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Effects of Tongue Resistance and Strengthening Exercises on Tongue Strength and Oropharyngeal Swallowing in Frail Older Adults With Mild Cognitive Impairment: A Double‐Blind Randomised Controlled Trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: Reduced tongue function in older adults leads to inefficient bolus transit. Tongue resistance exercises (TRE) involve isometric or isotonic tongue movements performed against an external load to improve tongue strength. Whereas, tongue strengthening exercises (TSE) involve repetitive, high-intensity tongue movements enhancing tongue pressure and swallowing coordination, contributing to safer and more efficient swallowing. However, evidence on the effectiveness of combined TRE and TSE in frail older adults with mild cognitive impairment (MCI) remains unknown. OBJECTIVE: Explore effects of combined TRE and TSE on tongue function, swallowing pressure, clinical swallowing function, and quality of life in frail older adults with MCI. METHODS: A prospective, double-blind, three-arm randomised controlled trial registered with ClinicalTrials.gov: NCT06490705. Participants were randomly assigned to (i) TRE + TSE (n = 29), (ii) TRE alone (n = 30), and (iii) cheek-bulging exercises (control group, n = 30) for 12 weeks with a follow-up 12-week booster program. The primary outcome was tongue function (IOPI), including anterior (ATS) and posterior (PTS) tongue strength, and anterior (ATE) and posterior (PTE) tongue endurance. The secondary outcomes were swallowing pressure (IOPI), including saliva (SSP) and effortful (ESP) swallowing pressure, clinical swallowing function including difficulty of oral phase (DOP) and number of saliva swallows - NRSS (repetitive saliva swallowing test, RSST), and swallowing quality of life (SWAL-QOL). Generalised estimating equation model was used for data analysis. RESULTS: Frail older adults with MCI (n = 89, mean age: 75.3 ± 6.9 years; 82% women) were recruited. Combined TRE + TSE significantly improved ATS [β = 9.5, 95% CI = 3.8-15.1], PTE [β = 9.7, 95% CI = 2.8-16.6], SSP [β = 8.9, 95% CI = 5.0-12.9], effortful swallow pressure (ESP) [β = 12.1, 95% CI = 6.8-17.4], NRSS [β = 4.0, 95% CI = 2.7-5.3] and SWAL-QOL [β = 29.3, 95% CI = 22.4-36.2] with sustained effects on NRSS and SWAL-QOL at 12-week follow-up compared to cheek-bulging exercises. TRE alone improved ATS, SSP, ESP, NRSS, and SWAL-QOL immediate post-test, with sustained effects on SSP, ESP, and SWAL-QOL at follow-up compared to cheek-bulging exercises. Booster training maintained these improvements over time. CONCLUSION: A combined tongue training offers more comprehensive benefits than TRE alone, with booster training maintaining short-term effects.

Source: Journal of Oral Rehabilitation

DOI: 10.1111/joor.70087