Swallowing Muscle Strength Research Articles

High-intensity intermittent inspiratory and abdominal muscle combined training in respiratory, swallowing and systemic muscles of healthy adults.

Low-intensity continuous inspiratory muscle training improves its strength. The abdominal muscles are the main expiratory muscles, and their training may improve expiratory muscle strength. Respiratory muscle strength regulates coughing effectiveness, which is critical for pneumonia management. In older people, risk factors for the development of pneumonia were respiratory muscle weakness and swallowing impairment. Currently, the impact of high-intensity intermittent inspiratory and abdominal muscle combined training on the respiratory, swallowing, and systemic muscles is unclear. We aimed to explore the effects of high-intensity inspiratory muscle training combined with or without abdominal muscle training on respiratory muscle strength as well as the strength, mass, and performance of swallowing and systemic muscles. Twenty-eight healthy adults were divided into two groups. Participants performed high-intensity intermittent inspiratory muscle single or its combination with abdominal muscle training for 4 weeks. Respiratory muscle strength, swallowing muscle strength and mass, systemic muscle strength, mass and performance were measured at baseline, Week 2 and Week 4. Both groups showed greater maximal respiratory pressures at Week 2 and Week 4 than baseline. Both groups showed improved tongue pressure and geniohyoid muscle thickness at Week 4. In addition, the combined training group improved body trunk muscle mass, handgrip strength and five-time chair stand test, whereas the single training group did not. This study revealed that high-intensity inspiratory muscle training improved inspiratory muscle strength and swallowing muscle strength and mass. Moreover, inspiratory and abdominal muscle combined training showed an additional benefit of improving systemic muscle strength, mass and performance. UMIN000046724; https://upload.umin.ac.jp/cgi-open-bin/ctr/index.cgi?ctrno=UMIN000046724.

Low muscle strength as a predictor of incident pneumonia in older patients with heart failure: sub-analysis of fragile-hf

Abstract Background Patients with heart failure often develop pneumonia during the course of their illness, which leads to high mortality. A decrease in swallowing muscle strength due to aging or concomitant disease may be involved in the development of pneumonia in the elderly. We sought to investigate the association between low muscle strength and the incidence of pneumonia in older patients hospitalized for worsening HF. Methods We carried out a sub-analysis of FRAGILE-HF, a prospective multicenter study, including 1228 consecutive older (>=65 years) hospitalized patients with HF (median age 81; 57.6% male; left ventricular ejection fraction (LVEF) 46±17%). The patients were followed-up for two years after discharge from the index hospitalization. Results A total of 87 patients (7.1%) developed pneumonia after discharge, with an incidence of 43 per 1,000 patient-years. The patients with incident pneumonia were more likely to be male and had lower body mass index than those without pneumonia. A total of 895 patients (72.9%) with low muscle strength, defined as handgrip strength <28 kg for men and <18 kg for women according to the international criteria, were more likely to develop pneumonia than those with normal muscle strength (p<0.001 for log-rank: figure). Low muscle strength was a significant predictor of incident pneumonia after adjustment with age, sex, body mass index, LVEF, and history of chronic lung disease and cerebral infarction (adjusted hazard ratio with 95% confidence interval: 3.31 [1.68-6.53], p<0.001). Furthermore, 43.7% and 19.1% died in patients with and without pneumonia during the follow-up period, respectively, with the subsequent risk of all-cause mortality after the occurrence of pneumonia (adjusted hazard ratio: 4.09 [2.85-5.87], p<0.001). Conclusions Low muscle strength was associated with incident pneumonia in older patients hospitalized for worsening HF. This finding may support the need for an interventional study targeting muscle wasting to prevent pneumonia in HF.

Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update.

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient's pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

Respiratory Muscle Weakness as a Risk Factor for Pneumonia in Older People

Introduction: The respiratory muscle strength regulates the effectiveness of coughing, which clears the airways and protects people from pneumonia. Sarcopenia is an aging-related loss of muscle mass and function, the worsening of which is associated with malnutrition. The loss of respiratory and swallowing muscle strength occurs with aging, but its effect on pneumonia is unclear. This study aimed to determine the risks of respiratory muscle weakness on the onset and relapse of pneumonia in older people in conjunction with other muscle-related factors such as malnutrition. Methods: We conducted a longitudinal study with 47 pneumonia inpatients and 35 non-pneumonia controls aged 70 years and older. We evaluated the strength of respiratory and swallowing muscles, muscle mass, and malnutrition (assessed by serum albumin levels and somatic fat) during admission and confirmed pneumonia relapse within 6 months. The maximal inspiratory and expiratory pressures determined the respiratory muscle strength. Swallowing muscle strength was evaluated by tongue pressure. Bioelectrical impedance analysis was used to evaluate the muscle and fat mass. Results: The respiratory muscle strength, body trunk muscle mass, serum albumin level, somatic fat mass, and tongue pressure were significantly lower in pneumonia patients than in controls. Risk factors for the onset of pneumonia were low inspiratory respiratory muscle strength (odds ratio [OR], 6.85; 95% confidence interval [CI], 1.56–30.11), low body trunk muscle mass divided by height2 (OR, 6.86; 95% CI, 1.49–31.65), and low serum albumin level (OR, 5.46; 95% CI, 1.51–19.79). For the relapse of pneumonia, low somatic fat mass divided by height2 was a risk factor (OR, 20.10; 95% CI, 2.10–192.42). Discussion/Conclusions: Respiratory muscle weakness, lower body trunk muscle mass, and malnutrition were risk factors for the onset of pneumonia in older people. For the relapse of pneumonia, malnutrition was a risk factor.

MRI Assessment of Swallow Muscle Activation with the Swallow Exercise Aid and with Conventional Exercises in Healthy Volunteers: An Explorative Biomechanical Study.

Swallowing muscle strength exercises are effective in restoring swallowing function. In order to perform the exercises with progressive load, the swallow exercise aid (SEA) was developed. Precise knowledge on which muscles are activated with swallowing exercises, especially with the SEA, is lacking. This knowledge would aid in optimizing the training program to target the relevant swallowing muscles, if necessary. Three healthy volunteers performed the three SEA exercises (chin tuck against resistance, jaw opening against resistance and effortful swallow) and three conventional exercises [conventional effortful swallow (cES), Shaker and Masako] in supine position inside an MRI scanner. Fast muscle functional MRI scans (generating quantitative T2-maps) were made immediately before and after the exercises. Median T2 values at rest and after exercise were compared to identify activated muscles. After the three SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles showed significant T2 value increase. After the Shaker, the lateral pterygoid muscles did not show such an increase, but the three other muscle groups did. The cES and Masako caused no significant increase in any of these muscle groups. During conventional (Shaker) exercises, the suprahyoid, infrahyoid, and sternocleidomastoid muscles are activated. During the SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles are activated. The findings of this explorative study further support the potential of the SEA to improve swallowing rehabilitation.

Relationship Between Tongue Pressure and Pharyngeal Function Assessed Using High-Resolution Manometry in Older Dysphagia Patients with Sarcopenia: A Pilot Study.

Tongue pressure is often used to evaluate swallowing muscle strength in dysphagia patients with sarcopenia. However, the amount of tongue pressure that reflects pharyngeal swallowing function is unclear. The aims of this descriptive study were (1) to assess the association between tongue pressure and swallowing function using high-resolution manometry (HRM), (2) to evaluate whether manometric parameters were related to maximum tongue pressure (MTP) and other sarcopenia-related factors, and (3) to evaluate the manometric characteristics of pharyngeal swallowing in sarcopenic dysphagia. Sixteen patients with dysphagia (13 men; mean age 85.0 ± 6.6) who were diagnosed with sarcopenia and sixteen healthy subjects (10 men; mean age 33.6 ± 7.2) were included. Evaluation of HRM parameters including velopharyngeal contractile integral (VPCI), mesohypopharyngeal contractile integral (MHPCI), upper esophageal sphincter (UES) relaxation duration, and UES nadir pressure was performed. HRM parameters of patients were compared with MTP, sarcopenia factors, and manometric parameters of healthy subjects. The VPCI showed no statistically significant differences between patient and healthy groups. In the patient group, the MHPCI was significantly lower (126.1 ± 76.6 vs 193.2 ± 34.1mmHgcms; p = 0.003), UES nadir pressure was significantly higher (10.5 ± 27.5 vs -11.2 ± 6.7mmHg; p < 0.001), and UES relaxation duration (318.0 ± 152.4 vs 520.6 ± 60.0ms; p = 0.007) was significantly shorter than those in the healthy group. HRM parameters were not significantly correlated with MTP and sarcopenia factors. Older dysphagia patients with sarcopenia had weaker pharyngeal contractility and UES dysfunction. Manometric evaluation of pharyngeal function may not be significantly associated with MTP and sarcopenia-related factors. Further study is needed to clinically apply tongue pressure for evaluating sarcopenic dysphagia.

Relationship between the nutritional state of elderly people in need of support or nursing care and jaw-opening force and tongue pressure.

[Purpose] We hypothesized that an association exists between the nutritional state of elderly people and the deterioration in the swallowing function associated with sarcopenia, which is reflected by the strength of the tongue and suprahyoid muscles. Therefore, we conducted a comparative study of the nutritional state and swallowing muscle strength. [Participants and Methods] The participants in this study were 25 elderly people in need of support or nursing care, situated at a geriatric health service facility, who were able to understand instructions and ate three meals per day orally. We evaluated the strength of the tongue muscles using a tongue pressure measurement device and the strength of the suprahyoid muscles by measuring the jaw-opening force. The nutritional state was evaluated using the Mini Nutritional Assessment. [Results] There was a significant correlation between the Mini Nutritional Assessment score and the jaw-opening force. Conversely, no correlation was found between the Mini Nutritional Assessment score and the tongue pressure. [Conclusion] The significant correlation between the Mini Nutritional Assessment score and the jaw-opening force suggests that the strength of the suprahyoid muscles, which reflects the swallowing function and jaw-opening force, deteriorates with age and is affected by the nutritional state. This suggests that the nutritional state could be an important indicator for the evaluation of the swallowing function.

Relationship between swallowing muscles and trunk muscle mass in healthy elderly individuals: A cross-sectional study

Background and objectiveA decrease of swallowing muscle strength causes dysphagia, and a relationship between swallowing muscle strength and appendicular muscle mass has been reported. Moreover, the effect of trunk retention function on swallowing function has been clinically recognized. However, the relationship between trunk muscle mass and swallowing muscle strength is unclear. We aimed to clarify the association between these variables in elderly individuals. MethodsSubjects were 118 healthy community-dwelling individuals aged ≥65 years (men: 37, women: 81). We measured total muscle mass, grip strength, jaw-opening force, tongue pressure, cross-sectional area (CSA) of the geniohyoid muscle, and tongue muscle thickness. The appendicular skeletal muscle mass index (ASMI) and trunk muscle mass index (TMI) were calculated based on the appendicular skeletal muscle mass and trunk muscle mass, and corrected by height squared. Multiple regression analysis was performed with jaw-opening force and tongue pressure as dependent variables and with age, sex, grip strength, ASMI, TMI, CSA of the geniohyoid muscle, and tongue muscle thickness as independent variables. ResultsSignificant explanatory factors for jaw-opening force were sex (p = 0.002) and TMI (p = 0.003). Significant explanatory factors for tongue pressure were aging (p = 0.001), tongue muscle thickness (p = 0.027), and TMI (p = 0.033). ConclusionsUntil now, the relationship between swallowing muscles and whole body muscle mass has been reported using ASMI as the indicator of whole body muscle mass. This study suggests that TMI may be used as a highly relevant indicator of swallowing muscles rather than ASMI.

Age-related declines in the swallowing muscle strength of men and women aged 20–89 years: A cross-sectional study on tongue pressure and jaw-opening force in 980 subjects

Swallowing muscle strength weakens with aging. Although numerous studies have investigated tongue pressure (TP) changes with age, studies on jaw-opening force (JOF), an indicator of suprahyoid muscle strength, are lacking. We investigated differences between age-related declines in TP and JOF in a cross-sectional study of 980 healthy and independent participants (379 men, 601 women) without dysphagia. Hand grip strength (HGS), TP, and JOF were compared among decade-based age groups in multiple comparison analyses with post-hoc tests and effect size calculated. Participants were divided into adult (20 s–50 s) and elderly groups (60 s–80 s); within each group, Pearson correlations between age and muscle strength indices were evaluated. TP started to significantly decline in the 60 s and 50 s for men and women (p < .01, medium effect size and p < .05, small effect size, respectively); HGS also declined at these ages (men: p < .01, women: p < .01, medium effect size). JOF started to significantly decline in men in their 80 s (p < .01, large effect size), but remained unchanged in women. In the elderly group, all measurements declined with age more sharply in men (HGS: r = −0.56, TP: r = −0.63, JOF: r = −0.13) than in women (HGS: r = −0.38, TP: r = −0.49, JOF: r = −0.003). TP declined more steeply than did JOF. Thus, the age related-decline in TP was similar to that of the HGS, but not the JOF. The results reveal that different patterns exist in the age-related decline in swallowing muscle strength, and suggest that maintenance of JOF might contribute to safe swallowing in healthy elderly individuals.

Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia

AbstractBackgroundSarcopenic dysphagia is characterized by difficulty swallowing due to loss of whole‐body skeletal and swallowing muscle mass and function. Despite multiple reports regarding sarcopenic dysphagia, no verified diagnostic methods exist. The purpose of this study was to develop a diagnostic algorithm for sarcopenic dysphagia and verify its reliability and validity.MethodsFirst, our research group, the Working Group on Sarcopenic Dysphagia, developed a diagnostic algorithm for sarcopenic dysphagia. Patients 65 years and older who could follow commands were eligible for assessment using the algorithm. Patients without whole‐body sarcopenia, with normal swallowing function, and with a disease that was an obvious cause of their dysphagia were considered not to have sarcopenic dysphagia. Then, swallowing muscle strength was assessed by tongue pressure. Those with poor swallowing muscle strength were deemed to be at probable risk for sarcopenic dysphagia and those with normal swallowing muscle strength to be at possible risk for sarcopenic dysphagia. Second, we applied the algorithm to inpatients 65 years and older and investigated their characteristics, muscle mass, muscle strength, motor function, swallowing muscle strength, swallowing function, and nutritional status. We investigated the reliability of the algorithm by analyzing intra‐ and inter‐class correlation coefficients using kappa statistics. Third, we investigated the validity of the algorithm by analyzing the difference in the proportion of patients with sarcopenic dysphagia between the no malnutrition and malnutrition groups and investigated the risk factors for sarcopenic dysphagia using logistic regression analysis.ResultsA total of 119 patients participated in this study. Their mean age was 86.1 years, and 55 (46%) were men. Among the 119 patients, 32 were categorized as having possible sarcopenic dysphagia, 18 probable sarcopenic dysphagia, and 69 no sarcopenic dysphagia. The intra‐class coefficient for the algorithm was 0.87 (95% confidence interval [CI]: 0.73‐1.01), and the inter‐class coefficient was 0.98 (95% CI: 0.92‐1.02), indicating high intra‐ and inter‐rater reliabilities. In the investigation of the algorithm's validity, 67 patients were analyzed. The proportion of patients with sarcopenic dysphagia was significantly higher in the malnutrition than in the no malnutrition group (P = 0.028). Malnutrition and age were independently associated with sarcopenic dysphagia (P = 0.013 and 0.003, respectively).ConclusionsA diagnostic algorithm for sarcopenic dysphagia was developed, and its reliability and validity were verified. All older patients with sarcopenia or dysphagia should be assessed for sarcopenic dysphagia, which requires treatment involving not only rehabilitation for dysphagia but also nutritional improvement.

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

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.