April is Parkinson’s Awareness Month and this year the Parkinson’s Foundation is bringing awareness to the fact that, in the U.S., someone will be diagnosed with Parkinson’s Disease every 6 minutes.
What is Parkinson’s Disease?
According to the Parkinson’s Foundation, Parkinson’s disease (PD) is a neurogenerative disorder that causes both motor symptoms and non-motor symptoms. While the severity and progression of the disease can vary considerably from person to person, common motor or movement-related symptoms include tremor, slowness and paucity of movement, limb stiffness, and gait and balance problems. Non-motor symptoms include depression, anxiety, apathy, hallucinations, constipation, orthostatic hypotension, sleep disorders, loss of sense of smell and a variety of cognitive impairments.
Unfortunately, the cause of this disease, which affects approximately 10 million people worldwide, is largely unknown and there is no cure.
Can Exercise Help?
However, one of the essential elements of treatment is exercise, which can help those with PD maintain their balance and mobility and retain the ability to perform activities of daily living. While a well-rounded exercise program is vital—including aerobic activity; strength training; balance, agility and multitasking; and flexibility training—one form of physical activity that may surprise you has emerged to offer significant benefits: boxing.
Non-contact boxing classes can yield many benefits that align with the treatment goals for PD patients with PD, including:
- Increased strength
- Enhanced cognitive processing
- Improved hand-eye coordination, posture, core strength, balance, agility and reaction time
What Does the Science Say?
Physical inactivity has been shown to be associated with the mild cognitive impairment and dementia that often accompanies PD. Importantly, the role of physical activity in the fight against cognitive impairment is well-established. Here, let’s take a look at a couple of pieces of research supporting the effectiveness of boxing programs in particular for individuals with PD.
- A recent study looked at the impact that community-based boxing programs have on symptoms in people with PD.
- Fourteen participants completed 24 boxing sessions, two per week for 12 weeks.
- What the researchers found was that there were statistically significant improvements in total motor and non-motor symptom severity, as well as in depression measures.
- A 2021 study evaluated gait instability (one of the more serious manifestations of PD), as well as gait and balance performance.
- In this study, 98 participants with PD completed boxing sessions twice a week for an average of 16 months.
- Prior to beginning the boxing sessions, participants reported 0.86 falls per month.
- That number fell to 0.11 falls per month.
- There were also dramatic improvements in a number of measures of performance (e.g., standing from a chair, unilateral standing and walking backward).
A Closer Look at Boxing Programs
Pia Abelardo, Senior Marketing Manager at ACE and an ACE Certified Health Coach, co-owns R3 Boxing in Poway, Calif., along with her husband, Brady Rein. In addition to offering a full slate of boxing classes for youth and adults, Rein leads Rock Steady Boxing (RSB) classes for individuals with PD. (Note that RSB is one of several PD-specific boxing programs available in the U.S. and around the world).
For Rein, who is a former professional boxer and has 18 years of boxing experience, adding RSB to his offerings was a way to use skills he already had to help people and serve his community.
Kari Merrill is an ACE Certified Group Fitness Instructor and the Group Fitness and Programming Director for Western Racquet and Fitness Club, in Green Bay, Wisc., where she oversees five studios and nearly 50 instructors. Like Rein, she jumped at the opportunity to add RSB classes to her club’s schedule and has been leading classes for the past five years.
Merrill explains that RSB allows its affiliate programs to design the class experience to suit the needs of their participants and community, so no two classes or programs are exactly alike. She teaches all-level classes, meaning that participants in a single session may range from those who are newly diagnosed to people who have been battling PD for years and use walkers, canes or gait belts. Each class is led by two certified instructors, who are supported by volunteers and often the participants’ caregivers.
Rein says that the RSB classes he teaches aren’t all that different from his youth and general population classes in terms of content and personalized intensity. The goal is to coach each participant as an individual so that they are seeing results, whatever that means for them.
Merrill agrees that the skeleton of her classes are is the same and features a circuit of stations, including heavy bags and speed bags. Her classes are designed to develop participants’ balance, core strength, flexibility, mobility and the ability to perform large and complex movement patterns.
Many adults, and those with PD in particular, live more sedentary lifestyles as they age. “As soon as you add exercise,” Rein explains, “Parkinson’s or not, your body is going to respond well. You’re not going to be as stiff. You’re not going to hurt so much in the morning.”
Some exercise is better than none, and steady-state exercise can yield benefits, but Rein says that it’s the high-intensity intervals that make boxing such a potent weapon in the fight to slow the progression of PD. There is a natural ebb and flow to boxing classes, with music pumping and people cheering one another on as they push themselves, then pull back and recover.
Rein points out that boxing also offers unique cognitive challenges, as participants must not only memorize complex punching combinations, but also think quickly when instructors call out cues and mix things up on the fly. These two tasks—memorization and quick mental processing—are important in the participants’ quest to maintain their independence and perform activities of daily living.
Merrill also includes things like handwriting, dexterity and voice-related tasks in her sessions (speech and swallowing issues are common in those with PD), along with games and brainteasers during the warm-up and recovery periods.
Abelardo, who assists in many of Rein’s classes and offers health coaching to club members, highlights perhaps the most vital element of these classes—the building of a community. There is a consistency and a camaraderie that develops in response to the enthusiasm that the participants bring each day. “They show up for each other,” she says.
Merrill agrees wholeheartedly and says the relationships and friendships she’s seen develop extend beyond the participants to include the caregivers and volunteers. “The biggest thing we see is the community,” she says. “Where else can you go and every person in the room understands what you’re going through? I think it’s so empowering.”
How You Can Get Involved
Both Rein and Merrill attended an affiliate training camp at RSB’s headquarters in Indianapolis, Ind., before launching their programs, though RSB offers the training at multiple locations. Holding an ACE Certification means you meet the prerequisites for serving as what they call a “head coach,” so if you’re interested in starting your own program or serving as a coach at an existing one RSB gym in your community, check out what RSB has to offer or explore other PD-specific boxing programs.
Before attending that training camp, Rein says, “You have to learn boxing. If you’re a personal trainer or group fitness instructor, go to a boxing gym and learn some boxing.”
Merrill agrees, but says her background was in “fitness boxing” and that was enough to get her started. Her participants begin their RSB experience by first working with an instructor to learnlearning proper technique on the heavy bag and speed bag, as well as proper execution of the various types of punches, and you, as an instructor, need to have those basic skills to keep your participants safe.
In addition, consider completing some continuing education or earning a specialization in working with people with PD. It’s vital that you understand the specific experience and symptoms of each of your participants, as each will move and react differently, not only in the boxing class but also in their daily lives.
“Classes like this give people hope,” Merrill says. So, if you’re looking for a way to use your skillset and your desire to help people meet their wellness goals, boxing classes for individuals with PD may be a great place to start.