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Dose in Exercise-Based Dysphagia Therapies: A Scoping Review

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Abstract

Background

Optimal exercise doses for exercise-based approaches to dysphagia treatment are unclear. To address this gap in knowledge, we performed a scoping review to provide a record of doses reported in the literature. A larger goal of this work was to promote detailed consideration of dosing parameters in dysphagia exercise treatments in intervention planning and outcome reporting.

Methods

We searched PubMed, Scopus[Embase], CINAHL, and Cochrane databases from inception to July 2019, with search terms relating to dysphagia and exercises to treat swallowing impairments. Of the eligible 1906 peer-reviewed articles, 72 met inclusionary criteria by reporting, at minimum, both the frequency and duration of their exercise-based treatments.

Results

Study interventions included tongue exercise (n = 16), Shaker/head lift (n = 13), respiratory muscle strength training (n = 6), combination exercise programs (n = 20), mandibular movement exercises (n = 7), lip muscle training (n = 5), and other programs that did not fit into the categories described above (n = 5). Frequency recommendations varied greatly by exercise type. Duration recommendations ranged from 4 weeks to 1 year. In articles reporting repetitions (n = 66), the range was 1 to 120 reps/day. In articles reporting intensity (n = 59), descriptions included values for force, movement duration, or descriptive verbal cues, such as “as hard as possible.” Outcome measures were highly varied across and within specific exercise types.

Conclusions

We recommend inclusion of at least the frequency, duration, repetition, and intensity components of exercise dose to improve reproducibility, interpretation, and comparison across studies. Further research is required to determine optimal dose ranges for the wide variety of exercise-based dysphagia interventions.

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Acknowledgements

This work was supported by NIH Grants 1F31AG059351-01, T32-DC009401, R01DC018071, R01DC008149, R01DC014358, R37CA225608. This manuscript was submitted in partial fulfillment of the requirements for the doctoral dissertation of the first author, BNK. She would like to thank and recognize her dissertation committee members for their valuable contributions to her training and feedback on this manuscript: Drs. Nicole Rogus-Pulia, Michelle R Ciucci, Gary Diffee, Catriona Steele, and Timothy McCulloch.

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Authors and Affiliations

  1. Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA

    Brittany N. Krekeler, Linda M. Rowe & Nadine P. Connor

  2. Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA

    Brittany N. Krekeler, Linda M. Rowe & Nadine P. Connor

  3. Department of Communication Sciences and Disorders, Northwestern University, Swallowing Cross-Systems Collaborative, 2240 Campus Drive, Evanston, IL, 60208, USA

    Brittany N. Krekeler

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  1. Brittany N. Krekeler
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Correspondence to Brittany N. Krekeler.

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Appendix

PubMed

((((((((((tongue[tw] AND (pressure*[tw] OR resistance[tw] OR hold*[tw] OR lift*[tw] OR strength*[tw]))))) OR (effortful swallow*[tw] OR shaker exercise*[tw] OR mendelsohn maneuver*[tw] OR supraglottic swallow*[tw] OR exercise*[tw]))) AND (((deglutition disorders[mh] NOT gastroesophageal reflux[mh]) OR (deglutition disorder*[tw] OR dysphagia[tw] OR swallowing disorder*[tw] OR swallowing difficult*[tw]))))))).

Scopus[Embase]

( ( ( TITLE-ABS-KEY ( tongue) AND TITLE-ABS-KEY ( pressure* OR resistance OR hold* OR lift* OR strength*)) OR ( TITLE-ABS-KEY ( "effortful swallow*" OR "shaker exercise*" OR "mendelsohn man*" OR “supraglottic swallow*” OR exercise*))) AND ( TITLE-ABS-KEY ( "deglutition disorder*" OR dysphagia OR "swallowing disorder*" OR "swallowing difficult*"))) AND ( INDEX ( embase)).

CINAHL

( ( tongue AND (pressure* OR resistance OR hold* OR lift* OR strength*)) OR ( ("effortful swallow*" OR "shaker exercise*" OR "mendelsohn man*" OR “supraglottic swallow*” OR exercise*))) AND ( ("deglutition disorder*" OR dysphagia OR "swallowing disorder*” OR "swallowing difficult*")).

Cochrane CENTRAL

( ( tongue AND (pressure* OR resistance OR hold* OR lift* OR strength*)) OR ( ("effortful swallow*" OR "shaker exercise*" OR "mendelsohn man*" OR “supraglottic swallow*” OR exercise*))) AND ( ("deglutition disorder*" OR dysphagia OR "swallowing disorder*" OR "swallowing difficult*")) in Title, Abstract, Keywords in Trials'.

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Krekeler, B.N., Rowe, L.M. & Connor, N.P. Dose in Exercise-Based Dysphagia Therapies: A Scoping Review. Dysphagia 36, 1–32 (2021). https://doi.org/10.1007/s00455-020-10104-3

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