Single-Case-Study: Long term benefits of sports climbing on fatigue, cognitive function and self-efficacy in multiple sclerosis (MS)

Purpose: Numerous studies documented the influence of physical activity on patients with MS [1,2,3,4,5,6]. Sports Climbing (SC) is new in therapy of neurological patients. It allows to target the various symptoms of MS-patients [7,8,9], even sitting in a wheel-chair. Kern [8] and Velikonja [9] provided first evidence for beneficial effects of SC in patients with MS. This study aimed to investigate if SC once a week has positive effects on the physical and mental state of a MS-patient sitting in a wheel-chair.

Patient and Methods: A 50 year old male with progressive MS since 1999, committed to a wheel-chair since 2005 has a score of 6.5 on the expanded disability status scale (EDSS). He underwent a SC-program in 20 two-hour sessions. Each session was adjusted individually and documented. Intervention-period was 6 month with follow-up SC once a week ever since. Questionnaires on fatigue (WEIMuS), QoL (HALEMS), self-efficacy (SWE) and the multiple sclerosis functional composite (MSFC) were used at baseline, after 6 and 18 month. The perceived physical state (WKV) examined the physical conditions throughout the SC-program. After 18 month an episodic interview memorizing situational and general experience detected alterations in comfort, physical and mental conditions.

Results: EDSS from 6.5 to 6.0, remaining stable. All Questionnaires showed an improvement over time. In the MSFC increased the PASAT clearly, whereas 9HPT and T25FW decreased (table1). Pain or discomforts were infrequent but, if present disappearing after climbing (table2). Interview results revealed the patient felt “more flexible”, “self-assured” and “clearer in mind” after climbing.

Table 1: intervention related endpoints with the perceived physical state (wahrgenommene körperliche Verfassung “WKV”, Kleinert, 2001) in 4 dimensions: energy, condition, flexibility, physical health and pain, discomfort; score 0–5

WKV dimensions	1. session pre	1. session post	20. session pre	20. session post
energy	3.4	2	4	3.6
condition	3	2.8	4	3.6
flexibility	2.2	2.8	2.8	3.2
physical health	3	4.8	4	4
pain	0	0	1	0
discomfort	0	0	1	0

Conclusions: In summary SC improved or stabilized mental and physical conditions in this MS-patient, especially in fatigue, cognitive function and self-efficacy. Therefore, regular sport participation, such as SC should be recommended to patients with MS. Further research is needed to prove this finding in cohort studies.

Table 2: clinical endpoints pre-post1-post2- tests a) The Expanded Disability Status Scale (EDSS) ranges from 0–10, with higher scores indicating greater disability. b) The Multiple Sclerosis Functional Composite (MSFC) creating a Z-score using standard population, including the Paced Auditory Serial Test (PASAT), counting the number of correct answers (0–60); theTimed 25 Foot Walk (T25FW) and the 9 Hole Peg Test (9HPT) measuring the time in seconds and questionaires: c) HALEMS (QoL) and d) SWE (self-efficiacy) a higher score means an improvement, e) WEIMuS (fatigue) a lower score indicates less fatigue.

	baseline	6 month	18 month
Questionaires	pre-test baseline	post-test1 6 month	post-test 2 18 month
a) EDSS	6.5	6.5	6.0
b) MSFC (Z-score)	-4.3	-4.7	-7.8
PASAT (n)	16	31	32
T25FW (s)	22.6	28.4	58.4
9HPT (s)	30.3	36.5	52.6
c) HALEMS	78	78	82
d) SWE	25	28	34
e) WEIMUS	34	30	27

Literatur: References 1. Rietberg M B, et al: Exercise therapy for multiple sclerosis. Cochrane Database of Systematic Reviews, 3, 2004 2. Motl R, et al: Physical activity and multiple sclerosis: a meta-analysis. Multiple Sclerosis 11(4), 2005; 459-463 3. Romberg A, et al:. Effects of a 6-month exercise program on patients with multiple sclerosis. Neurology 2004; 3: 2034-03 4. Brown T R, Kraft G H: Exercise and Rehabilitation for individuals with multiple sclerosis. PhysMed Rehabil Clin N Am., 2005; 16: 513-55 5. Gutierrez G M, et al: Resistance Training Improves Gait Kinematics in Persons With Multiple Sclerosis. Arch Phys Med Rehab, 2005; 86:1824-1829 6. Oken B S, et al: Cognition and fatigue in multiple sclerosis: Potential effects of medications with central nervous system activity. JRRD, 2006, 43(1), 83-90 7. Scharler D./Nepper H.U.: Klettern im Rahmen der Trainingstherapie. In: Gesundheitssport und Sporttherapie 2, 1996 8. Kern C, et al: “Multiple sclerosis and therapeutic climbing: an interventional long term pilot study indicates beneficial effects”, Poster, ECSS, 2006 9. Velkonja O, et al: Influence of sports climbing and yoga on spasticity, cognitive function, mood and Fatigue in patients with multiple sclerosis. J. clineuro, 2010, 112:597-601