Oropharyngeal dysphagia (OPD) associated with frailty is an important national healthcare concern with serious consequences, enormous cost and limited therapeutic options. Despite positive health outcomes with strength training exercises for locomotive health maintenance in the elderly, to date there has been no systematic approach for an exercise-based swallow function maintenance program. Aim: To determine the effect of a swallow exercise program on the oropharyngeal deglutitive biomechanics in healthy elderly and dysphagic patients using a novel technique of Swallowing Against Laryngeal Restriction (SALR). Methods: We studied 24 healthy elderly(76+/-7yrs,10M) by videofluoroscopy before and after six-weeks of real exercise. 12 of these volunteers also underwent pre and post-exercise high-resolution pharyngeal manometry. 10 elderly(81+/-6yrs,1M) were studied by videofluoroscopy before and after six-week of sham exercise. We also studied a heterogenous group of 21 OPD patients(64+/-10yrs,10F) with videofluoroscopy before and after a minimum of six-weeks of real exercise. Real exercise consisted of 30 swallows at 15 second intervals TID using a device hindering deglutitive laryngeal excursion. Results: In healthy elderly, real exercise, but not sham exercise, significantly improved upper esophageal sphincter (UES) opening, posterior pharyngeal-wall thickness, anterosuperior laryngeal excursion and pharyngeal contractile integral. In patients, UES opening, anterior laryngeal excursion and symptom-specific outcome EAT-10 improved significantly post-exercise. Conclusions: Strength training facilitated by SALR technique safely improves deglutitive biomechanics, function, and reverses pharyngeal sarcopenia. In addition to developing similar program for deglutitive rehabilitation of OPD, the findings of this study provide the basis for developing an exercise-based preventive swallow health maintenance program for the elderly.
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