Progressive Resistance Training Combined with Neuromuscular Electrical Stimulation for Sarcopenic Dysphagia in Elderly Inpatients: A Retrospective Cohort Study in China

Background: Sarcopenic dysphagia, defined as swallowing dysfunction attributable to generalized skeletal muscle loss involving swallowing-related musculature, poses a growing challenge in geriatric rehabilitation. While conventional swallowing therapy (CST) and neuromuscular electrical stimulation (NMES) have demonstrated individual efficacy, combined therapeutic approaches incorporating progressive resistance training (PRT) may yield superior outcomes, yet evidence specific to sarcopenic dysphagia remains limited. Objective: To evaluate the efficacy of PRT combined with NMES for improving swallowing function and nutritional status in elderly inpatients with sarcopenic dysphagia. Methods: This retrospective cohort study in Hangzhou, China analyzed 96 elderly inpatients (mean age: 81.9 years) with sarcopenic dysphagia treated from January 2022 to December 2024 (6-week follow-up). Patients received one of three treatment protocols: CST alone (n=36), CST combined with NMES (CST+NMES; n=33), or CST combined with NMES and PRT (CST+NMES+PRT; n=27). Primary outcomes included the Standardized Swallowing Assessment (SSA), Videofluoroscopic Dysphagia Scale (VDS), and oral transit time (OTT). Secondary outcomes included the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS), and nutritional parameters. Results: All groups demonstrated significant within-group improvements (P < 0.001). Between-group differences significantly favored CST+NMES+PRT. SSA improvement was greatest in CST+NMES+PRT (− 8.40 ± 2.85 points) versus CST+NMES (− 5.70 ± 2.42) and CST alone (− 3.20 ± 1.95) (F = 8.21, P < 0.001). VDS pharyngeal scores demonstrated significant between-group differences (P < 0.001). FOIS improvement was significantly greater in CST+NMES+PRT (median change: 3 [IQR: 2– 3]; H = 28.45, P < 0.001). Prealbumin showed significant between-group differences (P = 0.013); serum albumin did not reach significance. Conclusion: The combination of PRT with NMES and conventional swallowing therapy was associated with greater improvements in swallowing function compared with less intensive protocols in elderly inpatients with sarcopenic dysphagia. The retrospective design limits causal inference; randomized controlled trials are needed to confirm these findings.