How many repetitions does it take to improve swallowing? How hard should dysphagia exercises be? And are we prescribing enough therapy to make a meaningful difference?

In this episode of Speech Talk, Emily and Eva tackle a question many clinicians have asked but few were formally taught to answer: how do we dose dysphagia therapy?

Using the article Exercise Prescription for Dysphagia: Intensity and Duration Manipulation by Sapienza and colleagues, they explore how principles of exercise science can help guide swallowing rehabilitation. The discussion breaks down the concepts of treatment intensity and duration, why different energy systems matter for swallowing function, and how direct and indirect dysphagia exercises may target different physiologic goals.

The conversation also moves beyond the research and into real-world practice. Emily and Eva discuss the challenges of delivering adequate treatment intensity in skilled nursing facilities, strategies for increasing patient participation outside of therapy sessions, and practical ways to improve carryover without overwhelming patients or clinicians.

Whether you're prescribing effortful swallows, EMST, Shaker exercises, lingual strengthening, or sensory-based swallowing tasks, this episode will leave you thinking differently about the question: not just what exercise should I use, but how much exercise is enough?

Citations

Exercise prescription for dysphagia: Intensity and duration. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 17(2), 50–55.https://doi.org/10.1044/sasd17.2.50

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