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Effects of Strengthening Exercises on Swallowing Musculature and Function in Senior Healthy Subjects: a Prospective Effectiveness and Feasibility Study

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Abstract

Head and neck cancer (HNC) patients may develop dysphagia due to muscle atrophy and fibrosis following chemoradiotherapy. Strengthening of the swallowing muscles through therapeutic exercise is potentially effective for improving swallowing function. We hypothesize that a customized Swallow Exercise Aid (SEA), developed for isometric and isokinetic strengthening exercises (against resistance), can help to functionally strengthen the suprahyoid musculature, which in turn can improve swallowing function. An effectiveness/feasibility study was carried out with ten senior healthy volunteers, who performed exercises 3 times per day for 6 weeks. Exercises included chin tuck against resistance (CTAR), jaw opening against resistance (JOAR), and effortful swallow exercises with the SEA. Multidimensional assessment consisted of measurements of maximum chin tuck and jaw opening strength, maximum tongue strength/endurance, suprahyoid muscle volume, hyoid bone displacement, swallowing transport times, occurrence of laryngeal penetration/aspiration and/or contrast residue, maximum mouth opening, feasibility/compliance (questionnaires), and subjective swallowing complaints (SWAL-QOL). After 6-weeks exercise, mean chin tuck strength, jaw opening strength, anterior tongue strength, suprahyoid muscle volume, and maximum mouth opening significantly increased (p < .05). Feasibility and compliance (median 86 %, range 48–100 %) of the SEA exercises were good. This prospective effectiveness/feasibility study on the effects of CTAR/JOAR isometric and isokinetic strengthening exercises on swallowing musculature and function shows that senior healthy subjects are able to significantly increase swallowing muscle strength and volume after a 6-week training period. These positive results warrant further investigation of effectiveness and feasibility of these SEA exercises in HNC patients with dysphagia.

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Acknowledgments

Wim Kraan, emeritus-technician at the Netherlands Cancer Institute, is greatly acknowledged for the technical construction of the Swallow Exercise Aid (SEA). Jan-Ove Persson (Atos Medical, Hörby, Sweden) and Corina J van As-Brooks (PhD, SLP, MBA; Atos Medical and Netherlands Cancer Institute) are acknowledged for their input in the development of the SEA.

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Authors and Affiliations

  1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    S. A. C. Kraaijenga, L. van der Molen, F. J. M. Hilgers & M. W. M. van den Brekel

  2. Department of Physical Therapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    M. M. Stuiver

  3. Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    M. M. Stuiver

  4. Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    H. J. Teertstra

  5. Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands

    F. J. M. Hilgers & M. W. M. van den Brekel

  6. Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    F. J. M. Hilgers & M. W. M. van den Brekel

Authors
  1. S. A. C. Kraaijenga
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  2. L. van der Molen
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  3. M. M. Stuiver
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  4. H. J. Teertstra
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  5. F. J. M. Hilgers
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  6. M. W. M. van den Brekel
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Correspondence to F. J. M. Hilgers.

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Kraaijenga, S.A.C., van der Molen, L., Stuiver, M.M. et al. Effects of Strengthening Exercises on Swallowing Musculature and Function in Senior Healthy Subjects: a Prospective Effectiveness and Feasibility Study. Dysphagia 30, 392–403 (2015). https://doi.org/10.1007/s00455-015-9611-8

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  • DOI: https://doi.org/10.1007/s00455-015-9611-8

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