The intervention, known as ACTING (ACTivity-based Skill Training of INGestion), was developed by occupational therapists in Denmark and evaluated in a study published in the Scandinavian Journal of Occupational Therapy. Unlike traditional dysphagia treatments that rely on isolated strengthening exercises or texture-modified diets delivered in clinic rooms, ACTING embeds swallowing rehabilitation directly into real meals. Participants practise eating and drinking with actual food and fluids, progressively calibrated to their ability, across authentic mealtime contexts such as breakfast, lunch, and snacks.

Technically, ACTING is grounded in the Person-Environment-Occupation model, the Occupational Therapy Intervention Process Model, Self-Determination Theory, and motor learning theory. This theoretical scaffolding matters: the intervention deliberately balances task-specific skill practice with strategies that support autonomy, competence, and relatedness, the three psychological needs thought to sustain motivation in rehabilitation. Swallowing, after all, is not merely a reflex but a chain of coordinated, goal-directed skills spanning the preoral, oral, and pharyngeal phases of ingestion—from recognizing food and organizing the environment to manipulating the bolus and protecting the airway.

The program’s architecture is strikingly precise. Therapy is delivered individually, twice weekly for up to eight weeks, with a maximum of 16 sessions of up to 60 minutes each. Progression follows a structured 17-level hierarchy of liquid and food textures. A participant’s starting level is determined by the McGill Ingestive Skills Assessment (Danish version), which identifies the most complex texture that can be consumed without clinical signs of aspiration such as coughing, wet voice, or noisy breathing. A higher texture is introduced only when a participant can ingest the current one ten times safely and with reduced perceived exertion, rated on a standard 0-to-10 scale. Safety rules are explicit: if aspiration signs appear in two or more of ten attempts, the task level is downgraded to keep aspiration below 20 percent of attempts.

The proof-of-concept study was originally designed as a one-group pre-post trial with 30 participants, but recruitment proved far harder than anticipated. Over 17 months, 160 individuals were screened and 151 failed to meet inclusion criteria, often due to cognitive impairment, ineligible swallowing-screen scores, or palliative status. Of nine people allocated to the intervention, three died of natural causes before it began, leaving five participants—three men and two women aged 67 to 88—who completed both the program and post-intervention assessments. The results were therefore reported as a case series, an approach suited to early-stage evaluation of complex interventions, though it cannot establish causation.

Despite the tiny sample, the outcomes were notable. All five participants improved their dietary variety, measured on the Functional Oral Intake Scale, advancing by at least one clinically relevant level. Four of five achieved clinically meaningful gains in mealtime task performance on the MISA2DK, with improvements spanning positioning, self-feeding, and ingestion skills. Perceived improvements in eating and drinking were reported by four participants on a Global Rating of Change scale. Secondary outcomes showed encouraging trends: self-reported dysphagia severity improved in most cases, maximum tongue pressure rose meaningfully in three participants, orofacial function improved in four, and dysphagia-related interference with joy of life decreased in four cases. Crucially, there were no adverse events during therapy and no cases of physician-diagnosed aspiration pneumonia during the study period.

One striking finding underscores the multifactorial nature of age-related dysphagia. Participant A demonstrated marked gains in mealtime performance and diet variety despite showing no measurable increase in tongue strength. This dissociation suggests that meaningful improvements in feeding, eating, and swallowing performance can occur even when underlying physiological impairments persist—precisely the premise of occupation-centred rehabilitation, which targets task-level skill rather than isolated muscle function alone. The program uses effortful swallowing manoeuvres, texture progression, and motor-learning principles such as task variation, mixed practice, and realistic intake volumes to drive adaptation.

Yet the study is equally candid about implementation challenges. Direct observation of only 10 of 56 therapy sessions revealed that adherence to the intervention’s 38 core components was high in just 42 percent of observed items and unsatisfactory in another 42 percent, with problems concentrated at session start-up and closing and in the use of effortful swallowing and texture progression. No participant completed all eight weeks; home-practice worksheets were never returned, partly because cognitive limitations hindered participants’ self-monitoring. A focus group with the three treating occupational therapists, analysed through the Theoretical Domains Framework, identified 24 facilitators but also nine barriers, with environmental context and resources dominating. Rigid schedules clashed with mealtime-based delivery, and the frailty of the target group repeatedly complicated participation. Therapists nonetheless reported that ACTING sharpened their occupation-centred professional identity and confidence, shifting practice away from compensatory diet modifications toward retraining eating skills.

The researchers, led by Tina Hansen of Copenhagen University Hospital Amager and Hvidovre and the Parker Institute, conclude that ACTING shows promise as an occupation-centred approach to dysphagia rehabilitation in municipal practice, but that larger effectiveness trials must wait until implementation fidelity and clinician training are strengthened. The study also highlights a broader lesson for ageing societies: with swallowing difficulties entwined with sarcopenia, multimorbidity, and neurogenic change, rehabilitation that treats the meal—not just the swallow—as the unit of therapy may offer older adults something beyond clinical scores: the return of one of life’s most fundamental and social pleasures.

Subject of Research: Occupation-centred rehabilitation of age-related dysphagia in older adults

Article Title: Occupation-centred intervention for age-related dysphagia: A proof-of-concept study

Article References: Hansen, T., Andersen, U., Takeuchi Holm, M., & Wæhrens, E. E. (2025). Occupation-centred intervention for age-related dysphagia: A proof-of-concept study. Scandinavian Journal of Occupational Therapy, 32(1), 1-18. https://doi.org/10.1080/11038128.2026.2620346

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2620346

Keywords: age-related dysphagia, occupational therapy, ACTING intervention, swallowing rehabilitation, mealtime performance, older adults, presbyphagia, sarcopenic dysphagia, implementation fidelity, motor learning, aspiration pneumonia, rehabilitation

The study underscores a critical yet often underexplored area of gerontological health—namely, the role of habitual exercise not only in general musculoskeletal health but also in the intricate neuromuscular activities governing swallowing. Swallowing is an elaborate biomechanical process involving coordinated contractions of numerous muscles in the oral cavity, pharynx, and esophagus, all orchestrated through fine-tuned neural pathways. Degradation in any component of this system can manifest as dysphagia, which is further exacerbated by age-related sarcopenia and neural decline. Consequently, interventions targeting muscle strength and neurological function could offer promising avenues for prevention and therapy.

Nakamura et al.’s research commenced with a cross-sectional analysis involving older adults categorized based on their exercise habits. A comprehensive assessment of swallowing function was conducted using a battery of clinical examinations and symptom questionnaires designed to characterize the severity and prevalence of swallowing difficulties. Intriguingly, those with consistent exercise routines, particularly incorporating resistance and aerobic elements, reported fewer swallowing-related symptoms. This correlation suggests that systemic benefits of exercise might extend to the oropharyngeal muscles and related neural circuits, enhancing overall swallowing efficacy.

Delving deeper, the single-arm pre-post intervention phase adopted an exercise program tailored to enhance strength, endurance, and coordination, focusing on both general fitness and specific muscle groups implicated in the swallowing process. Muscle training protocols involved both gross motor exercises and targeted orofacial muscle conditioning. Participants demonstrated statistically significant improvements in several swallowing parameters post-intervention, including reduced reports of choking, coughing during meals, and awareness of food sticking in the throat. This improvement signals not only a functional but likely a structural and neurological adaptation stemming from the exercise regimen.

The ingenious aspect of this study lies in its multifaceted approach, discerning the role of habitual physical activity alongside a deliberate intervention, thereby providing robust evidence for causal inferences. While cross-sectional data establish associations, the pre-post intervention design elucidates a potential therapeutic pathway. The observed benefits highlight exercise as a non-pharmacological, low-cost strategy with wide-reaching implications for geriatric care policies, especially in community settings where accessibility to advanced medical interventions may be limited.

Physiologically, the exercise-induced improvements can be rationalized through several mechanisms. Resistance training combats the pervasive sarcopenia of aging, which notoriously affects orofacial and pharyngeal muscles critical for swallowing. Enhanced muscle mass and strength contribute to more effective bolus formation and propulsion. Concurrently, cardiovascular conditioning may improve neurovascular health, thereby supporting central nervous system structures involved in swallow reflex coordination. Additionally, repetitive motor activity inherent in exercise likely promotes neuroplasticity, fostering improved motor control circuits critical for swallowing.

Another fascinating implication of this study is related to the prevention of aspiration pneumonia, a severe and sometimes fatal complication of dysphagia. By mitigating swallowing difficulties through regular exercise, the incidence of microaspirations during eating may decline, thereby lowering pneumonia risk. This preventive potential aligns with public health imperatives aiming to minimize hospitalizations and healthcare expenditures driven by respiratory infections in older populations.

The research also opens a dialogue on the integration of swallowing assessments in routine evaluations of physical fitness and vice versa. Currently, dysphagia and physical inactivity are often treated as separate clinical concerns. This study advocates for an interdisciplinary approach, emphasizing the interdependence of motor functions and the need to consider comprehensive exercise programs as part of swallowing rehabilitation protocols. Such integration could streamline interventions and improve outcomes holistically.

Moreover, Nakamura and colleagues highlight the psychosocial dimensions of exercise and swallowing health. Older adults experiencing dysphagia often reduce food intake, leading to social isolation, depression, and decreased life satisfaction. Exercise, known to elevate mood and social interaction, may indirectly benefit swallowing functions by promoting healthier eating habits and enhancing overall motivation and well-being. This holistic improvement reinforces the multifactorial benefits of maintaining physical activity in aging.

While the findings are promising, the authors prudently call for further randomized controlled trials with larger cohorts to solidify the evidence base and refine exercise protocols. Different types, intensities, and durations of exercise could differentially affect swallowing-related outcomes. Personalized intervention regimens considering individual variability in baseline fitness, swallowing capability, and comorbidities would be an important next step to optimize clinical translations.

Technological advancements may further augment the potential of exercise interventions for dysphagia. Wearable sensors and biofeedback mechanisms could enable precise monitoring of oropharyngeal muscle engagement during exercise, allowing for adaptive training programs. Integration with telemedicine platforms can expand access to tailored exercise guidance, especially for those with mobility limitations or residing in remote areas. Such innovations align well with the study’s overarching theme that accessible, proactive health management is vital for aging populations worldwide.

In summary, the investigation by Nakamura et al. provides pioneering evidence that habitual exercise habits are linked to a reduction in swallowing-related symptoms among older adults, with structured exercise interventions yielding notable improvements in swallowing function. This paradigm-shifting insight situates physical activity as a cornerstone in the prevention and management of dysphagia, promising a future where aging populations maintain not only mobility but also fundamental life-sustaining functions like safe and effective swallowing.

As healthcare systems grapple with the costs and burdens of age-related morbidity, strategies that harness the multifaceted benefits of exercise could revolutionize geriatric care. This research calls for a reframing of exercise not merely as a tool for general health but as a targeted intervention with the capacity to preserve critical neurological and muscular functions intricately tied to survival and quality of life. Public health campaigns and clinical guidelines may soon incorporate these findings, fostering an era where the simple act of movement becomes a powerful defensive tool against the insidious declines of aging.

The intersection of exercise physiology, neural plasticity, and geriatric medicine uncovered in this study epitomizes the scientific progress needed to address complex aging phenomena. It exemplifies how understanding the body’s integrated systems can unlock novel prevention and rehabilitation pathways. In this context, swallowing transcends a mere reflex to become a marker of holistic health and an arena for transformative therapeutic innovation.

Ultimately, the study by Nakamura and colleagues shines a beacon on a promising frontier in aging research: empowering older adults with accessible interventions to sustain essential functions and enhance life quality. Their work is a clarion call for continued exploration at the nexus of exercise science and geriatric care, inspiring clinicians, researchers, and policymakers to embrace comprehensive, evidence-based strategies for healthy aging.

Subject of Research: Exercise habits and their impact on swallowing-related symptoms in older adults.

Article Title: Exercise habits and swallowing-related symptoms in older adults: a cross-sectional and a single-arm pre–post intervention study.

Article References:

Nakamura, M., Aoki, K., Murakami, T. et al. Exercise habits and swallowing-related symptoms in older adults: a cross-sectional and a single-arm pre–post intervention study.
BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07766-3

Image Credits: AI Generated