Sport climbing with Parkinson's Disease and its impacts on the quality of life
Creators: name: Gassner, Lucia
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 320905
subject: Neurology and neuromuscular diseases
classificationCode: 400399
subject: Biomedical engineering not elsewhere classified
classificationCode: 401799
subject: Mechanical engineering not elsewhere classified

description: Physical activity is of prime importance in non-pharmacological Parkinson's disease (PD) treatment. The current PhD manuscript examines the feasibility and effectiveness in terms of physical and psychosocial aspects of sport climbing (SC) in PD patients. For that purpose, a systematic review and meta-analysis, a longitudinal case study, and a feasibility survey study involving 26 people with PD (PwP) (mean age 68, range 55-78, Hoehn &amp; Yahr stage 1-3) were conducted in the first stage. 

In the second stage, two single-centred, semi-blinded, randomised controlled trials were completed. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn &amp; Yahr stage 2–3) were assigned either to participate in a 12-week SC course or to attend an unsupervised physical training group. The primary outcomes were evaluated using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III), Hoehn &amp; Yahr Assessment (HY), and truncal posture measurement (C7 test).

For the systematic review and meta-analysis, 18 trials with 568 patients were included in the data analysis and synthesis of the evidence. Therapeutic climbing can be seen as a safe activity and positively affects physical (e.g., fitness, motor control, movement velocity, dexterity, strength), mental (e.g., depressiveness, somatisation, psychoticism, emotion regulation, body perception, self-esteem, fatigue), and social health (e.g., social functioning, trust, communication, sense of responsibility) of patients with neurological, orthopaedic, psychiatric and paediatric conditions. 

The longitudinal case study gave insights into an 83 old climbing PwP. Mr Z.'s reflection on his climbing experiences and perceived positive impacts resulted in the three pillars of salutogenesis: the physical, psychological and social aspects of climbing. His reflection on these three pillars served as the fundament for the following survey. 

The feasibility survey study's results were based on self-reported perceptions of PwP and showed an improvement in overall physical (average 65%), psychological (average 59%) and social (average 39%) aspects after climbing. Improvements in strength (96%), range of motion (88%), balance (88%), body awareness (85%), physical well-being (77%), and fatigue (75%) were observed. PwP self-reported admiration in their social surrounding (42%) and felt more outgoing and sociable (40%). Treatment adherence was 100%, 96% of PwP intended to recommend climbing to peers, and 70% declared to be motivated to continue climbing. PwP improved in 10-meter walking tests (p&lt;0.01; n=16), 2-minute walking tests (p&lt;0.01; n=19), Functional Gait Assessment (p&lt;0.01; n=15), and Nine-Hole-Peg tests (p&lt;0.01; n=15).

The first construct, which was analysed using the RCT, found a significant reduction of the MDS-UPDRS-III score due to SC (−12.9 points; 95% CI −15.9 to −9.8), while the control group did not significantly improve (−3.0 points; 95% CI −6.0 to 0.1). Bradykinesia, tremor and rigidity subscales significantly improved after SC. Climbers were interviewed 12 ± 0.5 months after study completion, and 48% of them stated continuing in a newly established climbing course for PwP. The study showed a 99% adherence to climbing sessions and a dropout rate of only 8%, presenting SC's feasibility. 

The second construct, which was analysed using the RCT, investigated posture. Within 12 weeks of SC, there was a significant improvement in the seventh cervical vertebra sagittal vertical axis (C7SVA) in the climbing (-1.7 cm (95% CI [-2.6, -0.8]), but not in the control group (-0.5 cm; 95% CI [-1.3, 0.2]). According to the regression model, change in C7SVA over the 12 weeks was significantly associated with being part of the climbing vs the control group (coeff. 1.2; p=.044). 
 
This PhD thesis investigates that SC is a feasible whole-body activity improving physical, psychological and social outcomes in PwP. Furthermore, SC enhances clinical-motor and posture. SC can be seen as a feasible and effective training therapy for mildly to moderately affected PwP.