The Recline and Head Lift Exercises (Fujiki et al., 2019)

Purpose: The aim of this study was to compare biomechanical swallowing outcomes and perceived effort as well as detraining effects of the established Head Lift exercise (HLE) and the novel Recline Exercise (RE) in healthy older adults.

Method: Twenty-two healthy older adults were randomized to perform either the RE or the HLE for a period of 6 weeks. Subjects underwent videofluoroscopic swallowing studies at 3 time points (baseline, postexercise, and following a 6-week detraining period). Primary outcome measures included biomechanical measures of superior and anterior hyoid excursion and upper esophageal sphincter opening, obtained using kinematic analyses on the recorded swallows. Perceived exertion ratings during exercise, as measured by the Borg scale, were included as a secondary outcome measure. Linear mixed-effects models were utilized to compare exercise groups and evaluation time points.

Results: The 2 exercise groups did not differ significantly in age, body mass index, or body fat percentage at baseline. Significant postexercise increases were seen in superior hyoid excursion, F(2, 36.7) = 24.01, p ≤ .0001, and anterior hyoid excursion, F(2, 36.7) = 5.40, p = .0088, for both exercise groups. Upper esophageal sphincter opening did not increase significantly following the exercise regimens, F(2, 36.5) = 2.14, p = .1322. Both groups displayed a significant decrease in perceived exertion levels over the course of the exercises, F(5, 98) = 23.73, p ≤ .0001. On average, Borg ratings were 20% lower for the RE group than the HLE group at all time points, F(5, 20) = 7.94, p = .0106, indicating that this exercise was perceived as easier to perform. Eighteen participants were followed after detraining, and no differences in detraining effects were seen between groups. In general, gains in biomechanical measures were better maintained on larger bolus types.

Conclusions: In healthy older adults, the HLE and the RE produced similar gains and detraining effects in biomechanical swallow outcomes. The RE exercise, however, required significantly less effort. These findings suggest that the RE is easier to perform for healthy older adults and thus may be a valuable treatment option for individuals who have difficulty performing the HLE. Further investigation in patients with dysphagia is warranted.

Supplemental Material S1. Instructional videos used in participant training.

Fujiki, R. B., Oliver, A. J., Malandraki, J. B., Wetzel, D., Craig, B. A., & Malandraki, G. A. (2019). The Recline and Head Lift Exercises: A randomized clinical trial comparing biomechanical swallowing outcomes and perceived effort in healthy older adults. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2018_JSLHR-S-18-0117