A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson's disease

Abstract

Physical activity is of prime importance in non-pharmacological Parkinson's disease (PD) treatment. The current study examines the effectiveness and feasibility of sport climbing in PD patients in a single-centre, randomised controlled, semi-blind trial. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn & Yahr stage 2-3) were assigned either to participate in a 12-week sport climbing course (SC) or to attend an unsupervised physical training group (UT). The primary outcome was the improvement of symptoms on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III). Sport climbing was associated with a significant reduction of the MDS-UPDRS-III (-12.9 points; 95% CI -15.9 to -9.8), while no significant improvement was to be found in the UT (-3.0 points; 95% CI -6.0 to 0.1). Bradykinesia, rigidity and tremor subscales significantly improved in SC, but not in the unsupervised control group. In terms of feasibility, the study showed a 99% adherence of participants to climbing sessions and a drop-out rate of only 8%. No adverse events occurred. This trial provides class III evidence that sport climbing is highly effective and feasible in mildly to moderately affected PD patients.

Fig. 1. Schematic depiction of the top-rope climbing setup.

The climber is secured by the belayer via the rope, which is fixed to an anchor point at the top of the wall. The rope minimises the climber’s fall distance in the event of a fall.

Fig. 2. Trial flowchart.

In all, 93 patients were screened to meet the predefined necessary number of participants (24 participants in each group for a total of 48 participants). Other reasons for exclusion before randomisation: organisational reasons (timing issues, distance to climbing facility), unwilling to be randomised (preference for either intervention or control group). SC, sport climbing group; UT, unsupervised physical training group.

Fig. 3. The effect of sport climbing on Parkinson’s disease motor symptoms.

Data are mean and standard error of the mean (SEM). SC, sport climbing group (green lines); UT, unsupervised physical training group (blue lines); MDS-UPDRS-III, Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale part III (score ranges from 0 to 132); MDS-UPDRS-III_brad, severity of bradykinesia (14 items on the MDS-UPDRS-III; items 4–11 and 14; score ranges from 0 to 56); MDS-UPDRS-III_rig, severity of rigidity (5 items on the MDS-UPDRS-III; item 3; score ranges from 0 to 20); MDS-UPDRS-III_trem, severity of tremor (10 items on the MDS-UPDRS-III; items 15–18; score ranges from 0 to 40). a The effect of climbing on the total MDS-UPDRS-III score at baseline (BASE), after 6 weeks (MID) and after 12 weeks (END) compared to unsupervised physical training. Climbing significantly reduced total score on the MDS-UPDRS-III after 12 weeks, while unsupervised physical training stabilised motor symptoms. The cardinal symptoms are displayed in (b) (bradykinesia), (c) (rigidity) and (d) (tremor). All cardinal symptoms significantly improved in the climbing group and stabilised in the UT.