Dose in Exercise-Based Dysphagia Therapies: A Scoping Review

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.

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

“…Even though a significant effect on swallowing tongue pressure was obtained from this intervention program, it remains unclear if the actual cumulative exercise dosage (ie, intensity, frequency, and duration) employed in this study is significant [ 49 ]. According to a scoping review, a tongue exercise dosage of 3 times a day for 7 days with a frequency of 30 repetitions for each exercise was the most widely implemented regimen for studies including single tongue exercises [ 50 ]. However, for studies that adopted combined exercises (ie, more than one therapy method), treatment dosage, frequency, and duration varied widely, and thus, the improvements in various outcome measures could not be concluded to be attributable to the use of particular treatment dosages [ 50 ].…”

“…According to a scoping review, a tongue exercise dosage of 3 times a day for 7 days with a frequency of 30 repetitions for each exercise was the most widely implemented regimen for studies including single tongue exercises [ 50 ]. However, for studies that adopted combined exercises (ie, more than one therapy method), treatment dosage, frequency, and duration varied widely, and thus, the improvements in various outcome measures could not be concluded to be attributable to the use of particular treatment dosages [ 50 ].…”

Categorización de la atención fonoaudiológica: una propuesta para adultos en contexto hospitalario

“…La literatura avala el inicio precoz e intensivo de las intervenciones de rehabilitación con el objetivo de mejorar los outcomes funcionales (Arias-Fernández et al, 2018). Más allá de la frecuencia de las atenciones, que es un punto relevante, también debe ser considerada la dosis utilizada en las sesiones (intensidad, repeticiones, frecuencia, duración) y el tiempo desde el inicio del cuadro (Jette, 2017;Krekeler et al, 2020). A nivel fonoaudiológico, la evidencia sobre este aspecto es limitada y existe escasa información sobre la frecuencia y la dosis de las intervenciones (Baker, 2012).…”

“…Al igual que en las otras áreas, se cuenta con escasa literatura que entregue información sobre métodos que condicionen la frecuencia de las intervenciones. Sin embargo, existe evidencia, aunque no es totalmente concluyente, relacionada con la dosis utilizada en diferentes ejercicios deglutorios (Clark, 2005;Krekeler et al, 2020). Esta evidencia podría servir como sustento al momento de establecer la frecuencia de las atenciones.…”

“…Más bien se la definió como una ejecución sostenida, lo más fuerte posible o con máximo esfuerzo. Finalmente, las propuestas de duración total del programa de intervención variaron entre 4 semanas a 1 año (Krekeler et al, 2020).…”