Effects of tongue strengthening exercises in healthy adults and elderly: an integrative literature review

Silva, Juliana Oliveira; Giglio, Lucia Dantas; Trawitzki, Luciana Vitaliano Voi

doi:10.1590/2317-1782/20232021213pt

person Juliana Oliveira Silva

collection · tabulation · analysis of data · elaboration of the manuscript

schoolDepartamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil.

0000-0002-2144-9398

person Lucia Dantas Giglio

writing and reviewing the manuscript

schoolDepartamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil.

0000-0001-7448-3031

person Luciana Vitaliano Voi Trawitzki

study design and general orientation of the stages · data analysis · elaboration and revision of the manuscript

schoolDepartamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil.

0000-0002-2970-1113

Conflict of interest: nothing to declare.

Correspondence address: Luciana Vitaliano Voi Trawitzki Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto (SP), Brasil, CEP: 14049-900. E-mail:
luvoi@fmrp.usp.br

groupsAuthor contributions

JOS was responsible for the collection, tabulation, and analysis of data, as well as the elaboration of the manuscript; LDG was responsible for writing and reviewing the manuscript; LVVT was responsible for the study design and general orientation of the stages, data analysis, elaboration and revision of the manuscript.

	Study	N	Age	Instrument
Adults	Lazarus et al.(¹⁵) United States - Randomized clinical trial	G1=8; G2=10; GC=10	20 - 29	DL (G1) e IOPI (G2)
	Clark et al.(¹⁶) United States - Randomized clinical trial	39	18-67 (average 37.8)	IOPI
	Clark(¹⁴) United States - Randomized clinical trial	25	19-57 (average 29.8)	IOPI
	Arakawa et al.(¹⁷) Japan - Randomized clinical trial	32	21 - 27	JMS
	Oh(¹²) South Korea - Prospective cohort intervention	10	21-35	IOPI
	Yano et al.(¹¹) Japan - Prospective cohort intervention	11	20-21	JMS
	Hwang et al.(¹⁰) - South Korea - Randomized clinical trial	30	20-28	TPS System and IOPI
	Lin et al.(¹³) China - Randomized clinical trial	EG=44; GC=47	22-72 (average 35,3)	IOPI
	Park et al.(¹⁸) South Korea - Randomized clinical trial	10	21-28	IOPI
Elderly	Robbins et al.(¹) - United States - Prospective cohort intervention	10	70 - 89	IOPI
	Van den Steen et al.(¹⁹) - Belgium - Randomized clinical trial	G1=7; G2=9	70 - 95	IOPI
	Namiki et al.(²²) - Japan - Prospective cohort intervention	18	70 - 83	JMS
	Park et al.(²) - South Korea - Randomized clinical trial	20	65 - 73	TPS System
	Van den Steen et al.(²⁰) - Belgium - Randomized clinical trial	G1=15; G2=16; G3=16	70-90	IOPI
	Lee et al.(²¹) - South Korea - Randomized clinical trial	22	65 - 85	IOPI
	Szynkiewicz et al.(²³) - United States - Randomized clinical trial	G1=7; G2=8	60-86	IOPI

	Study	Exercises	Duration (weeks)	Frequency	Load
	Study	Exercises	Duration (weeks)	Frequency	(% de 1 MR)
Adults	Lazarus et al.(¹⁵)	Press the tongue against a tongue depressor or the IOPI bulb for 2s in four directions: left, right, protrusion, and elevation.	4	10 repetitions in each direction, 5 times a day for 5 days a week	Maximum contraction.
	Clark et al.(¹⁶)	Elevation: press the tongue against the hard palate	9	Sequential training group: perform only the lifting exercise for 3 weeks, followed by 3 weeks of the protrusion exercise and another 3 weeks of the lateralization exercise. They completed 3 sets with 10 repetitions of each exercise, with the lateralization exercise performed 5 times to the right and 5 times to the left in each set.	Maximum contraction.
		Protrusion: push the tongue against a blade positioned between the upper and lower incisors and stabilized with the support of the fingers		Concurrent training group: a set of 10 repetitions of each exercise.
		Lateralization: push the lateral region of the tongue against a blade positioned between the maxillary and mandibular premolars.		Both groups performed the exercises three times a day, every day.
	Clark(¹⁴)	Strength: Press the anterior region of the tongue against the instrument bulb. Isotonic resistance: press the anterior region of the tongue against the instrument bulb several times.	4	3 sessions per week. Strength: 5 sets of 5 repetitions.	Strength: maximum contraction.
		Power: make the /t/ sound as fast as possible and press the instrument's bulb		Isotonic resistance: 5 sets. Power: 5 sets of 10 reps	Resistance: 75.
		Speed: repeat the /t/ sound several times and as fast as possible.		Speed: 5 sets of 10s	Power: 75.
	Arakawa et al.(¹⁷)	Press the apex of the tongue against the gingivobuccal fold and rotate the tongue every 2s to the right and then to the left.	12	20 rotations to the right and 20 to the left, once a day and every day of the week	-
	Oh(¹²)	Press the instrument bulb, positioned between the tongue and the hard palate, first with the anterior and then the posterior region of the tongue for 2s each.	8	3 sessions per week	1st week: 60.
	Oh(¹²)		8	Lasting 30 min each. Rest of 10s between each repetition.	Following weeks: 80.
	Yano et al.(¹¹)	Press the anterior region of the tongue against the hard palate.	8	30 repetitions, three times a day, 3 days a week.	1st week: 60.
	Yano et al.(¹¹)		8	30 repetitions, three times a day, 3 days a week.	Following weeks: 80.
	Hwang et al.(¹⁰)	G1: through a “feeding game”, the participant pressed the tongue against the instrument bulb at different intensities depending on the game situation.	6	A 30min session 5 days a week	G2: 70.
	Hwang et al.(¹⁰)	G2: press the tongue against the IOPI bulb positioned on the hard palate.	6	A 30min session 5 days a week	G2: 70.
	Lin et al.(¹³)	Press the instrument bulb with the anterior and then the posterior region of the tongue for 10s each.	8	5 days a week, with each session lasting 30min 30 repetitions of an exercise for the anterior and posterior regions, respectively.	-
Elderly	Robbins et al.(¹)	Pressing the tongue against the instrument bulb positioned between the tongue and the hard palate	6	30 repetitions, 3 times a day 3 days a week	First week: 60.
	Robbins et al.(¹)		6	30 repetitions, 3 times a day 3 days a week	Following weeks: 80.
	Van den Steen et al.(¹⁹)	Press the anterior (G1) and posterior (G2) regions of the tongue against the bulb of the instrument positioned between the tongue and the hard palate	8	3 sessions per week	80
	Van den Steen et al.(¹⁹)		8	24 sets of 5 reps, with 30s rest between each set	80
	Namiki et al.(²²)	Press the entire tongue against the hard palate as hard as possible for 10s	4	2 sets with 5 repetitions each, with a 10s rest period between each repetition, twice a day, every day of the week.	Maximum contraction
	Park et al.(²)	Isotonic exercise: pressing the tongue against the instrument bulb positioned between the tongue and the hard palate	-	Isotonic exercise: 3 sets of 30 repetitions per day	70
	Park et al.(²)	Isometric exercise: press the tongue against the instrument bulb and keep the contraction for 30s	-	Isometric exercise: 3 sets of 30s each per day	70
	Van den Steen et al.(²⁰)	Press the anterior and then the posterior region of the tongue against the bulb of the instrument positioned between the tongue and the hard palate	8	3 sessions per week	G1:100.
				24 sets of 5 reps (12 sets of each region), with 30s rest between each set	G2: 80.
					G3:60.
	Lee et al.(²¹)	Press the tongue against the instrument bulb positioned between the tongue and the hard palate	8	30 times, 3 times a day 3 days a week	-
	Szynkiewicz et al.(²³)	G1- Pressing the tongue as hard as possible against a tongue depressor, during elevation, protrusion, and lateralization	6	3 sessions per week	Maximum contraction
	Szynkiewicz et al.(²³)	G2- Exercise mentioned above combined with the mental practice of lingual exercises using motor images	6	10 repetitions in each direction (protrusion, elevation, left lateralization, and right lateralization) 3 times a day	Maximum contraction

	Study	Strength measurements after training (%)
Adults	Lazarus et al.(¹⁵)	Tongue depressor: 12.8		IOPI: 14.2
	Clark et al.(¹⁶)	Strength in elevation: 6	Strength in lateralization: 26.6		Strength in protrusion: 13.4
	Clark(¹⁴)	Strength exercise: 25.5	Isotonic resistance exercise: 11.3	Power exercise: 10.6	Speed exercise: 10.4
	Arakawa et al.(¹⁷)	Men: 18.5		Women: 31.8
	Oh(¹²)	Anterior region of the tongue: 24.8		Posterior region of the tongue: 25.6
	Yano et al.(¹¹)	Anterior region of the tongue: 45.2		Posterior region of the tongue: 50
	Hwang et al.(¹⁰)	G1: 6.5		G2: 2.9
	Lin et al.(¹³)	Anterior region of the tongue: 3.5		Posterior region of the tongue: 10.4
	Park et al.(²⁰)	10,4
Elderly	Robbins et al.(¹)	19,5
	Van den Steen et al.(¹⁹)	Anterior region of the tongue: G1 = 72.4; G2= 15.1		Posterior region of the tongue: G1 = 59.7; G2= 44.9
	Namiki et al.(²²)	8,9
	Park et al.(²)	18
	Van den Steen et al.(²⁰)	Anterior region of the tongue: G1 = 61; G2 = 60.4; G3 = 51.8		Posterior region of the tongue: G1 = 74.5; G2 = 50.2; G3 = 53.3
	Lee et al.(²¹)	Anterior region of the tongue = 11.9		Posterior region of the tongue = 8.78
	Szynkiewicz et al.(²³)	G1=9		G2=16.9

	Study	Detraining period	Strength measurements after training (%)
Adults	Lazarus et al.(¹⁵)	-	There were no detraining measures
	Clark et al.(¹⁶)	4 weeks	Unable to get detraining values
	Clark(¹⁴)	-	There were no detraining measures
	Arakawa et al.(¹⁷)	-	There were no detraining measures
	Oh(¹²)	28 weeks	Anterior region of the tongue: -8.3	Posterior region of the tongue: -9.7
	Yano et al.(¹¹)	12 weeks	Anterior region: -2.6	Posterior region: +10
	Hwang et al.(¹⁰)	-	There were no detraining measures
	Lin et al.(¹³)	-	There were no detraining measures
	Park et al.(¹⁸)	-	There were no detraining measures
Elderly	Robbins et al.(¹)	-	There were no detraining measures
	Van den Steen et al.(¹⁹)	4 weeks	Anterior tongue strength: G1 = -6.7, G2 = +10.8	Posterior tongue strength: G1 = -10.5, G2 = -5.1
	Namiki et al.(²²)	-	There were no detraining measures
	Park et al.(²)	-	There were no detraining measures
	Van den Steen et al.(²⁰)	4 weeks	Anterior region of the tongue: G1 = -4.3, G2 = -2.9, G3 = +4.4 Posterior region of the tongue: G1 = + 4.1, G2 = - 5.1, G3 = + 1.5
	Lee et al.(²¹)	-	There were no detraining measures
	Szynkiewicz et al.(²³)	-	There were no detraining measures

[1] Caption: EG= Experimental Group; GC= Control Group; G1= Group 1; G2= Group 2; G3= Group 3; DL= Tongue Depressor; IOPI= Iowa Oral Performance Instrument (IOPI Medical, Redmond, WA); JMS= JMS tongue pressure measurement system (JMS Co. Ltd, Tokyo, Japan); TPS System=(TPS 100, CybermedicInc, Iksan, South Korea).