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expert views on therapeutic climbing—a multi-perspective, qualitative study 2021 anika frühauf.pdf

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InternationalJournalof
EnvironmentalResearch
andPublicHealth
Article
ExpertViewsonTherapeuticClimbing—AMulti-Perspective,
QualitativeStudy
AnikaFrühauf*,JuliaHeußner,MartinNiedermeierandMartinKopp
DepartmentofSportScience,UniversityofInnsbruck,6020Innsbruck,Austria;
julia.******@(.);martin.******@(.);Martin.******@(.)
*Correspondence:anika.******@;Tel.:+43-512-507-45859
Abstract:Therapeuticclimbing(TC)isregularlyusedasanadd-ontreatmentoptionforavariety
,evidenceontheassessmentofprofessionalsdecidingonthetreatment
,theaimofthe
presentstudywastoassessthepotentialofTCasanexerciseinterventionfromdifferentexpert
,problem-centeredinterviewexperimentto
assesstheperspectivesofpedagogues,physicians,andpsychologistsonexercisetherapyingeneral
(10pedagogues,10physicians,and
10psychologists)withdifferentlevelsofexperienceinTC(age:,=43%).Overall,the
potentialofTCasanadd-ontreatmentoptionforvariousdisorderswasratedbytherespondentsas
,
psychological,andphysiologicaldomainasasensiblyusedadd-,considering
thereportedpotentialadverseeffectsandthecostsconnectedwithTC,itshouldnotbeconsideredas
,thepositiveperspectiveofthe

professionalrepresentativessurveyedcouldfacilitateaccesstoTCforpatientsandmayfostermore
Citation:Frühauf,A.;Heußner,J.;researchinthisfleld.
Niedermeier,M.;Kopp,
ViewsonTherapeuticClimbing—AKeywords:exercisetherapy;attitudes;expertviews;mentalhealth
Multi-Perspective,QualitativeStudy.
,
18,:///
ijerph18073535

AcademicEditor:
mentalhealthpositively[1].Alongsideitspreventiveeffectaswellasitsinterventioneffect
Received:1March2021formanysomaticdisorders,exercisecanalsobeusedasalow-thresholdmentalhealth
Accepted:25March2021interventionstrategythatishighlyefflcient,costeffective,andwithfewsideeffects[2].
Published:29March2021Althoughexercisehasbeenshowntobeeffectiveinthetreatmentofmentalhealthdis-
orders[3–5],thereisnotenoughinformationaboutpotentialdifferingeffectsbetween
Publisher’sNote:MDPIstaysneutraldifferentmodalitiesofexerciseinterventionsanddifferentdosesofspeciflcactivities[5].
withregardtojurisdictionalclaimsinAlthoughexerciseinterventionshavebeenpredominantlyconductedusingaerobicexercise
publishedmapsandinstitutionalaffll-asaninterventionmethod,itseemsthatresistanceandmixedtrainingmightevenshow
[3,5].
Oneoftheseexercisemodalitiesusedinthetreatmentofdepressionandvariousdis-
ordersistherapeuticclimbing(TC).Consistingofelementsofresistanceandwhole-body
strengthendurancetraining[6,7],TCalsocontainsuniquesocio-psychologicalcharacter-
Copyright:©[8].TCcanbeorganizedindifferentforms,.,boulderinghorizontallywithouta
LicenseeMDPI,Basel,[9]orclimbingusingaropeand
Thisarticleisanopenaccessarticleaharnessbelayedbyaclimbingpartner[8].UsingTCasatreatmentformentalhealth
distributedunderthetermsanddisorders,psychotherapywasreportedtobeintegratedinclimbingsessions[9,10].This
conditionsoftheCreativeCommonsincludedamongothers,mindfulnessexerciseatthebeginningandendofeachsession,
Attribution(CCBY)license(https://aswellasreflectingonclimbingexperiencesandtheintegrationofthesemeasuresin
[10].TCisincreasinglyflndingitswayintoclinicaltreatment;however,
/).
,18,:///ijerph18073535:.
,18,35352of13
empiricalevidenceisnotyetclear[6].Fromaphysiologicalpointofview,preliminary
studiesassessingthephysiologicaleffectsofTCgroupsshowedincreasedmusclestrength,
balance,andmobility[7].Climbinghaspotentialpositiveeffectsoncoordination,strength,
andcoretension[11]andisconcomitantlyassociatedwithalowinjuryrisk(
per1000hinindoorclimbing)[12].Asidefromthephysiologicalbeneflts,TCprovides
-
larityofclimbing,TChasbeenusedforhealth-enhancingexerciseinterventionsandhas
recentlybeenevaluatedassuccessfulinreducingdepressivesymptomsandimproving
psychologicalwell-beinginclinicalpopulations[9,10].Inarecentstudy,ourgroupinvesti-
gateddifferentphysicalactivitiesinchildrenandadolescentsduringin-patienttreatment
formentalhealthdisorders;TCaswellasswimmingwereeffectiveinpositivelychanging
,TCmighthaveabeneflcialimpactonaffectivevalence,
especiallyintheflrsthalfoftheclimbingsession[13].Furthermore,throughitsunique
demands,involvingunusualheightsaswellasresponsibilityandtrustinthebelaying
partner,climbingmightenhanceconcentration,focus,andpsychosocialaspectssuchas
cooperationandrespect,andtriggeremotions,suchasfear,joy,orpride[11].Achievements
canbereachedbyadaptingheightordifflcultyindividually,andimprovementsareeasily
visibleforpatients(.,byreachingthetopofarouteorgettingthenexthold)[11,14].
Further,competitivenessbetweenparticipantsisbelievedtobelessimportantcompared
toteamballsports[14].Alltheseaspectsmayaddressautonomy,competence,andrelat-
edness,whichmight,basedonself-determinationtheoryincombinationwithactivation
andvalence,enhanceintrinsicmotivation[15].Despiteallthesepotentialpositiveaspects,
moredatafromrandomizedcontrolledtrialsareneededtoinvestigatewhetherornotTC
mightbeamodalityofexerciseinterventionthatimprovesthenamedphysiologicaland
psychologicalaspectsandshowshigherordifferenthealth-enhancingeffectsthanother
exerciseinterventions[6].
Nevertheless,climbingisincreasinglyestablishedintherapeuticsettingsinorder
topositivelyaffectphysiologicalandespeciallypsychosocialhealthdomains[6,16].In
thephaseofincreaseduseasahealthintervention,anessentialaspectistorecordthe
attitudeandoutcomeexpectanciestowardthisinterventionofprofessionallyinvolved

ofoutcomesregardingexercisehaveasigniflcantimpactonprescribingbehavior[17,18].
Theexpectationsofhealthcareprovidersevenplayanimportantroleinthetreatment
outcome[19].Toverifytheconditionsforthesystematicintegrationofatherapeutic
interventionintothehealthcaresystem,itseemsimportanttoknowmoreaboutattitudes
andexpectationsregardingTCandregardingexerciseingeneral,whichmightinfluence
theattitudetowardTCoftheprofessionalswhoareworkinginhealthcareoreducation.
Tothebestofourknowledge,therearenoreportsontheattitudesandexpectationsof
,this
paperaimstoshedlightonthefollowingquestions:(1)Whataretheattitudesofhealth
expertsfromdifferentfleldstowardtheuseofexerciseingeneralandspeciflcallytherapeu-
ticclimbingasanadd-ontreatmentoption?(2)Whatarethedomainswheretherapeutic
climbingisexpectedtoresultinimprovedhealth-enhancingoutcomes?(3)Whatshould
beconsideredwhenestablishingTCasatreatmentoption?


Sincetheaimofthestudywastoexploreratherthantovalidatepre-existinghypothe-
ses,-structuredinterviewwascarriedoutwith

thesamequestionsbutatthesametimewasallowedtotalkfreelyabouttheirexperiences.
Theinterviewguidewasdevelopedandagreeduponbytheresearchteamfollowingthe
guidelinesofWeischer[20].Asanintroductoryquestion,expertswereaskedabouttheir
:.
,18,35353of13
ofTC,thefollowinginformationwasgiventothem:“Aprerequisitefortherapyisthe

usuallyanadjunctivetherapyandisalreadyusedinthefleldofphysiotherapy,occupa-
tionaltherapy,,thepatient
communicateswiththetherapistinasecuresettingwiththehelpofathirdmedium,the

theexperiences,withthegoalofindividuallytreatingthepatient.”
Next,sixopenquestionswereaskedabouttheattitudetowardexercisetherapyin
general(Whatisyouropiniononexercisetherapy?)andfurtherabouttheattitudeand
effectivenessoftherapeuticclimbing(.,HowdoyouestimatetheeffectivenessofTC?In
whichareaswouldyouexpectTCtobeeffective?DoyouthinkTCcouldbeassociatedwith
negativeeffects?InwhichareaswouldyouconsiderTCtobeausefultherapymethod?).
Ifanswerswereshort,intervieweeswereaskedtofurtherelaborateonthetopicorgive


conductedandanalyzedinGermanandwerecarriedoutone-to-one.
Theinterviewquestionswerestructuredintoattitudestowardtheeffectivenessof
exercisetherapies,theoreticalandpracticalknowledgeinthefleldofTC,attitudestoward
theeffectivenessoftherapeuticclimbing,assumptionsofpotentialeffectsofTC,and
considerationswhenestablishingTCasatreatmentoption.

Sincedatasaturationisexpectedafter20–30interviews[21],30expertsfromthree
differentprofessionalgroups(medicine,education,psychology)
selectionoftheseprofessionalgroupswasbasedontherationalethattheapproachesof
-
gogueswasselectedtoassessthesocio-psychologicalpotentialofTCandappropriateness
ofexercise/TCfromaneducationalperspective.
Whenselectingtheinterviewpartners,attentionwaspaidtoensuringthattheaverage

,
andtheselectionoftheinterviewpartnerswasdonebyasnowballsystemstartingwith
twoknownspecialistsineachgroup[22].
Thegroupofphysicianscomprisedgeneralpractitioners,orthopedists,neurologists,
andpsychiatrists,andthepedagoguescamefromthefleldsofsocialpedagogy,curativeand
specialeducation,
organizationalpsychology,andbehavioralandclinicalpsychology,andflveweretrained




bytheBoardforEthicalQuestionsinScienceoftheUniversityofInnsbruckinaccordance
withtheDeclarationofHelsinki.
.
MeanAgeSexExperiencewithTherapeuticClimbing
(Years)FemaleMaleTheoryPractice
%50%20%20%
%50%30%30%
%70%90%70%
%57%47%40%:.
,18,35354of13

Beforeanalyzingthedata,allinterviewsweretranscribedverbatim;transcriptionwas

werehighlighted,andanynon--
alyzedusingthematiccontentanalysis[23],transcripts
,athematiccontentanalysis
wascarriedout