The swallowing muscles are prone to decreased strength and function as part of the natural aging process which can lead to difficulty swallowing, malnutrition, and frailty. Exercise and nutrition are powerful stimulators of muscular change. The proposed research will investigate the effectiveness of a 12-week proactive regimen of swallowing exercises (with or without daily protein supplement drinks) to improve the composition, force, and physiology of the swallowing muscles and explore the relationship to overall health and physical function in 80 community-dwelling older adults. Each participant will serve as their own control for 12 weeks before being randomized to complete swallowing exercises alone or swallowing exercises with protein drinks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
120
12-weeks of proactive pharyngeal swallowing exercises conducted 5 times per week. The exercise program will include the following four exercises: effortful saliva swallows, tongue-hold swallows, effortful pitch glides and posterior lingual resistance. Each exercise set will include 10 repetitions of each exercise (40 reps per set). The number of sets will be gradually increased as tolerance builds.
12-week supply of the commercially-available Premier Protein Clear ® High Protein (20 grams of protein and 90 calories per 16.9 oz. drink). Participants will be asked to consume one drink per day for the 12-week intervention period.
Participants will be scanned using a 3T MRI scanner and a 16-channel phased array neck coil.
NYU Steinhardt School of Education
New York, New York, United States
RECRUITINGNYU Langone Health
New York, New York, United States
RECRUITINGChange in Thickness of the Superior Pharyngeal Constrictor Muscle
Axial T2-weighted images through the C1 level, hyoid bone and arytenoid cartilages will be used to measure the thickness of the superior pharyngeal constrictor muscle.
Time frame: Baseline, Week 13
Change in Thickness of the Superior Pharyngeal Constrictor Muscle
Axial T2-weighted images through the C1 level, hyoid bone and arytenoid cartilages will be used to measure the thickness of the superior pharyngeal constrictor muscle.
Time frame: Baseline, Week 28
Change in Thickness of the Middle Pharyngeal Constrictor Muscle
Axial T2-weighted images through the C1 level, hyoid bone and arytenoid cartilages will be used to measure the thickness of the middle pharyngeal constrictor muscle.
Time frame: Baseline, Week 13
Change in Thickness of the Middle Pharyngeal Constrictor Muscle
Axial T2-weighted images through the C1 level, hyoid bone and arytenoid cartilages will be used to measure the thickness of the middle pharyngeal constrictor muscle.
Time frame: Baseline, Week 28
Change in Thickness of the Inferior Pharyngeal Constrictor Muscle
Axial T2-weighted images through the C1 level, hyoid bone and arytenoid cartilages will be used to measure the thickness of the inferior pharyngeal constrictor muscle.
Time frame: Baseline, Week 13
Change in Thickness of the Inferior Pharyngeal Constrictor Muscle
Axial T2-weighted images through the C1 level, hyoid bone and arytenoid cartilages will be used to measure the thickness of the inferior pharyngeal constrictor muscle.
Time frame: Baseline, Week 28
Change in Maximum Pharyngeal Constriction During Swallowing
Maximum pharyngeal constriction area (normalized to spine length) will be captured at the height of the swallow on videofluoroscopy.
Time frame: Baseline, Week 13
Change in Maximum Pharyngeal Constriction During Swallowing
Maximum pharyngeal constriction area (normalized to spine length) will be captured at the height of the swallow on videofluoroscopy.
Time frame: Baseline, Week 28
Change in Short Physical Performance Battery (SPPB) Scores
The SPPB comprises a gait speed test, a chair stand test, and three balance tests. The gait speed test score ranges from 0 (worst outcome) to 4 (best outcome); the chair stand test score ranges from 0 (worst outcome) to 4 (best outcome); the side-by-side stand test score ranges from 1 (best outcome) to 0 (worst outcome); the semi-tandem stand test score ranges from 1 (best outcome) to 0 (worst outcome); and the tandem stand test scores range from 2 (best outcome) to 0 (worst outcome). The total SPPB score is the sum of the test scores and ranges from 0-12, with lower scores indicating greater disability.
Time frame: Baseline, Week 13
Change in Short Physical Performance Battery (SPPB) Scores
The SPPB comprises a gait speed test, a chair stand test, and three balance tests. The gait speed test score ranges from 0 (worst outcome) to 4 (best outcome); the chair stand test score ranges from 0 (worst outcome) to 4 (best outcome); the side-by-side stand test score ranges from 1 (best outcome) to 0 (worst outcome); the semi-tandem stand test score ranges from 1 (best outcome) to 0 (worst outcome); and the tandem stand test scores range from 2 (best outcome) to 0 (worst outcome). The total SPPB score is the sum of the test scores and ranges from 0-12, with lower scores indicating greater disability.
Time frame: Baseline, Week 28
Change in Fat-Free Muscle Index
Fat-free muscle index measured via bioelectrical impedance analysis using the InBody 570 multi-frequency analyzer.
Time frame: Baseline, Week 13
Change in Fat-Free Muscle Index
Fat-free muscle index measured via bioelectrical impedance analysis using the InBody 570 multi-frequency analyzer.
Time frame: Baseline, Week 28
Change in Pre-Albumin Levels
Levels of pre-albumin, a marked of undernutrition, will be measured using patient blood samples.
Time frame: Baseline, Week 13
Change in Pre-Albumin Levels
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Levels of pre-albumin, a marked of undernutrition, will be measured using patient blood samples.
Time frame: Baseline, Week 28