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Effect of sport climbing on patients with multiple sclerosis - Hints or evidence?

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Abstract

Multiple sclerosis mainly affects young adults, which would be still able to work. Sport climbing as a relatively new form of therapy for neurological patients has a highly intrinsic motivation. Following Turner et al. (2009) a key-point to enhance psycho-social constitution and quality of life in patients with MS is the facilitation of physical activity. The aim of therapeutic climbing is to use the different effects on motor function and psychological components, to target various symptoms of patients with MS individually and to motivate them for an active lifestyle. Climbing in a therapeutic context is developing fast. Many field reports and case studies exist for therapeutic use. But there are only a few, heterogeneous studies. The aim is to demonstrate if sports climbing has a beneficial effect in the treatment of patients with MS. Climbing allows training body perception, strength, flexibility and endurance as well as self-esteem, courage and confidence. Within the climbing sessions an experienced therapist is able to work holistically and can adapt to the individual needs and symptoms of the patient. Velikonja et al. (2010) was first to show evidence to reduce fatigue about 32,5 % through a climbing-intervention in patients with MS. Our own randomized, controlled study assessed the impact of sport climbing on motor function and psycho-social factors in multiple sclerosis. We included 27 patients. The intervention of two hours a week lasts 6 month. First significant results in the climbing group encourage the findings on fatigue. Climbing seems to be an appropriate therapeutic medium to work on individual handicaps and motivate for more independence and activity in daily living, especially for patients with MS. The current absence of studies on evidence and setting in therapeutic climbing allows a wide area of research in the future in a therapeutic context.

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Therapeutic climbing had been used successfully as an intervention in orthopedic-traumatologic, neurologic, psychomotoric and congenital or chronic diseases. The aim of this abstract is to give an overview of the existing literature on this new form of therapy. This could also aid in assessing the methodology and work out future research directions. National and international databases within the medical field (Evidence Based Medicine Reviews, PubMed …) have been searched for German and English articles that dealt with climbing in a therapeutic context. Only a limited amount of scientific investigations regarding the effects of therapeutic climbing were found. Evidence for the effectiveness of this form of climbing was only found in the field of orthopedics. Other published results were field reports or individual case studies which did not make any reliable statements/conclusions. Based on the current review, therapeutic climbing cannot be wholly recommended as an interventional method. However, this should not be interpreted as a refusal to use therapeutic climbing as an intervention. The use of systematic analysis in studying the general effects of climbing movements as well as comparisons to classical interventional methods is necessary. Further approaches to this research study will be given.
Article
A randomized controlled study investigated the effects of therapeutic climbing in patients with chronic low back pain. Before and after 4 weeks of training, physical and mental well-being were measured by two questionnaires (36-Item Short Form Health Survey [SF-36]; Hannover Functional Ability Questionnaire for measuring back pain-related disability [FFbH-R]). Therapeutic climbing has been suggested to increase muscular strength and perceived physical and mental well-being. This study focused on the psychological effects of therapeutic climbing and compared it with standard exercise therapy. Therapeutic climbing has become increasingly popular in rehabilitation and its effects on muscular strengthening have been shown. Therapeutic climbing has also been suggested to yield psychological effects such as changes in attentional focus from pain to physical capabilities. To date, no controlled clinical trial has investigated these psychological effects and it is unclear whether therapeutic climbing is comparable or superior to other forms of exercise. Twenty-eight patients with chronic low back pain conducted either a therapeutic climbing or a standard exercise regime. Each program took 4 weeks, including four guided training sessions per week. Before and after the program, patients answered two questionnaires assessing their physical and mental well-being. For the Hannover Functional Ability Questionnaire for measuring back pain-related disability, there was no difference before versus after or between the treatments. For the SF-36, both treatments showed significant improvements in 3/8 subscales of the SF-36. In 2/8 subscales, only the participants of the therapeutic climbing improved and in 1/8 subscales the converse was true. Comparing both groups, significantly larger improvements were found after therapeutic climbing in two subscales of the SF-36: physical functioning and general health perception. The benefits of therapeutic climbing were comparable with those of a standard exercise regime. In two subscales of the SF-36, the benefits of therapeutic climbing exceeded those of standard exercise therapy, primarily in perceived health and physical functioning of the patients. This finding demonstrates that therapeutic climbing is equivalent and partly superior to standard exercise therapy for patients with chronic low back pain.
Article
Multiple sclerosis (MS) is a neurological disease that may result in the progressive worsening of disability. Recent research has identified physical activity as a behavioral correlate of disability in MS. The current review highlights that previous research has generally included samples with minimal disability and provides a rationale for considering physical activity as an influence of disability in the second stage of MS.
Article
Spasticity, cognitive impairment, depression and fatigue significantly reduce the quality of life in multiple sclerosis (MS) patients. To find out whether nonpharmalogical treatment approaches can reduce these symptoms we investigated effects of sports climbing (SC) and yoga on spasticity, cognitive impairment, mood change and fatigue in MS patients. Sports climbing (SC) and yoga are aerobic physical activities comprised a series of stretching techniques, implementation of which demands body control and planning of complex movements. 20 subjects with relapsing-remitting or progressive MS, 26-50 years of age, with EDSS<or=6 and EDSS pyramidal functions score (EDSSpyr)>2 were enrolled in a randomized prospective study. The participants were randomly divided into SC and yoga group. We evaluated spasticity, cognitive function, mood and fatigue before and after both programs, that lasted 10 weeks, with standardized assessment methods. There were no significant improvements in spasticity after SC and yoga. In the SC group we found a 25% reduction (p=0.046) in EDSSpyr. There were no differences in executive function after the completion of both programs. There was a 17% increase in selective attention performance after yoga (p=0.005). SC reduced fatigue for 32.5% (p=0.015), while yoga had no effect. We found no significant impact of SC and yoga on mood. Yoga and SC might improve some of the MS symptoms and should be considered in the future as possible complementary treatments.
Article
The impact of a six-week indoor wall climbing on the perceptions of self for children with special needs aged 6-12 years was explored. Participants (n = 46) were randomly assigned to the intervention (girls, n = 4; boys, n = 19) and control groups (girls, n = 5; boys, n = 18). Belayers' and children's perceptions of efficacy were measured using specifically designed questionnaires and perceptions of competence and global self-worth were measured using Harter's (1985) Self-Perception Profile for Children for participants with an adaptive age of 8 years or higher. Children's self-efficacy and belayers' ratings of children's efficacy improved significantly, t(21) = 3.9, p = .001, d= .84 and F(2, 44) = 30.03, p < .001, respectively. The children's judgments of their athletic and social competence and global self-worth, however, did not change over time or differ from the wait-listed control group (p > .05). These results suggest that it is likely that many experiences that enhance self-efficacy may be needed to improve self-perceptions.
Article
To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction. Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999. Veterans Health Administration. Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires. Not applicable. Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency. Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties). Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.
Article
One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
Article
A meta-analytic study was conducted to examine the hypothesis that aerobic fitness training enhances the cognitive vitality of healthy but sedentary older adults. Eighteen intervention studies published between 1966 and 2001 were entered into the analysis. Several theoretically and practically important results were obtained. Most important fitness training was found to have robust but selective benefits for cognition, with the largest fitness-induced benefits occurring for executive-control processes. The magnitude of fitness effects on cognition was also moderated by a number of programmatic and methodological factors, including the length of the fitness-training intervention, the type of the intervention, the duration of training sessions, and the gender of the study participants. The results are discussed in terms of recent neuroscientific and psychological data that indicate cognitive and neural plasticity is maintained throughout the life span.
Article
In patients with multiple sclerosis (MS) fatigue is the most common symptom and one of the most disabling features. As many as 40% have described it as the single most disabling symptom--a higher percentage than weakness, spasticity, motor problems, or bowel or bladder problems. The etiology and pathophysiology of MS-related fatigue remain unknown. Studies have failed to demonstrate an association between MS-related fatigue and the level of disability, clinical disease subtype, or gender, although recent data show an association between MS-related fatigue and depression and quality of life. Imaging studies using positron emission tomography suggest that fatigue in MS is related to hypometabolism of specific brain areas, including the frontal and subcortical circuits. The impact of fatigue on patient functioning and quality of life clearly warrants intervention. In addition to nonpharmacologic measures, such as exercise and energy conservation strategies, several pharmacologic agents have been evaluated for their ability to reduce MS-related fatigue, including amantadine, central nervous system stimulants (pemoline), and the novel wake-promoting agent modafinil.
Article
Rock climbing has increased in popularity as both a recreational physical activity and a competitive sport. Climbing is physiologically unique in requiring sustained and intermittent isometric forearm muscle contractions for upward propulsion. The determinants of climbing performance are not clear but may be attributed to trainable variables rather than specific anthropometric characteristics.
Article
It is the coexistence of physical and cognitive impairments, together with emotional and social issues in a disease with an uncertain course, that makes MS rehabilitation unique and challenging. Inpatient rehabilitation improves functional independence but has only limited success improving the level of neurologic impairment. Benefits are usually not long lasting. Severely disabled people derive equal or more benefit than those who are less disabled, but cognitive problems and ataxia tend to be refractory. There is now good evidence that exercise can improve fitness and function for those with mild MS and helps to maintain function for those with moderate to severe disability. Therapy can be performed over 6 to 15 weeks in outpatient or home-based settings or as a weekly day program lasting several months. Several different forms of exercise have been investigated. For most individuals, aerobic exercise that incorporates a degree of balance training and socialization is recommended. Time constraints, access, impairment level, personal preferences, motivations, and funding sources influence the prescription for exercise and other components of rehabilitation. Just as immunomodulatory drugs must be taken on a continual basis and be adjusted as the disease progresses, so should rehabilitation be viewed as an ongoing process to maintain and restore maximum function and QOL.
Article
To evaluate the effects of an 8-week lower-body resistance-training program on walking mechanics in persons with multiple sclerosis (MS). Repeated-measures design, evaluating gait kinematics before and after an 8-week progressive resistance-training intervention. Biomechanics laboratory and fitness center (with conventional, commercially available resistance-training equipment). Eight ambulatory subjects with MS (age, 46.0+/-11.5 y) with Expanded Disability Status Scale scores ranging from 2.5 to 5.5. An 8-week progressive resistance-training program. Kinematic gait parameters including knee range of motion, duration of stance, swing, and double-support phases in seconds and as percentages of the stride time, percentage of stride time spent in stance, swing, and double-support phases, step length, foot angle, stride length, velocity, step width, and toe clearance for both the more affected and less affected lower limbs. Isometric strength, 3-minute stepping, fatigue, and self-reported disability were also measured. After 2 months of resistance training, there were significant increases (P<.05) in percentage of stride time in the swing phase, step length, stride length, and foot angle; and significant decreases (P<.05) in percentage of stride time in the stance and double-support phases, duration of the double-support phase, and toe clearance. Isometric leg strength improved (P<.05) in 2 of the 4 muscle groups tested. Fatigue indices decreased (P=.04), whereas self-reported disability tended to decrease (P=.07) following the training program. Three-minute stepping increased by 8.7%. Resistance training may be an effective intervention strategy for improving walking and functional ability in moderately disabled persons with MS.
Article
Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.
Article
Reliable, language-independent, short screening instruments to test for cognitive function in patients with multiple sclerosis (MS) remain rare, despite the high number of patients affected by cognitive decline. We developed a new, short screening instrument, the Faces Symbol Test (FST), and compared its diagnostic test characteristics with a composite of the Digit Symbol Substitution Test (DSST) and the Paced Auditory Serial Addition Test (PASAT), in 108 MS patients and 33 healthy controls. An Informant-Report Questionnaire, a Self-Report Questionnaire, and a neurologist's estimation of the Every Day Life Cognitive Status were also applied to the MS patients. The statistical analyses comprised of a receiver operating characteristic analysis for test accuracy and for confounding variables. The PASAT and DSST composite score estimated that 36.5% of the MS patients had cognitive impairment. The FST estimated that 40.7% of the MS patients were cognitively impaired (sensitivity 84%; specificity 85%). The FST, DSST and PASAT results were significantly correlated with the patients' physical impairment, as measured by the Expanded Disability Status Scale (EDSS). The results suggest that the FST might be a culture-free, sensitive, and practical short screening instrument for the detection of cognitive decline in patients with MS, including those in the early stages.
Article
Using meta-analytic procedures, this study examined the overall effect of exercise training interventions on quality of life (QOL) among individuals with multiple sclerosis (MS). We searched MEDLINE, PSYCHINFO and CURRENT CONTENTS PLUS for the period of 1960 to November 2006 using the key words exercise, physical activity and physical fitness in conjunction with QOL and MS. We further conducted a manual search of bibliographies of the retrieved papers as well as literature reviews and contacted study authors about additional studies. Twenty-five journal articles were located and reviewed, and only 13 provided enough data to compute effect sizes expressed as Cohen's d. One hundred and nine effect sizes were retrieved from the 13 studies with 484 MS participants and yielded a weighted mean effect size of g=0.23 (95% CI=0.15, 0.31). There were larger effects associated with MS-specific measures of QOL and fatigue as an index of QOL. The nature of the exercise stimulus further influenced the magnitude of the mean effect size. The cumulative evidence supports that exercise training is associated with a small improvement in QOL among individuals with MS.
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Sports climbing once a week improves balance, fatigue and cognitive function in multiple sclerosis (MS). 17 th European College of Sport Science Congress
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