The Effects of Whole-Body Exercise on Swallowing Function in Older Adults With Parkinson's Disease: A Proof-of-Principle Study.

Abstract

Rodent models suggest that when respiratory demands increase during an exercise program, tongue and thyroarytenoid muscles engage to maintain a patent airway, leading to increased muscle strength. This suggests that nonspecific exercises that increase respiratory rate may improve swallowing. As such, the purpose of this proof-of-principle study was to determine the potential for whole-body exercise to improve tongue strength, cough strength, and self-reported swallowing function in older adults with Parkinson's disease (PD). Nine community-dwelling adults with PD (six men, three women; M ± SD age = 73 ± 7 years) were enrolled in a 10-week (30 min/session, three sessions/week, for a total of 30 sessions) virtual, whole-body exercise program, designed to increase respiratory rate. Demographic, frailty (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls [SARC-F]), mobility (Schwab & England Activities of Daily Living Scale), and swallowing (tongue strength, cough strength, Eating Assessment Tool 10 [EAT-10]) measures were collected. Data were analyzed using descriptive statistics and linear mixed models. Baseline frailty and mobility severity scores indicated mild PD severity. Post-exercise, four of nine participants demonstrated improvement in either anterior or posterior tongue strength, as well as cough strength. Three participants with higher exercise heart rate or rating of perceived exertion scores reported a decrease in EAT-10 scores to a level of below clinical concern (< 3). Results from linear mixed models demonstrated no statistically significant effects on any measures of swallowing function. Findings from this pilot study suggest potential signal for a higher intensity whole-body exercise program to improve self-reported swallowing function, given that heart rate and/or exertion intensity that met or exceeded the target was associated with positive changes in self-reported swallowing function, but not tongue or cough strength. Future research including a larger sample size and intervention controls is needed to further elucidate a relationship between whole-body exercise and swallowing.