Therapeutic Boxing Exercise for Parkinson’s Disease
Parkinson’s disease is a progressive neurodegenerative disorder that impairs movement, coordination, and cognitive function over time. Physical therapy can help a patient with Parkinson’s disease combat movement dysfunction and impaired balance and coordination in a fun and effective way using therapeutic boxing within a comprehensive treatment program. Therapeutic boxing requires full-body movement, combining upper-body punching sequences with lower-body footwork to build strength, counter muscle rigidity, and improve hand-eye coordination, balance, posture, and agility.
How Parkinson’s Disease Affects the Body
Parkinson’s disease is a progressive neurodegenerative disorder that occurs when the neurons that produce the neurotransmitter dopamine become impaired. This impairs movement, coordination, and cognitive function over time. In the United States, nearly 60,000 individuals a year are diagnosed with Parkinson’s disease and nearly one million people in the U.S. are living with Parkinson’s disease (PD). While it occurs in both men and women, it affects 50% more men than women. The disease often first develops around age 60; however, 5 to 10% of people can develop early onset of the disease at age 50.
Symptoms develop gradually and can worsen over time. Normally, symptoms develop on one side of the body or even in one limb on one side of the body and spread to the rest of the body over time. Disease progression varies from person to person.
The most common symptoms of Parkinson’s include tremors in the hands, arms, legs, jaw, or head, slow movement, limb stiffness, and impaired balance and coordination. Parkinson’s patients may also experience difficulty swallowing or speaking, depression, urinary issues and constipation, a softer and lower voice, decreased facial expression, sleep disruptions, and restless legs. Parkinson’s patients have a distinctive gait: a tendency to lean forward, making small quick shuffling steps and reduced swinging of the arms.
Therapeutic Boxing Exercise & Physical Therapy
Physical therapy can help a patient with Parkinson’s disease combat movement dysfunction and impaired balance and coordination in a fun and effective way using therapeutic boxing within a comprehensive treatment program. The Parkinson’s physical therapy treatment program can include cueing strategies to improve gait and cognitive movement strategies to improve transfer performance like getting up from a chair.
The physical therapist also breaks down complex automated movements into a series of sub-movements executed in a fixed order to help the patient perform the movement consciously, bypassing the internal control dysfunction that can occur with the disease. An important aspect of physical therapy is a customized exercise program involving balance training, aerobic conditioning, strength training, and therapeutic boxing.
Therapeutic boxing requires full-body movement, combining upper-body punching sequences with lower-body footwork to build strength, counter muscle rigidity, and improve hand-eye coordination, balance, posture, and agility. The physical therapist first works with the Parkinson’s patient to master a set position and boxing stance, establishing basic balance and holding a specific posture. Then, boxing footwork is incorporated involving forward, side, and backward steps made with increasing speed, based on the set position. Lastly, the therapist teaches the patient a series of punches against focus mitts that the therapist wears, timed to maximize force based on balance, posture, and footwork. Using the focus mitts as targets, the therapist calls out various instructions to hit the focus mitts in a certain sequence using a number system (right cross, left hook). Translating the numbers called out to punches stimulates cognitive processing while demanding balance, strength, coordination, and agility and forcing patients to box using their strong and weak sides.
Mangiarelli Rehabilitation physical therapist Bobby demonstrates therapeutic boxing in action with a Parkinson’s patient:
Mangiarelli Rehabilitation physical therapist Bobby engages in therapeutic boxing with a Parkinson’s patient. [The physical therapy patient provided written consent to participate in the video and permission to share the video.]
Therapeutic boxing addresses symptoms of tremors, postural rigidity and instability, balance issues, and gait mobility by encouraging agility of movement in multiple directions, coordination of movement at faster speeds, and flexibility of the spine. Since therapeutic boxing was first pioneered in 2006 at Rock Steady Boxing, a number of studies have been conducted to assess the effectiveness of therapeutic boxing in addressing Parkinson’s disease symptoms and patient quality of life.
A two-year study compared 39 Rock Steady boxers with 26 other exercisers, all of whom have Parkinson’s disease. After one year, while all participants benefited from the exercise, the boxers demonstrated significant improvements in walking speed and no progression of symptoms. Another study of Rock Steady Boxers showed improvements in balance, gait, disability, and quality of life in the majority of patients at 12 weeks and all patients made improvements at the 24-week and 26-week mark.
A recent 2021 study noted that therapeutic boxing can improve gait stability and reduce the risk of falls in patients with Parkinson’s disease. Falling risk is heightened in Parkinson’s patients due to impairments in balance and gait stability. In the study, 98 patients worked with a trainer twice a week to perform boxing therapy exercises to improve gait, coordination, and balance. Due to the 2020 pandemic lockdowns, patient training was stopped for an average of 3 months and then resumed, providing researchers an opportunity to assess the effect of training and cessation of training on fall risk.
Prior to the lockdown, the average number of self-reported falls per month per participant decreased by 87% while engaging in boxing. From the beginning of the lockdown to the resumption of boxing therapy, the relative risk of falling increased by 51% each month. Once boxing therapy was resumed after the lockdown, the risk of falling decreased by 20% each month and reached nearly the same level of reduction in falls as before the lockdown.
Therapeutic boxing under the supervision of a physical therapist can be an effective way to address symptoms of Parkinson’s disease and improve the mobility, coordination, and independence of Parkinson’s patients. Managing Parkinson’s disease is a marathon, and our physical therapists are here to accompany you as you navigate the condition to maximize your quality of life. Give us a call to start punching out Parkinson’s at Mangiarelli Rehabilitation!
