作为一种创新的运动疗法,治疗性攀岩(As an innovative exercise therapy, therapeutic climbing (TC)近年来吸引了比以往更多的关注。在本文对TC相关研究的综述中,作者探讨了其起源和发展;总结其在治疗抑郁症,腰痛等疾病的治疗效果;并进一步分析其潜在机制。根据文献,TC主要应用于骨科领域,然后逐渐应用于神经病学,精神病学和心理学。它为治疗抑郁症,下背部疼痛,多发性硬化症和其他疾病提供了新的手段。有两种潜在的机制:生理和心理。未来,应通过大样本和高质量随机对照试验来探索TC的运动效果,不良反应和运动处方。) has attracted more attention than ever before in recent years. In this review of the related studies on TC, the authors explore its origin and development; summarize its therapeutic effect in treating depression, low back pain and other diseases; and further analyze its underlying mechanism. According to the literature, TC was primarily applied in the field of orthopedics and then was gradually used in neurology, psychiatry and psychology. It provides a new means for the treatment of depression, lower back pain, multiple sclerosis and other diseases. There are two potential mechanisms: physiological and psychological. In the future, exercise effects, adverse effects and exercise prescriptions of TC should be explored with large samples and high-quality randomized controlled trials.
3.4. Other Diseases
Many foreign studies provided new ideas for the rehabilitation of patients with diseases other than the abovementioned (Table 1). For example, TC positively affects the prevention and treatment of shoulder joint trauma [66]. It increases the range of motion of the shoulder muscles of patients with impingement syndrome and reduces their disability scores, which can be attributed to the fact that TC activates shoulder muscles, strengthening the muscles and coordination [67–69]. In addition, studies showed that TC can also be viewed as a means of rehabilitation after calcaneal fractures [70], a complementary treatment option for patients with scoliosis [71], and a way to enhance the self-worth and concentration of patients with anxiety and obsessive compulsive disorders [72,73]. It can reduce the annual bleeding rate and improve the joint condition of patients with hemophilia [74–77], promote self-esteem and self-efficacy for alcohol addicts, and improve adolescent gait function for children with cerebral palsy [78–81]. For children with attention deficit hyperactivity disorder, it can activate their brain waves and further focus their attention [82]. For patients with gynecological cancer, it can improve their health and functional suitability [83]. Moreover, it can improve speed up movement and strengthen the balance and flexibility of children with autism [84,85]. It can also improve the physical health of children with cancer and intellectual disabilities [86,87], intensify movement and coordination for patients with cerebellar ataxia, and improve the quality of life and upper limb function for stroke patients by enhancing their balance and walking function [88–90]. Furthermore, it can alleviate the symptoms of Parkinson’s patients by boosting their self-confidence and dynamic balance ability [91,92], and the static balance and gait can improve for patients with a spinal cord injury [93]. Overall, we found TC to be a potent treatment method for the improvement of physical fitness or disease rehabilitation of the abovementioned patients. However, the current literature only provides a basis for rehabilitation. In follow-up studies, the intervention effect should be further explored through high-quality randomized controlled trials.
4 Potential Mechanisms of TC
4.1. Physiological Mechanisms
When practicing TC, static and dynamic muscles work alternatively. The dynamic muscle follows the process from dynamic to centripetal and then dynamic to centrifugal to strengthen the neuromuscular adaptability. Centripetal movement has a unique advantage in disease recovery since it can increase cortical excitability and decrease intracortical inhibition and spinal cord excitability to develop neuromuscular adaptability [95,96]. Furthermore, the entire treatment process is conducted in a so-called “closed chain”. Climbing can compress the joints without generating joint shearing forces, increasing the stability of the joints so that the stress on the limbs prevents muscle atrophy and osteoarthritis. Despite training being a closed chain, TC requires better coordination. There are two reasons for this, one is that a small rock support can allow for the entire body’s center of gravity to be balanced very well. The other is that the entire body moves diagonally during the climbing process. The complex diagonal movement is functional and is more effective than simple movements. Therefore, the climber must focus on a specific muscle or muscle group that involves the complete myofascial chain, which helps damaged or weakened structures readapt . At the same time, the entire musculoskeletal system is improved by adopting a three-dimensional movement pattern in which pressure and stretch sensations in the muscles, as well as tendons, joint capsules and connective tissues, are stimulated by pressure, stretching and relaxation (it is similar to the PNF pattern). The relatively small support area of the hold and the demands on the limbs and core stability improve motor and postural control. As many studies showed, the diverse and equally targeted training of functional muscle groups and the entire musculoskeletal system in rehabilitated patients is effective.
4.2. Psychological Mechanisms
社会支持假说4.2.1. Social Support Hypothesis
社会支持意味着个人可以感受到,感知或接受他人的照顾或帮助。许多登山者可以同时参加Social support means that an individual can feel, perceive or receive care or assistance from others. Many climbers can take part in TC,他们必须依靠彼此的保护。登山者经常在登山者和保护者之间转移自己的角色,共同解决问题,相互鼓励和支持,从而培养了友爱和鼓励的精神。研究表明,登山者对人际关系的敏感度较低,并且有更多的技能来应对它们[38]。同时,他们不仅受到成就的启发,也受到同龄人成功的鼓舞。他们更愿意帮助别人解决各种心理问题,改善心理健康。 at the same time and they must rely on each other’s protection. A climber frequently transfers their role between climber and protector to solve problems together and encourage and support each other, which develops the spirit of camaraderie and encouragement. Research showed that climbers can be less sensitive to interpersonal relationships and have more skills to cope with them [38]. Meanwhile, they are inspired not only by their achievements but also by the success of their peers. They are more willing to assist others to solve a variety of psychological problems and improve mental health.
4.2.2. 分心假说Distraction Hypothesis
注意力是心理活动对某个物体的指向和聚焦,具有指向和聚焦的特征。当一个人将他们的意识引导并集中在某项活动上时,他们对周围一切事物的意识就会相应地下降。分心假说在大约Attention is the pointing and focusing of mental activity on a certain object and has both pointing and focusing characteristics. When an individual directs and focuses their awareness on a certain activity, their awareness of everything around them decreases accordingly. The distraction hypothesis was first conceptualized about 40年前首次概念化[97],分心理论认为,运动可以分散个体对不利刺激的注意力,忽略消极刺激并专注于积极刺激,从而改善情绪[98,99]。换句话说,个人注意力的认知资源是有限的,当它被完全占据时,新的刺激不会被处理。当个体将其分配给重要的活动时,例如,当一个人沉迷于运动时,负面情绪将被排除在注意力之外,个体只能从运动中体验到积极的感觉。在治疗性攀岩过程中,身体与攀岩墙的接触面积仍然很小,这确保了高水平的浓度。在TC过程中,患者专注于攀爬运动,以平衡身体并调整呼吸,从而将他们的注意力从疼痛和残疾上移开,专注于个人的能量体验。此外,患者会改变他们对疼痛的看法,不要太害怕而无法逃避疼痛。他们将对改善健康更加乐观,而不是抱怨这种疾病。然后,他们的抑郁可以缓解,认知缺陷和偏倚将消失[40]。 years ago [97], and distraction theory suggests that exercise can distract an individual’s attention from unfavorable stimuli, ignore negative stimuli and focus on positive stimuli, thus achieving an improvement in mood [98,99]. In other words, the cognitive resource for individual’s attention is limited, and when it is fully occupied, new stimuli are not processed. When the individual allocates it to important activities, for example, when one is addicted to exercise, negative emotions will be excluded from attention and the individual can only experience the positive feelings from exercise. The body’s contact area with the climbing wall remains small during therapeutic climbing, which ensures a high level of concentration. During the process of TC, the patient focuses on climbing movements to balance their body and adjust their breathing, which takes their attention away from pain and disability and focuses on individual energetic experience. In addition, the patient will change their idea on pain and not be too frightened to elude it. They will be more optimistic about improving their health instead of complaining about the disease. Then, their depression can be eased and the cognitive deficits and bias will disappear [40].
自我效能假说4.2.3. Self-Efficacy Hypothesis
自我效能感被定义为一个人对自己充分利用技能完成某项工作的能力的信心。有四个因素可以增强或削弱个体的自我效能感:成功经验、替代经验、言语说服和生理状况,其中发展自我效能感的最有效因素是成功经验Self-efficacy is defined as a person’s confidence in their ability to make full use of their skills to complete a certain job. Four factors may enhance or weaken individual self-efficacy: successful experience, substitution experience, verbal persuasion and physiological condition, of which the most effective factor in developing self-efficacy is successful experiences [100]。在TC方面,练习通常是模块化的,可以灵活地进行。这些模块的范围和复杂性各不相同,从单个运动序列到复杂的运动序列。通过这种方式,可以灵活地设计训练,使锻炼能够快速适应当前的健身水平。我们可以根据身高和难度对运动水平进行精心评分,通过微小的调整来满足患者的需求,从而获得成就感。通过不断的攀岩,患者获得成功的喜悦,激活他们强烈的积极情绪,增强自我效能感。因此,他们面对疾病的信心得到了加强。当一个人采取积极行动时,挑战很重要,因为人类大脑的复杂奖励系统允许个人在成功克服挑战时体验到一种特殊的幸福感。此外,当前TC固有的治疗成分涉及正念的各个方面。通过在练习开始和结束时进行短暂的正念练习,患者可以在正念冥想期间感知他们当前的身体和情绪状况,而不是评估他们当前的疾病状况,从而将注意力从消极思想上转移开来,从而改善他们的抑郁和情绪[34]。. In terms of TC, the exercise is often modular and can be performed flexibly. The modules vary in scope and complexity from single to complex motion sequences. In this way, the training can be flexibly designed so that the exercise can be quickly adapted to the current fitness level. We can grade the level of exercise elaborately based on height and difficulty, meeting the patient’s needs via tiny adjustments to achieve a sense of achievement. Through continuous rock climbing, the patient gains the joy of success, their strong positive emotion is activated and self-efficacy is enhanced. Thereby, their confidence in the face of disease is strengthened. Challenges are important when one takes positive action because the complex reward system of the human brain allows individuals to experience a special sense of well-being when challenges are successfully overcome. In addition, a therapeutic component that is inherent in current TC involves all aspects of mindfulness. With brief mindfulness exercises at the beginning and end of the practice, the patient can perceive their current physical and emotional condition during mindfulness meditation instead of assessing their current disease situation, thus diverting attention away from negative thoughts so that their depression and mood are improved [34].
TC provides a new way of thinking about the rehabilitation and treatment of patients with depression, low back pain, hemophilia and other diseases. On the one hand, the movement pattern of muscles that are used when climbing is complex, diagonal and functional. The closed-chain movement pattern is beneficial to the patient’s neuromuscular and musculoskeletal system. On the other hand, TC is designed to be refined and modular. Its intensity has a significant effect on the patient’s self-efficacy. Because of the high concentration and social support when climbing, the patient improves their mental health and has more courage to face challenges.