Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder characterized by motor symptoms like bradykinesia, rigidity, and tremor. Current treatments offer only symptomatic relief, highlighting the need for multimodal approaches including non-pharmacological interventions. Physical exercise is a cornerstone of PD management, with various forms of exercise demonstrating positive effects on motor symptoms. Studies have shown benefits from treadmill training, Nordic walking, cycling, and resistance training. While most exercise types offer general benefits, some are particularly effective for specific body parts, leading to the concept of whole-body training for optimal results. Beyond symptomatic relief, exercise may offer disease-modifying effects through improved neuroplasticity and behavioral changes. Randomized trials have shown promise in this area. However, consistent exercise routines require high patient motivation. Engaging and motivating sports are therefore crucial to overcome apathy, a common issue in PD patients that impacts adherence to exercise programs. Alternative sports like dance, boxing, Tai Chi, and yoga have shown promise in addressing motor symptoms in PD. Climbing, with its various forms (bouldering, lead climbing, top-rope climbing), offers potential as a safe and effective sport for PD patients. It's a whole-body exercise with a low injury risk, improving fitness, strength, posture, balance, and flexibility. The large movements required align with the "BIG" concept in PD therapy, emphasizing large amplitude movements. Climbing is already used in neurorehabilitation for other conditions. This randomized controlled trial aims to evaluate the effectiveness and feasibility of top-rope climbing as a 12-week intervention for mildly to moderately affected PD patients without prior climbing experience.

The introduction thoroughly reviews the existing literature on exercise interventions for Parkinson's disease, highlighting the benefits of various types of physical activity, such as treadmill training, Nordic walking, cycling, and resistance training. It emphasizes the importance of whole-body training approaches and mentions the potential disease-modifying effects of exercise. The review also discusses the challenges of maintaining long-term adherence to exercise programs due to apathy and the need for engaging and motivating activities. Finally, it points to the emerging interest in alternative sports, such as dance, boxing, Tai Chi, and yoga, as well as the potential of climbing as a beneficial exercise for PD patients, supported by its known effects on physical fitness, balance, and flexibility. Several studies are cited to support these claims.

This study employed a single-center, randomized controlled, semi-blind trial design. 93 PD patients were screened, with 48 climbing-naive patients (average age 64 ± 8 years, Hoehn & Yahr stage 2–3) ultimately included. Patients were randomly assigned (1:1 ratio) to either a 12-week sport climbing course (SC) or an unsupervised physical training (UT) group. The SC group participated in a 90-minute-per-week supervised top-rope climbing course with an instructor-to-participant ratio of 1:3–4. The UT group received education on the European Physiotherapy Guidelines and WHO recommendations for physical activity and were instructed to follow these independently, with regular phone calls for support and adherence monitoring via training logs. The primary outcome measure was the change in Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) scores from baseline to 12 weeks. Secondary outcomes included MDS-UPDRS-III subscales for bradykinesia, rigidity, and tremor. Feasibility was assessed through adherence rates, dropout rates, and adverse events. A follow-up telephone interview was conducted 12 ± 0.5 months post-intervention. Statistical analysis included calculation of mean differences, confidence intervals, and linear regression to assess the effect of group assignment on MDS-UPDRS-III scores. A sample size of 24 participants per group was chosen to ensure adequate power.

The study found that sport climbing significantly improved motor symptoms in PD patients. Specifically, the sport climbing group showed a significant reduction of 12.9 points (95% CI -15.9 to -9.8) on the MDS-UPDRS-III scale after 12 weeks, compared to a non-significant reduction of 3.0 points (95% CI -6.0 to 0.1) in the unsupervised training group. This difference was statistically significant (p<0.001). Substantial improvements were also observed in bradykinesia (28% improvement after 12 weeks), rigidity (30% improvement after 12 weeks), and tremor (51% improvement after 12 weeks) in the sport climbing group, while the unsupervised training group showed no significant changes in these subscales. The adherence rate to the sport climbing intervention was remarkably high (99%), with a dropout rate of only 8%. No adverse events were reported in either group. A follow-up interview revealed that 48% of the sport climbing participants continued climbing after the study, primarily due to perceived improvements in mobility, posture, enjoyment, and overall well-being. In contrast, the unsupervised physical training group reported almost double the amount of exercise time recommended by WHO guidelines.

The findings strongly support the effectiveness and feasibility of sport climbing as a therapeutic intervention for PD. The significant improvement in MDS-UPDRS-III scores and the subscales in the sport climbing group, compared to the unsupervised training group, highlight the unique benefits of this activity. The large effect size observed is comparable to only a few other studies using equally demanding activities like tango dancing. The results suggest that whole-body workouts, especially those combining resistance training, balance, flexibility, and coordination, are highly effective for improving motor symptoms. Sport climbing's substantial impact on bradykinesia, rigidity, and tremor can be attributed to its multifaceted nature. The resistance training element likely contributes to improvements in bradykinesia and rigidity, while the balance and coordination aspects likely improve functional mobility and reduce fall risk. The high adherence and low dropout rates demonstrate the sport's appeal and feasibility for PD patients. Despite the high level of activity in the unsupervised training group, which maintained symptom stability, the significant superiority of climbing highlights its efficacy. Although the control group was unsupervised, this reflects real-life scenarios, and their reported activity levels (nearly double WHO recommendations) likely prevented the expected symptom deterioration in the UT group, which nonetheless underscores the advantages of sport climbing.

This randomized controlled trial provides strong class III evidence supporting the efficacy and feasibility of sport climbing as a therapeutic intervention for Parkinson's disease. Sport climbing significantly improves motor symptoms, exceeding the effects of many previous exercise interventions. Its safety, high adherence rate, and motivational aspects make it a highly attractive and promising treatment option for PD patients. Future research should focus on long-term effects, larger cohorts, and direct comparisons with other established therapies, potentially leading to increased access and insurance coverage of climbing programs.

The study acknowledges several limitations. The primary outcome measure, MDS-UPDRS-III, is influenced by medication, although efforts were made to minimize medication changes. A potential inclusion bias exists due to the self-selection of participants with a positive attitude towards exercise and climbing. The follow-up assessment did not include a clinical examination. The unsupervised nature of the control group, while mimicking a real-life setting, may have contributed to the observed differences. Lastly, the relatively limited number of participants means larger, longer-term trials are still necessary to further confirm these findings.