Effects of Effortful Swallowing Exercise with Progressive Anterior Tongue Press Using Iowa Oral Performance Instrument (IOPI) on the Strength of Swallowing-Related Muscles in the Elderly: A Preliminary Study


The purpose of this study was to confirm the effect of effortful swallowing (ES) exercise programs applied to increase the swallowing-related muscle strength in the elderly. In this study, 20 healthy elderly people (76.65 ± 5.87 years; 10 women and 10 men) participated and exercised for 7 weeks. The experimental group performed ES exercise combined with external resistance using Iowa Oral Performance Instrument (IOPI), and the control group performed pure ES without external resistance. The exercises were performed for 20 min a day, 2 days a week for 7 weeks in both groups. ES was repeated 60 times in weeks 1 and 2, 80 times in week 3 and 4, and 120 times in weeks 5–7. In the experimental group, the isometric and swallowing tongue pressures at week 8 were significantly improved compared to baseline. At week 8, the anterior and swallowing tongue pressures and anterior tongue endurance were significantly higher than those of the control group. In the control group, no significant change in tongue pressure-related variables was observed after 7 weeks of exercise. ES exercise combined with IOPI resistance for 7 weeks tended to increase the suprahyoid muscle activation level without statistical significance. For clinical application of this exercise protocol, further studies including more elderly people and patients with dysphagia are required.

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The author would like to acknowledge the support of So-Yeon Park, Kyung-Hee Kang, Na-Rae Kim, Ji-Hyeon Kim, So-Jeong Lee, and Se-Jin Han.


This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2017R1C1B5017285). Role of the Funding Source The funding source was not involved in the study design; the collection, analysis, and interpretation of the data; the writing of the report; or in the decision to submit the article for publication.

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Correspondence to Jong-Chi Oh.

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Ethical Approval and Consent to Participate

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committees and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All the participants provided informed consent to participate in this study. The protocol was approved by the ethics committee of Institutional Review Board of Cheongju University (1041107-202004-HR-009-01).

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Oh, JC. Effects of Effortful Swallowing Exercise with Progressive Anterior Tongue Press Using Iowa Oral Performance Instrument (IOPI) on the Strength of Swallowing-Related Muscles in the Elderly: A Preliminary Study. Dysphagia (2021). https://doi.org/10.1007/s00455-021-10259-7

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  • Deglutition
  • Deglutition disorders
  • Electromyography
  • Exercise
  • Tongue