mucositis induced by chemotherapy and/or radiotherapy. J Support Oncol. 2007;5(9):13–21.

  2. 2.

    Robbins J, Langmore S, Hind JA, Erlichman M. Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21. J Rehabil Res Dev. 2001;39(4):543–8.

  3. 3.

    Pontes ÉS, Amaral AK, Rêgo FL, Azevedo EH, Silva PO. Quality of life in swallowing of the elderly patients affected by stroke. Arquivos de gastroenterological. 2017;54(1):27–32. https://doi.org/10.1590/S0004-2803.2017v54n1-05.

  4. 4.

    Bressan V, Bagnasco A, Aleo G, Catania G, Zanini MP, Timmins F, Sasso L. The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis. Support Care Cancer. 2017;25(5):1699–712. https://doi.org/10.1007/s00520-017-3618-7.

  5. 5.

    Ayres A, Jotz GP, Rieder CR, Schuh AF, Olchik MR. The impact of dysphagia therapy on quality of life in patients with Parkinson’s disease as measured by the swallowing quality of life questionnaire (SwalQol). Int Arch Otorhinolaryngol. 2016;20(3):202–6.

  6. 6.

    Langmore SE, Pisegna JM. Efficacy of exercises to rehabilitate dysphagia: a critique of the literature. Int J Speech Lang Pathol. 2015;17(3):222–9.

  7. 7.

    Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59–64. https://doi.org/10.1111/joor.12461.

  8. 8.

    Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, Robbins J. Effects of device-facilitated isometric progressive resistane oropharyngeal therapy on swallowing and health-related outcomes in older adults with dysphagia. J Am Geriatr Soc. 2016;64:417–24. https://doi.org/10.1111/jgs.13933.

  9. 9.

    Steele CM, Bailey GL, Polacco RE, Hori SF, Molfenter SM, Oshalla M, Yeates EM. Outcomes of tongue-pressure strength and accuracy training for dysphagia following acquired brain injury. Int J Speech Lang Pathol. 2013;15:492–502. https://doi.org/10.3109/17549507.2012.752864.

  10. 10.

    Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, Wolkin T. A randomized trial comparing two tongue pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016;31:452–61. https://doi.org/10.1007/s00455-016-9699-5.

  11. 11.

    Park JS, Kim HJ, Oh DH. Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia. J Phys Ther Sci. 2015;27:3631. https://doi.org/10.1589/jpts.27.3631.

  12. 12.

    Oh JC. Effects of tongue strength training and detraining on tongue pressures in healthy adults. Dysphagia. 2015;30:315–20. https://doi.org/10.1007/s00455-015-9601-x.

  13. 13.

    Lazarus CL, Logemann JA, Huang CF, Rademaker W. Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatr Logop. 2003;55:199–205.

  14. 14.

    Lazarus CL, Husaini H, Hu K, Culliney B, Li Z, Urken M, Jacobson A, Persky M, Tran T, Concert C, Palacios D, Metcalfe-Klax R, Kumar M, Bennett B, Harrison L. Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment. Dysphagia. 2014;29(3):365–75. https://doi.org/10.1007/s00455-014-9519-8.

  15. 15.

    Clark HM, O’Brien K, Calleja A, Corrie SN. Effects of directional exercise on lingual strength. J Speech Lang Hear Res. 2009;52:1034–47. https://doi.org/10.1044/1092-4388(2009/08-0062).

  16. 16.

    Yeates EM, Molfenter SM, Steele CM. Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports. Clin Interv Aging. 2008;3:735–47.

  17. 17.

    Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53:1483–9. https://doi.org/10.1111/j.1532-5415.2005.53467.x.

  18. 18.

    Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88:150–8. https://doi.org/10.1016/j.apmr.2006.11.002.

  19. 19.

    Steele CM, Cichero JA. Physiological factors related to aspiration risk: a systematic review. Dysphagia. 2014;29(3):295–304. https://doi.org/10.1007/s00455-014-9516-y.

  20. 20.

    Humbert IA, German RZ. New directions for understanding neural control in swallowing: the potential and promise of motor learning. Dysphagia. 2013;28(1):1–10. https://doi.org/10.1007/s00455-012-9432-y.

  21. 21.

    Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22:251–65. https://doi.org/10.1007/s00455-006-9074-z.

  22. 22.

    Pekünlü E, Agalağ O. Relationship between fatigue index and number of repetitions maxima with submaximal loads in biceps curl. J Hum Kinetics. 2013;38:169–81. https://doi.org/10.2478/hukin-2013-0057.

  23. 23.

    Pollock M, Gaesser G, Butcher J, Despres J, Dishman R, Franklin B, et al. ACSM position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30(6):975–91.

  24. 24.

    Sheppard JM, Triplett NT. Program design for resistance training. In: Haff GG, Triplett NT, editors. Essentials of strength training and conditioning. 4th ed. Champaign: Human Kinetics; 2016. p. 439–69.

  25. 25.

    Rhea MR, Alvar BA, Burkett LN, Ball SD. A meta-analysis to determine the dose response for strength development. Med Sci Sports Exerc. 2003;35(3):456–64. https://doi.org/10.1249/01.MSS.0000053727.63505.D.

  26. 26.

    Cowley JC, Gates DH. Proximal and distal muscle fatigue differentially affect movement coordination. PLoS ONE. 2017;12(2):e0172835. https://doi.org/10.1371/journal.pone.0172835.

  27. 27.

    Silver JK, Rozmaryn LM. Overuse tendinitis of the intrinsic muscles. Orthopedics. 1998;21(8):891–4.

  28. 28.

    Van den Steen L, Schellen Van den C, Verstraelen K, Beeckman A, Vanderwegen J, De Bodt M, Van Nuffelen G. Tongue strengthening exercises in healthy older adults: specificity of bulb position and detraining effects; 2017. Submitted to dysphagia; accepted October 2017.

  29. 29.

    Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, Lee N, Ho M, Ganz C, Smith B, Sanfilippo N. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Surg. 2014;43:523–30. https://doi.org/10.1016/j.ijom.2013.10.023.

  30. 30.

    Solomon NP, Drager KD, Luschei ES. Sustaining a constant effort by tongue and hand: effects of acute fatigue. J Speech Lang Hear Res. 2002;45(4):613–24.

  31. 31.

    Solomon NP. What is orofacial fatigue and how does it affect function for swallowing and speech? Semin Speech Lang. 2006;27(4):268–82.

  32. 32.

    Saigusa H, Nijmi S, Yamashita K, Gotoh T, Kumada M. Morphological and histochemical studies of the genioglossus muscle. Ann Otol Rhinol Laryngol. 2001;110(8):779–84.

  33. 33.

    Stål P, Marklund S, Thornell LE, De Paul R, Eriksson PO. Fibre composition of human intrinsic tongue muscles. Cells, Tissues, Organs. 2003;173(3):147–61.

  34. 34.

    Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A. Orofacial problems in musicians: a review of the literature. Med Probl Perform Artist. 2011;26(3):150–6.

  35. 35.

    Sanders I, Mu L. A 3-dimensional atlas of the human tongue muscles. Anat Rec. 2013;296:1102–14. https://doi.org/10.1002/ar.22711.

  36. 36.

    Gilbert RJ, Napadow VJ, Gaige TA, Wedeen VJ. Anatomical basis of lingual hydrostatic deformation. J Exp Biol. 2007;210:4069–82.

  37. 37.

    Kier WM, Smith KK. Tongues, tentacles and trunks: the biomechanics of movement in muscular-hydrostats. Zool J Linn Soc. 1985;83:307–24.

  38. 38.

    Felton SM, Gaige TA, Reese TG, Wedeen VJ, Gilbert RJ. Mechanical basis for lingual deformation during the propulsive phase of swallowing as determined by phase contrast magnetic resonance imaging. J Appl Physiol. 2007;103:255–65.

  39. 39.

    Folstein MF, Folstein SE, McHugh PR. “Mini mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

  40. 40.

    Vanderwegen J, Guns C, Van Nuffelen G, Elen R, De Bodt M. The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy Belgian adults. Dysphagia. 2013;28:159–66. https://doi.org/10.1007/s00455-012-9425-x.

  41. 41.

    Suiter DM, Sloggy J, Leder SB. Validation of the Yale Swallow Protocol: a prospective double-blinded videofluoroscopic study. Dysphagia. 2014;29:199–203. https://doi.org/10.1007/s00455-013-9488-3.

  42. 42.

    Hiraoka A, Yoshikawa M, Nakamori M, Hosomi N, Nagasaki T, Mori T, Oda M, Maruyama H, Yoshida M, Izumi Y, Matsumoto M, Tsuga K. Maximum tongue pressure is associated with swallowing dysfunction in ALS patients. Dysphagia. 2017. https://doi.org/10.1007/s00455-017-9797-z.

  43. 43.

    O’Day C, Frank E, Montgomery A, Nichols M, McDade H. Repeated tongue and hand strength measurements in normal adults and individuals with Parkinson’s disease. Int J Orofac Myol. 2005;31:15–25.

  44. 44.

    Murdoch BE, Spencer TJ, Theodoros DG, Thompson EC. Lip and tongue function in multiple sclerosis: a physiological analysis. Mot Control. 1998;2(2):148–60.

  45. 45.

    Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. Pharyngocise: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):210–9. https://doi.org/10.1016/j.ijrobp.2011.06.1954.

  46. 46.

    Lazarus C, Logemann JA, Song CW, Rademaker AW, Kahrilas PJ. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002;54(4):171–6.

  47. 47.

    Schoenfeld BJ, Ratamess NA, Peterson MD, Contreras B, Tiryaki-Sonmez G. Influence of resistance training frequency on muscular adaptations in well-trained men. J Strength Cond Res. 2015;29(7):1821–9. https://doi.org/10.1519/JSC.0000000000000970.

  48. 48.

    Fernández-Lezaun E, Schumann M, Mäkinen T, Kyröläinen H, Walker S. Effects of resistance training frequency on cardiorespiratory fitness in older men and women during intervention and follow-up. Exp Gerontol. 2017;95:44–53. https://doi.org/10.1016/j.exger.2017.05.012.

  49. 49.

    Van den Steen L, Vanderveken O, Vanderwegen J, Van Gestel D, Daisne JF, Allouche J, Delacroix L, Van Rompaey D, Beauvois S, Cvilic S, Mariën S, Desuter G, Vermorken JB, Van den Weyngaert D, Specenier P, Van Laer C, Peeters M, Van de Heyning P, Chantrain G, Lawson G, Lazarus C, De Bodt M, Van Nuffelen G. Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients. Support Care Cancer. 2017. https://doi.org/10.1007/s00520-017-3761-1.

  50. 50.

    Van Nuffelen G, Van den Steen L, Vanderveken O, Specenier P, Van Laer C, Van Rompaey D, Guns C, Mariën S, Peeters M, Van de Heyning P, Vanderwegen J, De Bodt M. Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter? Trials. 2015;16:395. https://doi.org/10.1186/s13063-015-0889-5.

  51. 51.

    Perry BJ, Richburg BD, Pomahad B, Bueno EM, Green JR. The effects of lip-closure exercise on lip strength and function following full facial transplantation: a case report. Am J Speech Lang Pathol. 2017;26(2S):682–6. https://doi.org/10.1044/2017_AJSLP-16-0101.

  52. 52.

    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.

  53. 53.

    Adams V, Mathisen B, Baines S, Lazarus C, Callister R. Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with elderly adults. Disabil Rehabil. 2015;37(5):389–95. https://doi.org/10.3109/09638288.2014.921245.

  54. 54.

    Clark HM. Specificity of training in the lingual musculature. J Speech Lang Hear Res. 2012;55:657–76. https://doi.org/10.1044/1092-4388(2011/11-0045).

  55. 55.

    Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003;1:40–50.

Download references

Acknowledgements

We thank Aline Callant (UGent), Sophie De Maertelaere (UGent), Bastiane De Vuyst (UGent), Tine Derycke (UGent), Charissa Eyskens (Thomas More), Hannah Theuwis (Thomas More), Laura Van den Eynde (Thomas More), Lissa Van de Schoot (Thomas More), Sara Van Evercoren (Thomas More), Karen Van Leuven (UGent), and Liesje Weyers (Thomas More) for thorough work during data collection. This study was funded by Fonds Wetenschappelijk Onderzoek (166652/1901518N).

Author information

Correspondence to Leen Van den Steen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Committee

This study was approved by the Ethical Committee of the University Hospital of Antwerp (B300201421549). All subjects agreed voluntarily to participate in this study and signed an informed consent.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Van den Steen, L., Vanderwegen, J., Guns, C. et al. Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial. Dysphagia 34, 315–324 (2019). https://doi.org/10.1007/s00455-018-9940-5

Download citation

Keywords

  • Dysphagia
  • Tongue-strengthening exercises
  • Resistive load
  • Lip-strengthening exercises