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 Australian mixed-mode observing program.

Global geodetic VLBI is upgrading to its next-generation observing system, VGOS. This upgrade has turned out to be a process over multiple years, until VGOS reaches its full capabilities with the envisaged continuous observations. Until then, for the Australian stations, the upgrade means ceasing their legacy S/X observations, leaving a large gap in the global network as well as in the station time series. The Australian mixed-mode observing program is a series of sessions where the VGOS stations in Hobart and Katherine observe legacy S/X VLBI together with other stations in the region. This paper describes the technical details of these observations and their processing strategies and discusses their suitability for geodetic results by comparison with those of standard legacy S/X sessions. The presented mixed-mode sessions allow a continuation of the station time series, a benefit for the stations themselves as well as for future realisations of the terrestrial and celestial reference frames. A novel mode of observing is introduced and tested. The results are promising and it is suggested for acceptance into standard legacy S/X IVS observations, overcoming current gaps in the network due to VGOS upgrades and preventing a worsening of global results otherwise.

Probing a southern hemisphere VLBI Intensive baseline configuration for UT1 determination.

The deviation of Universal Time from atomic time, expressed as UT1-UTC, reflects the irregularities of the Earth rotation speed and is key to precise geodetic applications which depend on the transformation between celestial and terrestrial reference frames. A rapidly varying quantity such as UT1-UTC demands observation scenarios enabling fast delivery of good results. These criteria are currently met only by the Very Long Baseline Interferometry (VLBI) Intensive sessions. Due to stringent requirements of a fast UT1-UTC turnaround, the observations are limited to a few baselines and a duration of one hour. Hence, the estimation of UT1-UTC from Intensives is liable to constraints and prone to errors introduced by inaccurate a priori information. One aspect in this context is that the regularly operated Intensive VLBI sessions organised by the International VLBI Service for Geodesy and Astrometry solely use stations in the northern hemisphere. Any potential systematic errors due to this northern hemisphere dominated geometry are so far unknown. Besides the general need for stimulating global geodetic measurements with southern observatories, this served as a powerful motivation to launch the SI (Southern Intensive) program in 2020. The SI sessions are observed using three VLBI antennas in the southern hemisphere: Ht (South Africa), Hb (Tasmania) and Yg (Western Australia). On the basis of UT1-UTC results from 53 sessions observed throughout 2020 and 2021, we demonstrate the competitiveness of the SI with routinely operated Intensive sessions in terms of operations and UT1-UTC accuracy. The UT1-UTC values of the SI reach an average agreement of 32 µs in terms of weighted standard deviation when compared with the conventional Intensives results of five independent analysis centers and of 27 µs compared with the 14C04 series. The mean scatter of all solutions of the considered northern hemisphere Intensives with respect to C04 is at a comparable level of 29 µs. The quality of the results is only slightly degraded if just the baseline HtHb is evaluated. In combination with the e-transfer capabilities from Ht to Hb, this facilitates continuation of the SI by ensuring rapid service UT1-UTC provision.

Baseline-dependent clock offsets in VLBI data analysis.

The primary goal of the geodetic Very Long Baseline Interferometry (VLBI) technique is to provide highly accurate terrestrial and celestial reference frames as well as Earth orientation parameters. In compliance with the concept of VLBI, additional parameters reflecting relative offsets and variations of the atomic clocks of the radio telescopes have to be estimated. In addition, reality shows that in many cases significant offsets appear in the observed group delays for individual baselines which have to be compensated for by estimating so-called baseline-dependent clock offsets (BCOs). For the first time, we systematically investigate the impact of BCOs to stress their importance for all kinds of VLBI data analyses. For our investigations, we concentrate on analyzing data from both legacy networks of the CONT17 campaign. Various aspects of BCOs including their impact on the estimates of geodetically important parameters, such as station coordinates and Earth orientation parameters, are investigated. In addition, some of the theory behind the BCO determination, e.g., the impact of changing the reference clock in the observing network on the BCO estimate is introduced together with the relationship between BCOs and triangle delay closures. In conclusion, missing channels, and here in particular at S band, affecting the ionospheric delay calibration, are identified to be the dominant cause for the occurrence of significant BCOs in VLBI data analysis.

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

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.

How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review.

The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson's disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.