Skip to main content

Advertisement

SpringerLink
Log in

Changes in Cardiac Function During a Swallow Exercise Program in Patients with Coronary Artery Disease

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Research regarding risks of swallow treatment suggests that patients with coronary artery disease (CAD) experience changes in heart rate/rhythm when completing the supraglottic swallow and super-supraglottic swallow. The current study evaluated cardiac function during multiple swallowing exercises in patients with dysphagia and CAD. Eligible patients had CAD and confirmed pharyngeal dysphagia from VFS and sufficient cognitive ability to follow direction. The protocol included an a priori concealed randomized order of seven swallowing exercises (supraglottic swallow, super-supraglottic swallow, Mendelsohn and Masako maneuvers, effortful swallow with and without breath hold, and jaw opening exercise). Objective measures of heart rate/rhythm, oxygen saturation, and blood pressure were compared before vs after the overall session and each exercise using the Wilcoxon signed-rank test, and McNemar’s and Cochran’s Q tests with alpha at 0.05 and power at 0.80. Participants were 20 adults (15 male), aged 28–88 (median 76.5 years). 90% were intubated during their hospital stay (44% > 1 intubation) and 20% suffered post-op stroke. Severe dysphagia, marked by NPO status, occurred in 30% of patients. Sessions were 26 min long (mean; SD = 2.29). With few exceptions, objective measures were stable pre vs post overall and after each exercise. Potential vulnerability was noted with increased heart rate after the super-supraglottic swallow and increased arrhythmias after the effortful swallow (p < 0.05 for both). The order that swallowing exercises were completed did not significantly impact cardiovascular function. Telemetry and pulse oximetry proved to be feasible tools to monitor for subtle changes in cardiovascular function during completion of swallowing exercises.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Barker J, Martino R, Reichardt B, Hickey EJ, Ralph-Edwards A. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. Can J Surg. 2009;52:119–24.

    Google Scholar 

  2. Skoretz SA, Yau TM, Ivanov J, Granton JT, Martino R. Dysphagia and associated risk factors following extubation in cardiovascular surgical patients. Dysphagia. 2014;29:647–54. https://doi.org/10.1007/s00455-014-9555-4.

    Article  Google Scholar 

  3. Suiter DM, Easterling CS. Update on current treatment and practice patterns for dysphagia. Topics Geriatr Rehabilit. 2007;23:197–210.

    Google Scholar 

  4. Logemann JA. Evaluaton and treatment of swallowing disorders. 1st ed. Austin, TX: Pro-Ed Inc.; 1983.

    Google Scholar 

  5. Bulow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia. 2001;16:190–5.

    CAS  Google Scholar 

  6. Logemann JA. Manual for the videofluoroscopic study of swallowing. 2nd ed. Austin, TX: Pro-Ed Inc.; 1993.

    Google Scholar 

  7. Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on postural pharyngeal wall movement during deglutition. Am J Speech Lang Pathol. 1996;5:23–30.

    Google Scholar 

  8. Choi JB, Jung YJ, Park JS. Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift exercise for dysphagic stroke: a pilot study. Medicine. 2020;99: e22136. https://doi.org/10.1097/MD.0000000000022136.

    Article  CAS  Google Scholar 

  9. Cipriano GF, Cipriano G Jr, Santos FV, Guntzel Chiappa AM, Pires L, Cahalin LP, Chiappa GR. Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis. Integr Blood Press Control. 2019;12:1–11. https://doi.org/10.2147/IBPC.S159386.

    Article  Google Scholar 

  10. Puntil-Sheltman J. Medically fragile patients: fitting dysphagia into the bigger clinical picture. ASHA Leader. 2002;7:1–15. https://doi.org/10.1044/leader.ftr3.07182002.1.

    Article  Google Scholar 

  11. Chaudhuri G, Hildner C, Brady S, Hutchins B, Aliga N, Abadilla E. Cardiovascular effects of the supraglottic and super-supraglottic swallowing maneuvers in stroke patients with dysphagia. Dysphagia. 2002;17:19–23.

    Google Scholar 

  12. Metzger BL, Therrien B. Effect of position on cardiovascular response during the Valsalva maneuver. Nurs Res. 1990;39:198–202.

    CAS  Google Scholar 

  13. Laciuga H, Davenport P, Sapienza C. The acute effects of a single session of expiratory muscle strength training on blood pressure, heart rate, and oxygen saturation in healthy adults. Front Physiol. 2012;3:1–6.

    Google Scholar 

  14. Gomes LM, Silva RG, Melo M, Silva NN, Vanderlei FM, Garner DM, de Abreu LC, Valenti VE. Effects of effortful swallow on cardiac autonomic regulation. Dysphagia. 2016;31:188–94. https://doi.org/10.1007/s00455-015-9676-4.

    Article  Google Scholar 

  15. Gomes LMS, da Silva RG, Pedroni CR, Garner DM, Raimundo RD, Valenti VE. Effects of effortful swallowing on cardiac autonomic control in individuals with neurogenic dysphagia: a prospective observational analytical study. Sci Rep. 2020;10:10924. https://doi.org/10.1038/s41598-020-67903-9.

    Article  CAS  Google Scholar 

  16. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8. https://doi.org/10.1007/BF00417897.

    Article  CAS  Google Scholar 

  17. Martin-Harris B, Brodsky M, Michel Y, Castell D, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImP: establishing a standard. Dysphagia. 2008;23:392–405. https://doi.org/10.1007/s00455-008-9185-9.

    Article  Google Scholar 

  18. American Heart Association: All about heart rate (pulse). https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse. Accessed 31 Jul 2015

  19. American Heart Association: About arrhythmias. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia. Accessed 30 Sep 2016

  20. Mayo Clinic: Hypoxemia. https://www.mayoclinic.org/symptoms/hypoxemia/basics/definition/sym-20050930. Accessed 1 Dec 2018

  21. American Heart Association: Understanding blood pressure readings. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings. Accessed 2020

  22. Tsang JP, Mohan S. Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors. Med Devices. 2013;7:1–5. https://doi.org/10.2147/MDER.S54038.

    Article  Google Scholar 

  23. Sapienza C. Take two swallows and call me in the morning; perspectives on swallowing and swallowing disorders. Dysphagia. 2007;16:14–8.

    Google Scholar 

  24. Rio-Rodriguez D, Iglesias-Soler E, del Olmo MF. Set configuration in resistance exercise: muscle fatigue and cardiovascular effects. PLoS ONE. 2016;11:e0151163. https://doi.org/10.1371/journal.pone.0151163.

    Article  CAS  Google Scholar 

  25. Nelesen R, Dar Y, Thomas K, Dimsdale JE. The relationship between fatigue and cardiac functioning. Arch Internal Med. 2008;168:943–9. https://doi.org/10.1001/archinte.168.9.943.

    Article  Google Scholar 

  26. Cook CM, Ahmad Y, Howard JP, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease. J Am Coll Cardiol. 2018;72:970–83. https://doi.org/10.1016/j.jacc.2018.06.033.

    Article  Google Scholar 

Download references

Funding

Partial financial support was received from the Allied Health Research Committee, University Health Network. The authors have no relevant financial or non-financial interests to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article. RM is supported by a CIHR Chair (Tier II) in Swallowing Disorders.

Author information

Authors and Affiliations

  1. Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 4EB-316, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada

    Jennifer Barker

  2. Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada

    Jennifer Barker & Rosemary Martino

  3. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Rosemary Martino

  4. Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

    Rosemary Martino

  5. Krembil Research Institute, University Health Network, Toronto, ON, Canada

    Rosemary Martino

  6. Division of Cardiovascular Surgery, University of Toronto, Toronto, ON, Canada

    Terrence M. Yau

  7. Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada

    Terrence M. Yau

Authors
  1. Jennifer Barker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosemary Martino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Terrence M. Yau
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors made substantial contributions to the conception and design of the work, revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jennifer Barker.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

Ethics approval was granted by the Research Ethics Board of the University Health Network, Study ID 13-7149.9.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barker, J., Martino, R. & Yau, T.M. Changes in Cardiac Function During a Swallow Exercise Program in Patients with Coronary Artery Disease. Dysphagia 38, 389–396 (2023). https://doi.org/10.1007/s00455-022-10477-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-022-10477-7

Keywords

Search

Navigation