{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T01:33:38Z","timestamp":1793928818768,"version":"4.8.0"},"reference-count":64,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005795","name":"Chang Gung Memorial Hospital, Linkou","doi-asserted-by":"publisher","award":["CMRPG5L0031"],"award-info":[{"award-number":["CMRPG5L0031"]}],"id":[{"id":"10.13039\/501100005795","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Oral Rehabilitation"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reduced tongue function in older adults leads to inefficient bolus transit. Tongue resistance exercises (TRE) involve isometric or isotonic tongue movements performed against an external load to improve tongue strength. Whereas, tongue strengthening exercises (TSE) involve repetitive, high\u2010intensity tongue movements enhancing tongue pressure and swallowing coordination, contributing to safer and more efficient swallowing. However, evidence on the effectiveness of combined TRE and TSE in frail older adults with mild cognitive impairment (MCI) remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Explore effects of combined TRE and TSE on tongue function, swallowing pressure, clinical swallowing function, and quality of life in frail older adults with MCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective, double\u2010blind, three\u2010arm randomised controlled trial registered with\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      : NCT06490705. Participants were randomly assigned to (i) TRE\u2009+\u2009TSE (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929), (ii) TRE alone (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930), and (iii) cheek\u2010bulging exercises (control group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930) for 12\u2009weeks with a follow\u2010up 12\u2010week booster program. The primary outcome was tongue function (IOPI), including anterior (ATS) and posterior (PTS) tongue strength, and anterior (ATE) and posterior (PTE) tongue endurance. The secondary outcomes were swallowing pressure (IOPI), including saliva (SSP) and effortful (ESP) swallowing pressure, clinical swallowing function including difficulty of oral phase (DOP) and number of saliva swallows \u2010 NRSS (repetitive saliva swallowing test, RSST), and swallowing quality of life (SWAL\u2010QOL). Generalised estimating equation model was used for data analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Frail older adults with MCI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200989, mean age: 75.3\u2009\u00b1\u20096.9\u2009years; 82% women) were recruited. Combined TRE\u2009+\u2009TSE significantly improved ATS [\u03b2\u2009=\u20099.5, 95% CI\u2009=\u20093.8\u201315.1], PTE [\u03b2\u2009=\u20099.7, 95% CI\u2009=\u20092.8\u201316.6], SSP [\u03b2\u2009=\u20098.9, 95% CI\u2009=\u20095.0\u201312.9], effortful swallow pressure (ESP) [\u03b2\u2009=\u200912.1, 95% CI\u2009=\u20096.8\u201317.4], NRSS [\u03b2\u2009=\u20094.0, 95% CI\u2009=\u20092.7\u20135.3] and SWAL\u2010QOL [\u03b2\u2009=\u200929.3, 95% CI\u2009=\u200922.4\u201336.2] with sustained effects on NRSS and SWAL\u2010QOL at 12\u2010week follow\u2010up compared to cheek\u2010bulging exercises. TRE alone improved ATS, SSP, ESP, NRSS, and SWAL\u2010QOL immediate post\u2010test, with sustained effects on SSP, ESP, and SWAL\u2010QOL at follow\u2010up compared to cheek\u2010bulging exercises. Booster training maintained these improvements over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A combined tongue training offers more comprehensive benefits than TRE alone, with booster training maintaining short\u2010term effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joor.70087","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T13:26:27Z","timestamp":1762349187000},"page":"402-414","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Tongue Resistance and Strengthening Exercises on Tongue Strength and Oropharyngeal Swallowing in Frail Older Adults With Mild Cognitive Impairment: A Double\u2010Blind Randomised Controlled 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