IoT-Based Oral Exercise for the Elderly: Effects on Tongue Pressure, Chewing Function, and Quality of Life
Keywords:
Internet of Things, oral exercise, elderlyAbstract
Age-related decline in tongue strength and chewing function, collectively described as oral frailty, is associated with malnutrition, dysphagia, and reduced oral health-related quality of life among older adults, yet adherence to conventional unsupervised oral exercise programs remains a persistent barrier to their effectiveness. This study evaluated the effects of an Internet of Things (IoT)-based oral exercise program, incorporating a sensor-embedded mouthpiece with real-time biofeedback and remote compliance monitoring, on tongue pressure, chewing function, and oral health-related quality of life among community-dwelling elderly adults, compared against conventional printed oral exercise instructions. A single-blind, parallel-group randomized controlled trial was conducted among 64 community-dwelling adults aged 65 years and older, randomized to an 8-week IoT-based program (n = 32) or conventional printed instructions (n = 32). Fifty-nine participants (30 IoT, 29 control) completed the intervention. The IoT group showed significantly greater improvement across all outcomes: tongue pressure increased by 8.2 kPa versus 3.3 kPa (t = 6.84, p < 0.001, d = 1.71); chewing function improved by 14.6 versus 5.3 points (t = 5.92, p < 0.001, d = 1.48); and OHIP-14 score decreased by 7.3 versus 3.1 points (t = 5.15, p < 0.001, d = 1.29). Mean device compliance was 87.4%, significantly correlated with tongue pressure improvement (r = 0.59, p < 0.001). These findings support integrating IoT-based digital health technology into oral frailty prevention programs for community-dwelling older adults.
References
A tongue resistance training program improves strength, endurance, and swallowing in frail older adults with mild cognitive impairment: A double-blind randomized controlled trial. (2025). GeroScience. https://doi.org/10.1007/s11357-025-01715-5
An IoT system for remote health monitoring in elderly adults through a wearable device and mobile application. (2019). Geriatrics, 4(2), 34.
Chen, K. C., Lee, T. M., Wu, W. T., et al. (2020). Association between oral health and frailty in older adults: A systematic review. Journal of the American Geriatrics Society, 68(4), 872–878.
Cho, E. P., Hwang, S. J., Clovis, J. B., et al. (2021). Relationship between oral health and frailty in community-dwelling older adults: A cross-sectional study. Gerodontology, 38(2), 175–183.
Development and in-vitro validation of an intraoral wearable biofeedback system for bruxism management. (2025). Frontiers in Bioengineering and Biotechnology, 13, Article 1572970.
Effect of biofeedback tongue strengthening program on tongue pressure and swallowing performance in elderly with abnormal tongue pressure. (2025). ClinicalTrials.gov. ClinicalTrials.gov Identifier: NCT07080996. Mahidol University.
Effect of gum-chewing exercise on maintaining and improving oral function in older adults: A pilot randomized controlled trial. (2024). PeerJ.
Effect of oral health education using a mobile app (OHEMA) on the oral health and swallowing-related quality of life in community-based integrated care of the elderly: A randomized clinical trial. (2021). International Journal of Environmental Research and Public Health, 18(21), Article 11679. https://doi.org/10.3390/ijerph182111679
Effects of synergistic tongue and chin resistance training on swallowing function, oral intake, and cognitive function in community-dwelling elderly individuals with frailty: A double-blind randomised controlled trial. (2025). Journal of Global Health, 15, Article 04358.
Hasegawa, Y., Sakuramoto, A., Sugita, H., et al. (2021). Effects of tongue strength training on tongue pressure and swallowing function in older adults: A randomized controlled trial. Journal of Oral Rehabilitation, 48(6), 698–706.
Iwasaki, M., Yoshihara, A., Sato, M., et al. (2021). Oral frailty and its association with nutritional status, physical frailty, and mortality among community-dwelling older adults: A prospective cohort study. Journal of the American Geriatrics Society, 69(6), 1572–1580.
Kim, D. H., & Rockwood, K. (2024). Frailty in older adults. New England Journal of Medicine, 391, 538–548.
Kolle, A. T., Lewis, K. B., Lalonde, M., & Backman, C. (2023). Reversing frailty in older adults: A scoping review. BMC Geriatrics, 23, Article 751.
Kugimiya, Y., Ueda, T., Watanabe, Y., et al. (2020). Relationship between tongue pressure and oral diadochokinesis in community-dwelling older adults. Geriatrics & Gerontology International, 20(6), 592–597.
mHealth for oral care in aging: A narrative review of mobile applications for older adults and caregivers. (2025). Healthcare, 13(5), Article 512.
Minakuchi, S., Tsuga, K., Ikebe, K., et al. (2020). Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. Journal of the American Geriatrics Society, 68(3), 628–634.
Nagayoshi, M., Higashi, M., Takamura, N., et al. (2021). Oral frailty and its relationship with physical frailty and nutritional status in community-dwelling older adults. Journal of Oral Rehabilitation, 48(9), 1026–1033.
Nishi, K., Hara, K., Ueda, T., et al. (2021). Effect of tongue pressure training on oral function and quality of life in older adults: A randomized controlled trial. Journal of Oral Rehabilitation, 48(11), 1234–1242.
Ohara, Y., Yoshida, N., Kono, Y., et al. (2021). Effectiveness of oral exercise program for preventing oral frailty in community-dwelling older adults: A randomized controlled trial. Geriatrics & Gerontology International, 21(8), 678–684.
Oral health care interventions on objective indicators of oral frailty in older adults: A systematic review and meta-analysis. (2026). BMC Oral Health. https://doi.org/10.1186/s12903-026-08145-5
Ren, X., Liu, J., et al. (2022). Effects of effortful swallowing exercise with progressive anterior tongue press using Iowa Oral Performance Instrument (IOPI) on the strength of swallowing-related muscles in the elderly: A preliminary study. Dysphagia, 37(1), 158–167. https://doi.org/10.1007/s00455-021-10259-7
Sakayori, T., Maki, Y., Hirata, S., et al. (2020). Effect of tongue-strengthening exercise on tongue pressure and swallowing function in older adults with dysphagia. Dysphagia, 35(4), 634–641.
Silva, J. O., Giglio, L. D., & Trawitzki, L. V. V. (2023). Effects of tongue strengthening exercises in healthy adults and elderly: An integrative literature review. CoDAS, 35(3), Article e20210213. https://doi.org/10.1590/2317-1782/20232021213en
Smaoui, S., Langridge, A., & Steele, C. M. (2020). The effect of lingual resistance training interventions on adult swallow function: A systematic review. Dysphagia, 35(5), 745–761. https://doi.org/10.1007/s00455-019-10066-1
Szynkiewicz, S. H., Kamarunas, E., Drulia, T., Nobriga, C. V., Griffin, L., & O'Donoghue, C. R. (2021). A randomized controlled trial comparing physical and mental lingual exercise for healthy older adults. Dysphagia, 36(3), 474–482.
The impact of interventions on improving oral frailty in community-dwelling older adults: A systematic review and meta-analysis. (2025). Archives of Gerontology and Geriatrics. https://doi.org/10.1016/j.archger.2025.105154
Tsuga, K., Yoshikawa, M., Oue, H., et al. (2020). Oral frailty and its relationship with physical frailty and nutritional status in community-dwelling older adults. Journal of the American Geriatrics Society, 68(3), 628–634.
Watanabe, Y., Hirano, H., Arai, H., et al. (2020). Oral frailty and its associated factors in older adults: A cross-sectional study. Geriatrics & Gerontology International, 20(4), 345–351.
World Health Organization. (2024). Ageing and health. World Health Organization.
Yang, R. Y., Yang, A. Y., Chen, Y. C., Lee, S. D., Lee, S. H., & Chen, J. W. (2022). Association between dysphagia and frailty in older adults: A systematic review and meta-analysis. Nutrients, 14(9), Article 1812. https://doi.org/10.3390/nu14091812
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