Effects of Physical Rehabilitation and Nutritional Intake Management on Improvement in Tongue Strength in Sarcopenic Patients

Abstract

The study aimed to investigate the impact of physical intervention and the amount of nutritional intake on the increase in tongue strength and swallowing function in older adults with sarcopenia. From November 2018 and May 2019, older patients with sarcopenia who were admitted for rehabilitation were analyzed. The intervention employed in the study was the usual physical and occupational therapy for two months. Tongue strength was measured before and after two months of treatment. Data on tongue strength, the amount of energy and protein intake, intervention time, and swallowing function were examined. A total of 95 sarcopenic older patients were included (mean age 83.4 ± 6.5 years). The mean tongue strength after the intervention was significantly increased from 25.4 ± 8.9 kPa to 30.5 ± 7.6 kPa as a result of the treatment (p < 0.001). After adjusting the confounding factors in the multivariable models, an energy intake of ≥30 kcal/kg/day and a protein intake of ≥1.2 g/kg/day based on the ideal body weight had a significant impact on the increase in tongue strength after the treatment (p = 0.011 and p = 0.020, respectively). Swallowing function assessed using the Mann Assessment of Swallowing Ability was significantly increased after the treatment (mean difference between pairs: 1.12 [0.53–1.70]; p < 0.001). Physical intervention and strict nutritional management for older inpatients with sarcopenia could be effective to improve tongue strength and swallowing function.

Nutritional Management Enhances the Recovery of Swallowing Ability in Older Patients with Sarcopenic Dysphagia

“…Physical interventions may also affect muscle tissue throughout the body, including swallowing-related muscle groups [ 30 , 31 ]. Physical rehabilitation may be effective in improving swallowing ability [ 13 , 14 ]. Nagano et al [ 14 ] showed that physical rehabilitation was associated with a significant increase in tongue strength, a swallowing-related muscle group.…”

“…Physical rehabilitation may be effective in improving swallowing ability [ 13 , 14 ]. Nagano et al [ 14 ] showed that physical rehabilitation was associated with a significant increase in tongue strength, a swallowing-related muscle group. A combination of nutritional management and physical interventions is considered preferable for the treatment of systemic sarcopenia [ 32 ].…”

“…Protein provision is also thought to be an effective nutritional management strategy for systemic sarcopenia [ 36 ]. A protein intake of 1.2 g/IBW/day (kg) may effectively improve tongue strength in older adults with sarcopenia [ 14 ]. Further research is needed to determine the effectiveness of the protein provided in the nutritional management of patients with sarcopenic dysphagia.…”

“…These case reports also implemented nutritional management with an energy intake of ≥30 kcal/ideal body weight (IBW)/day (kg) [ 10 , 11 , 12 ]. Physical rehabilitation is effective in improving swallowing ability [ 13 , 14 ]. Moreover, physical interventions and a high energy intake of ≥30 kcal/IBW/day (kg) improved tongue pressure in older patients with sarcopenia [ 14 ].…”

“…Physical rehabilitation is effective in improving swallowing ability [ 13 , 14 ]. Moreover, physical interventions and a high energy intake of ≥30 kcal/IBW/day (kg) improved tongue pressure in older patients with sarcopenia [ 14 ]. Tongue pressure is a key component of the diagnostic criteria for sarcopenic dysphagia [ 3 , 5 ].…”