Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise

Abstract

Earlier studies have shown that the cross-sectional area of the deglutitive upper esophageal sphincter (UES) opening in healthy asymptomatic elderly individuals is reduced compared with healthy young volunteers. The aim of this study was to determine the effect of a head-raising exercise on swallow-induced UES opening and hypopharyngeal intrabolus pressure in the elderly. We studied a total of 31 asymptomatic healthy elderly subjects by videofluoroscopy and manometry before and after real (19 subjects) and sham (12 subjects) exercises. A significant increase was found in the magnitude of the anterior excursion of the larynx, the maximum anteroposterior diameter, and the cross-sectional area of the UES opening after the real exercise (P < 0.05). These changes were associated with a significant decrease in the hypopharyngeal intrabolus pressure studied in 12 (real-exercise) and 6 (sham-exercise) subjects (P < 0.05). A similar effect was not found in the sham-exercise group. In normal elderly subjects, deglutitive UES opening is amenable to augmentation by exercise aimed at strengthening the UES opening muscles. This augmentation is accompanied by a significant decrease in hypopharyngeal intrabolus pressure, indicating a decrease in pharyngeal outflow resistance. This approach may be helpful in some patients with dysphagia due to disorders of deglutitive UES opening.

Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

“…The Shaker exercise is a simple isotonic/isometric head-raising exercise that has been shown to increase the anteroposterior deglutitive opening diameter and cross-sectional area of the UES [1,2]. The original design of the Shaker exercise was based on patient tolerance and reported fatigue and consisted of three isometric repetitions of 1-min sustained head raisings with 1-min rest periods.…”

“…Before and after completing 6 weeks of the exercise, the subjects were instructed to perform the isometric portion of the Shaker exercise while surface EMG electrodes were placed as described above. Direction was given to each participant to perform the isometric or sustained portion of the two-part exercise [1,2].…”

“…The UES is normally in a state of tonic contraction that prevents air passage from the pharynx into the esophagus. Sphincteric relaxation and distensibility also contribute to UES opening.The Shaker exercise is a simple isotonic/isometric head-raising exercise that has been shown to increase the anteroposterior deglutitive opening diameter and cross-sectional area of the UES [1,2]. This exercise consists of three isometric repetitions of 1-min sustained head raisings with the patient in the supine position, alternating with 1-min rest periods.…”

“…Before and after completing 6 weeks of the exercise, the subjects were instructed to perform the isometric portion of the Shaker exercise while surface EMG electrodes were placed as described above. Direction was given to each participant to perform the isometric or sustained portion of the two-part exercise [1,2].For the Shaker exercise trials, the subjects were placed flat on an examining table in a supine position and asked to raise only their head off the table, flexing the neck to look at their feet. The intent of the exercise was to have the subject look at their feet while keeping their shoulders flat on the table with the thoracic muscles relaxed.…”

Oropharyngeal Dysphagia: Neurogenic Etiology and Manifestation

“…They obtained an average GUSS scoring of two. PEG was done in all the four patients along with Shaker's exercise [31,32] to improve opening of the cricopharyngeal sphincter. There were two patients with traumatic brain injury who showed global aphasia with aspiration.…”