Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial

BACKGROUND

In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort.

METHODS

Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test.

RESULTS

Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking.

CONCLUSIONS

Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).

Climb up! Head up! Climbing improves posture in Parkinson's disease. A secondary analysis from a randomized controlled trial

OBJECTIVE

To investigate the effect of sport climbing on a biomechanical marker of axial posture in patients with Parkinson's disease, as well as its association with age, body mass index and health-related quality-of-life outcome measures.

DESIGN

Pre-planned secondary analysis of our randomized controlled, semi-blind trial (unblinded patients, blinded assessors) comparing sport climbing to unsupervised exercise.

SETTING

Single-centre study conducted at the Department of Neurology of the Medical University of Vienna, Austria.

PARTICIPANTS

Forty-eight Parkinson's disease patients (aged 64 ± 8 years, Hoehn & Yahr stage 2-3) were included.

INTERVENTION

Sport climbers (n = 24) followed a 12-week, 90 min/week supervised top-rope sport climbing course in an indoor climbing gym. The unsupervised training group (n = 24) independently followed the 'European Physiotherapy Guidelines for Parkinson's Disease' and World Health Organization recommendations for an active lifestyle for 12 weeks.

MAIN MEASURES

Posture was assessed with the horizontal distance of the seventh cervical vertebra to the wall at baseline and after the intervention.

RESULTS

Participating in the sport climbing group significantly predicted the biomechanical marker of axial posture (P = 0.044). The improvement in the biomechanical marker did not affect the quality of life, depression, fatigue, physical activity or fear of falling. Participants in the sport climbing group showed a significantly decreased horizontal distance of the seventh cervical vertebra to the wall after the intervention (-1.7 cm (95%CI [-2.6, -0.8]). In the unsupervised training group, no difference was found (-0.5 cm; 95%CI -1.3, 0.2]).

CONCLUSIONS

We conclude that sport climbing improves a biomechanical marker of axial posture in Parkinson's disease.

The therapeutic effects of climbing: A systematic review and meta-analysis

OBJECTIVE

Several recent studies show a growing popularity of therapeutic climbing (TC) for patients with various conditions. This could be an attempt to fill the gap left by traditional exercises that do not always address physical, mental, and social well-being. This review provides an overview of the physical, mental, and social effects and safety aspects of climbing for different indications.

LITERATURE SURVEY

A literature search was conducted on July 8, 2020 (update search August 26, 2021). We searched MEDLINE via Ovid, Embase, and PubMed and bibliographies of included studies, and we conducted a manual search.

METHODOLOGY

Two independent reviewers evaluated the quality of the studies using appropriate Risk of Bias (RoB) tools, and the level of evidence for each domain was graded. Study characteristics and effectiveness data for TC were extracted and synthesized. Meta-analyses were conducted for the three dimensions (physical/mental/social health), using a random-effects model.

SYNTHESIS

A total of 112 publications were reviewed, and 22 full-text articles were assessed regarding the eligibility criteria, of which 18 trials involving 568 patients were included. TC is safe 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 (e.g., social functioning, trust, communication, sense of responsibility) health for individuals with neurological, orthopedic, psychiatric, and pediatric ailments. The meta-analysis showed a statistically significant improvement in the physical dimension favoring the climbing group. Improvements that were not statistically significant were found for the mental/social dimensions in the climbing group. The heterogeneity of data was moderate/high (social/mental dimension), and for the physical dimension, data were homogenous.

CONCLUSIONS

The studies investigating TC outline its positive effects in various patient groups. TC is a safe and effective treatment for improving physical/mental/social well-being. This review is based on the best available evidence; however, significant gaps remain in providing sufficiently strong evidence.

Therapeutic plasma exchange in steroid-refractory multiple sclerosis relapses. A retrospective two-center study

Background:

Therapeutic plasma exchange (TPE) is frequently used in glucocorticosteroid (GCS)-refractory multiple sclerosis (MS) relapses. Data regarding predictors of treatment response are scarce. The objective of this study was to analyze predictive factors for response to TPE in GCS-refractory MS patients.

Methods:

A total of 118 MS patients in two tertiary MS centers were analyzed. Primary outcome was TPE response defined as marked, mild, or no improvement. Secondary outcome was change in expanded disability status scale (ΔEDSS). ΔEDSS and relapse activity within 6 months after TPE were studied.

Results:

Marked or mild improvement was observed in 78.8% of patients. ΔEDSS correlated significantly inversely with time from relapse to start of TPE (τ = –0.239, p = 0.001), age (τ = 0.182, p = 0.009) and disease duration (τ = –0.167, p = 0.017). In multivariate analysis, TPE response was predicted by diagnosis of relapsing MS [odds ratio (OR): 3.1], gadolinum-enhancement on magnetic resonance imaging (OR 3.2), age (OR 0.5 per 5 years older) and time from relapse onset to TPE (OR 0.7 per 7 days longer).

Conclusion:

Patients with longer disease duration and higher EDSS pre and post-TPE were more likely to show further disability progression or relapses within 6 months after TPE. No sustained effects were observed during the follow-up period.

Biochemische Untersuchungen über die Staubphagocytose an einem etablierten Zellstamm (strain L 929) und über die Beeinflussung der cytotoxischen Quarzwirkung durch Polyvinylpyridin-N-oxid (P 204)

Kohlenhydratstoffwechsel-Untersuchungen an Mäusefibroblasten (strain L) zeigten bei Inertstaubphagocytose (Korund) von 1200 μg/106 Zellen gegenüber der unbehandelten Kontrolle eine erhöhte Stoffwechselaktivität. Diese Steigerung wird auf die aktive Leistung der Zelle während der Phagocytose zurückgeführt.

Bei Applikation geringerer Staubmengen (120 und 60 μg/108 Zellen), deren Phagocytose bereits nach 6 Stdn. abgeschlossen war, wurde der Gipfel des KH-Umsatzes innerhalb der ersten 6 Stdn. beobachtet.

Bei der Quarzstaubphagocytose kommt es ebenfalls als Ausdruck der aktiven Zelleistung zu einem erhöhten Glucoseumsatz, der aber auch nach Abschluß der Phagocytose bis zum 2. Tag andauerte. Dieses Stoffwechselverhalten wird auf eine fortlaufende Quarzphagocytose, eine Sekundärphagocytose oder aber auf die cytotoxische Quarzwirkung zurückgeführt. Die Stoffwechselaktivitäts-Kurven der mit Polyvinylpyridin-N-oxid (P 204) behandelten Zellen zeigten während der Quarzstaubphagocytose einen ähnlichen Verlauf wie die der Inertstaubkontrolle. Der hierdurch zum Ausdruck gebrachte Schutzeffekt durch P 204 konnte auch nach 70-tägiger Speicherung des Polymeren nachgewiesen werden. Die errechnete intrazelluläre Konzentration in diesem Versuch reicht nicht aus, um den Quarz quantitativ zu bedecken. Es wird daher angenommen, daß P 204 an der Zelle selbst angreift. O2-Verbrauchsmessungen ließen durch eine 50-proz. Atmungsdepression drei Stdn. nach Staubapplikation die zelltoxische Wirkung des Quarzes erkennen. 22 Stdn. nach Quarzverabreichung kam es zu einem Stopp der Atmung.

Die anfängliche 50-proz. Atmungserniedrigung konnte durch vorherige P 204-Behandlung nicht aufgehoben werden, obwohl das morphologische Bild keine quarztypischen Schäden an der Zelle zeigte. Ein weiterer Abfall der Atmung, der auf die Zellnekrose zurückzuführen ist, wurde in der 22. Stde. nicht beobachtet.

Es wird vermutet, daß P 204 in biologische Vorgänge eingreift, die nach der Atmungshemmung liegen.