. 2022 Dec 6;280(3):1017–1045. doi: 10.1007/s00405-022-07735-7

Table 2.

Combined intervention programs in included studies (including participants, exercise descriptions and dosages, outcome measures and pre–post Hedges g effect sizes in exercise-based intervention group)

Study	Number of participants (mean age in yrs ± SD)	Mean time post CVA ± SD	Summary of exercises	Intensity	Frequency (per day/wk)	Duration	Outcome measures	Effect sizes (if p < 0.05)
El-Tamawy et al. (2015) [39]	Exp^a: 15 (61.53 ± 7.26) Con: 15 (61.33 ± 6.57)	NR	Ex₁: Tongue exercises, Ex₂: Jaw exercises, Ex₃: Swallow boluses, Ex₄: Vibrate laryngeal musculature downward, Ex₅: Push head and neck in flexion, extension and lateral flexion vs resistance	70–75 min 10 reps of each exercise	3x/wk	6 wks	Oral transit time	g = 1.47
							Hyoid and laryngeal elevation	NR
							Oesophageal sphincter opening	NR
							Aspiration/penetration	NR
Hamzic et al. (2021) [30]	1 (57)	NR	Ex₁: Ice stimulation of anterior faucial arches Ex₂: Chin tuck against resistance Ex₃: Jaw opening exercise	Ex₁: 5 times each side Ex_2-3: 10 s hold × 5 reps for 5 sets, 10 s break between reps	3x/day, 5x/wk sessions (daily home practice)	7 wks	PAS	NR
							Yale Pharyngeal Residue Severity Rating Scale
							Valleculae	NR
							Pyriform sinuses	NR
							FOIS	NR
Jiao et al. (2022) [46]	Con^a: 32 (57.3 ± 9.1) Exp: 29 (60 ± 10.6)	NR	Basic rehabilitation training: Ex₁: Suck training, Ex₂: Tongue muscle training, Ex₃: Pharyngeal cold stimulation, Ex₄: Pronunication of “a”, “yi”, “wu”, Ex₅: Facial muscle training, Ex₆: Neck muscle training, Ex₇: Food intake training	20 reps of each exercise	2x/day, 5x/wk	2 wks	WST	NR
Kim (2010) [40]	8 (58.75 ± 6.40)	NR	Music-enhanced swallowing treatment:	15 min	3x/wk	4 wks	Frenchay including dysphagia subtests:
			Ex₁ (2 min): pitch glides Ex₂ (3 min): sing song	Ex_1-2: 1 rep each			Cough	n/s
							Swallow	n/s
							Drool	g = 0.81
			Ex₃ (4 min): 2-step and 3-step breathing (with 2–3 s breath hold after inhalation) Ex₄ (3 min): hum notes using vowel sounds	Ex_3-4: 10 reps each			Drool	g = 0.81
Krajczy et al. (2019) [80]	Exp^a: 30 (62.1 ± 3.3) Con: 30 (64.1 ± 1.5)	Acute stage	Ex₁: Lip exercises. Ex₂: Tongue ROM and resistance exercises.	60 min Ex_1-3: × 10 reps each		15 days	Swallow reflex	NC
							Assessment of coughing	NC
			Ex₃: Cheek exercises Ex₄: Breathing exercises	Ex₄: Duration as per patient			Timed swallow test	g = 0.74
							Average number of swallows	g = 0.77
			Ex₅: Swallow after thermal–tactile stimulation	Ex₅: × 5 swallows			SpO₂ (after test)	g = 0.27
Li et al. (2019) [56]	A (swallow Tx) ^a: 15 (57 ± 7)	A: 2.2 ± 1.1	Ex₁: Active lip, tongue and resistance exercises Ex₂: Rapidly start swallowing	Ex₁: 5 s hold × 5 reps	1x/day, 5x/wk	6 wks (or after removal of tube)	VFSS dysphagia score	g = 0.75^b
							Oral	g = 0.61^b
							Pharyngeal	g = 0.72^b
							Aspiration	NC
	B: 15 (57 ± 8) C1: 15 (57 ± 8) C2: 15 (60 ± 6)	B: 2.5 ± 1.4 C1: 2.5 ± 1.8 C2: 2.9 ± 2.6 C3: 2.4 ± 1.1 D: 2.5 ± 1.6	Ex₃: Respiration training	Ex₂: × 10–15 reps Ex₃: × 5 reps each as long as tolerated			Evaluation of swallowing function (Fujishima Ichiro standard)	NC
	C3: 15 (58 ± 8) D: 15 (56 ± 8)		Ex₄: Masticatory muscle training	Ex₄: 5 s hold × 5 reps			Extubation rate	NC
Malandraki et al. (2016) [33]	10 (64.6 ± 14.5)	8.89 ± 9.70 mos	Ex₁: Regimen A and B practised on alternating days. Regimen A: lingual strengthening (IOPI), tongue hold with mirror, effortful swallow with VAS. Regimen B: effortful swallow and Mendelsohn with VAS, head lift with timer Ex₂: Daily targeted swallow with materials identified from FEES (and consistencies changed based on performance)	Ex₁: Re-evaluated and increased either target goals, reps or duration every 1–2 wks Ex₂: 20 swallows × 3	2x/wk, Daily home practice 45 min/day	4 wks	PAS	NC
							Lingual pressures
							Anterior	g = 0.96^b
							Posterior	g = 0.54^b
							EAT-10	g = 1.41
							ASHA NOMS	NC
Momosaki et al. (2014) [41]	4 (66.25 ± 9.0)	29.25 ± 5.2 mos	Ex₁: Jaw, cheek and tongue exercises	20 min Ex₁: 10–20 reps each	2x/day	6 consecutive days	PAS	g = 1.98^b
							LEDT	g = 1.44^b
							FOIS	g = 0.46^b
			Ex₂: Push tongue up against resistance	Ex₂: 10 s hold × 5 reps (3 s rest)			MASA	g = 0.29^b
			Ex₂: Push tongue up against resistance	Ex₂: 10 s hold × 5 reps (3 s rest)			RSST	g = 0.45^b
			Ex₃: Isokinetic Shaker	Ex₃: 10 reps × 3 (30 s rest)			RSST	g = 0.45^b
Momosaki et al. (2015) [42]	8 (65 ± 2.7)	33.5 ± 4.2 mos	(as per Momosaki et al. [41])	(as per Momosaki et al. [41])	(as per Momosaki et al. [41])	(as per Momosaki et al. [41])	MASA	g = 0.95
							PAS	NR
							LEDT	g = 0.41
							SWAL–QOL	g = 0.84
							FOIS	NR
Moon et al. (2019) [81]	Exp^a: 8 (54.13 ± 5.41) Con^a: 8 (55.38 ± 14.88)	Exp: 22.75 ± 9.21, Con: 21.00 ± 9.02	Orofacial exercise program: jaw, lip, tongue and cheek exercises	20 min × 5 reps each	3x/day, 3x/wk	4 wks	FDS	g = 2.08
							PAS	g = 1.97
							VASS	NC
Oh et al. (2013) [48]	Exp^a: 7 (53.71 ± 12.46)	Exp:43 ± 27.9 mos	Stomatognathic therapy: Ex₁: pull chin back (in supine)	Ex_{1, 3}: 10 s hold × 10 reps	3x/wk	4 wks	MASA	g = 0.81
							Mouth opening range	g = 0.48
							Craniomandibular index	g = 0.96
	Con: 7 (56.14 ± 12.31)	Con: 13.57 ± 16.53 mos	Ex₂: pull chin back (standing against wall) Ex₃: head and shoulders pressed against wall while maintaining chin tuck and straight back, arms at 45° shoulder abduction and elbows fully extended Ex₄: neck and jaw exercises	Ex₂: 2 min hold × 5 reps Ex₄: 10 s hold × 10 reps × 2 sets			Neck mobility:
							Flexion	g = 0.80
							Extension	g = 0.40
							Rotation	g = 0.61
							Lateral flexion	g = 0.73
Xing et al. (2019) [82]	Con^a: 50 (67 ± 7.2) Exp: 50 (66.9 ± 7.3)	Con: 28.1 ± 3.4 Exp: 28.1 ± 3.5 mos	Ex₁: Tongue ROM exercises Ex₂: Buccinator exercises Ex₃: Breathing exercises Ex₄: Throat/voicing exercises	Ex₁: × 4 reps each Ex₂: × 4 reps each Ex₃: × 8 reps Ex₄: × 4 reps each	1x/day	4 wks	Waitian drinking test SSA SWAL–QOL VFSS	NC
Zhou et al. (2019) [57]	Con^a: 30 (58.41 ± 8.65) Exp: 30 (58.54 ± 8.71)	NR	Ex₁: Head and neck training Ex₂: Lip exercises Ex₃ Tongue exercises, Ex₄: Mandibular training, Ex₅: Pharynx training using cold stimulation Ex₆: Swallow reflex training Ex₇: Eating training Ex₈: UES opening training (Mendelsohn)	Ex₁: 10 reps × 3 sets Ex₂: 5 s hold × 10 reps × 2–3 sets Ex_{3, 4}: Not stated Ex₅: 10–15 min Ex₆: × 10 reps Ex₇: 45 min meal times Ex₈: 3–5 s hold	1x/day, 6x/wk	4 wks	VFSS scores	g = 4.66^b
							BMI	g = 2.06^b
							Nutritional status:
							Albumin	g = 1.53^b
							Hemoglobin	g = 1.05^b
							Nitrogen	g = 4.69^b
							Occurrence of aspiration pneumonia	NC

ASHA NOMS American Speech–Language Hearing Association’s National Outcomes Measurement System, BMI body mass index, Con control group, CVA cerebrovascular accident, EAT Eating Assessment Tool, Ex exercise, Exp experimental group, FDS Functional Dysphagia Scale, FEES Fiberoptic Endoscopic Evaluation of Swallowing, FOIS Functional Oral Intake Score, g Hedges’ g, IOPI Iowa Oral Performance Instrument, LEDT laryngeal elevation delay time, MASA Mann Assessment of Swallowing Ability, min minute/s, mos months, n/s not significant, NC not calculable, NR not reported, PAS Penetration–Aspiration Scale, rep repetition, ROM range of motion, RSST Repetitive Saliva Swallowing Test, s seconds, SD standard deviation, SpO₂ oxygen saturation, SSA Standardized Swallowing Assessment, SWAL–QOL Swallowing Quality-of-Life questionnaire, Tx treatment, UES upper esophageal sphincter, VAS visual analogue scale, VFSS Videofluoroscopic Swallow Study, vs versus, wk/s week/s

^aIntervention, dosage and effect sizes reported for the first listed group (with studies containing > 1 group)

^bNot reported whether results were significant or not