Research and Exercise for Parkinson’s disease:

Exercise is an important part of healthy living for everyone. Exercise is a vital component for people with Parkinson’s disease and can improve both motor and non-motor PD symptoms.

The Parkinson’s Foundation Parkinson’s Outcomes Project, the largest-ever clinical study of Parkinson’s disease, shows that people with Parkinson’s disease who start exercising earlier experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is an essential part of overall disease management and can delay the progression of the disease. With this proven knowledge, neurologists are now recommending exercise as part of most PD treatment plans.

Boxing as a Source of Vigorous Exercise:

Historically, exercise and physical therapy were viewed as “adjunctive” or “helpful”. Now, the body of evidence suggests vigorous exercise is very important in PD treatment. Inactivity is degenerative.

Recently, there has been a significant increase in research and clinical interest in using exercise as a treatment for mobility problems in people with Parkinson’s disease. The number of publications addressing exercise for PD has more than tripled in the last decade.

In one study, Goodwin and colleagues conducted a review of the literature related to exercise interventions and functional improvements in people with Parkinson’s.  Of the 14 studies reviewed, 5 demonstrated exercise-related improvements in balance, 4 showed exercise-related improvements in strength, and 4 showed a higher quality of life related to exercise. A 2017 review of literature suggested that the overall body of evidence supports the idea that vigorous exercise be accorded a central place in treatment of PD. Further, the review recommends that exercise be encouraged and emphasized as a potential strategy for a more favorable disease course.

Research Findings and Boxing:

Boxing is considered the most demanding sport, according to a study by ESPN. Unlike other programs, the LDBF Boxing Training Program incorporates elements of vigorous exercise, goal-based exercise, community-based exercise, and endurance-based exercise principles; each on its own effective in combatting PD. Combined they provide a powerhouse for Fighting Back Against Parkinson’s disease.
Traditional boxing training incorporates elements and moves that benefit PD specific symptoms:

  • Footwork
  • Balance
  • Agility
  • Movement in all planes of motion
  • Hand-eye coordination
  • Speech and voice projection (by grunting and yelling while punching)
  • Builds strength and lower body endurance
  • Improves flexibility, posture & breathing
  • Enhances cognition through attention, task switching, dual tasking, and short-term memory recall of boxing sequences
  • Promotes camaraderie
  • Promotes vigor and high intensity exercise for aerobic conditioning

Studies and Scholarly reviews of the scientific literature on exercise and PD.

  • “Boxing Training for Patients With Parkinson Disease: A Case Series,” Stephanie A. Combs, M. Dyer Diehl, William H. Staples, Lindsay Conn, Kendra Davis, Nicole Lewis, Katie Schaneman, Physical Therapy, Vol. 91-No. 1, pp 1-11, January 2011.
  • University of Indianapolis Provost’s Lecture Features Latest PT Research on Boxing Training and PD: new research by Stephanie Combs-Miller of the University of Indianapolis provides evidence that people with Parkinson’s disease who participate in boxing training maintain greater physical ability and quality of life than those who participate in other modes of exercise.
  • Peer reinforcement: Group based exercise programs provide an environment where participants and caregivers can network, gain enormous support, and shared information and experiences with other PwP’s. LDBF members consider our organization a “family” . The camaraderie shared by members, trainers and volunteers is a huge contributor to emotional healing.
  • Social, supportive and fun experience: Depression and anxiety are common in people with PD. It is estimated that more than 50% of PwP will suffer from depression and 40% with anxiety. The Parkinson’s Foundation Parkinson’s Outcomes Project found that together, mood, depression and anxiety have the greatest impact on health status in PwP, even more than motor impairments commonly associated with the disease.
  • Neurologists should prescribe participation in community-based exercise programs and physical therapy to their patients immediately after diagnosis and during every appointment thereafter.
  • Continuum of Care- encourages a working relationship between Neurologists, Physical Therapists and Fitness Professionals for the benefit of the PD patient. Physical Therapy should be recommended immediately after diagnosis to establish a baseline. The PT should then refer the patient to a community-based exercise program, such as the LDBF Boxing Program for Parkinson’s. The Fitness Professional then refers the patient back to the Neurologist or PT as needed.
  • 2018 Department of Neurology, Mayo Clinic: Aerobic Exercise: Evidence for a Direct Brain Effect to Slow Parkinson Disease Progression. DOI: https://doi.org/10.1016/j.mayocp.2017.12.015
  • “Does vigorous exercise have a neuroprotective effect in Parkinson disease?” Review of recent clinical trials published by The Mayo Clinic’s, American Academy of Neurology, J. Eric Ahlskog, PhD, MD, Neurology 2011, pp 288-294, June 2011.
  • “Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease,” Giselle M. Petzinger, Beth E Fisher, Sarah McEwen, Jeff A Beeler, John P Walsh, Michael W Jakowec, Lancet Neurol (2013).
  • Exercises that incorporate goal-based training and aerobic activity have the potential to improve both cognitive and automatic components of motor control in individuals with mild to moderate disease through experience-dependent neuroplasticity.
  • “Exercise and neuroplasticity in persons living with Parkinson’s disease,” Mark A. Hirsch, Ph. D and Becky G. Farley, Ph. D, European Journal of Physical and Rehabilitation Medicine, /Vol. 45-no. 2, pp. 215-228, (2009).
  • “The Cognition-Exercise Interaction in Parkinson’s Disease: A Perspective on Current Rehabilitative Approaches with Promise to Impact the Whole Disease Sequelae,” Nocera JR and Hackney ME, J Gerontol Geriatr Med 2015, 1: 003.
  • “Community-Based Exercise and Wellness Program for People Diagnosed with Parkinson Disease: Experiences From a 10-Month Trial,” Teresa Steffen, PT, PhD, Cheryl Petersen, PT, DHS, Leah Dvorak, PhD, J Geriatr Phys Ter (2012).
  • “Promoting exercise in Parkinson’s disease through community-based participatory research,” Mark A. Hirsch, Sanjay SIyer, Danielle Englert and Mohammed Sanjak, Neurodegener Dis Manag. (2011).
  • “Effects of a formal exercise program on Parkinson’s Disease – A pilot study using a delayed start design” Park, D. Zid, J. Russell, A Malone, A. Wehr, X. Li, Parkinson and Related Disorders (October 2013).
  • “Ohio State Study Shows Exercise Improves Depression In Parkinson’s Patients”.
  • “Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease,” Margaret Schenkman, PhD, PT, et al., JAMA Neurol. Published online December 11, 2017. doi:10.1001/jamaneurol.2017.3517.
  • Abstract: phase 2 randomized clinical trial of 128 participants established that 80% to 85% and 60% to 65% exercise intensities are safe and feasible. Furthermore, high-intensity treadmill exercise is non-futile; therefore, an efficacy trial is warranted for high- but not moderate-intensity exercise.
  • “Intensive Rehabilitation Treatment in Early Parkinson’s Disease: A Randomized Pilot Study With a 2-Year Follow-up,” Frazzitta et al., Neurorehabil Neural Repair. 2014 Jul 18.
  • Abstract: intensive exercise in the early stages of the disease might slow down the progression of motor decay, it might delay the need for increasing drug treatment, and thus, it might have a neuroprotective effect.
  • “The impact of high intensity physical training on motor and non-motor symptoms in patients with Parkinson’s disease (PIP): A preliminary study,” Morberg, Jensen, et al., Neuro Rehabilitation. 2014 Jan 1;35(2):291-8/
  • Abstract: a personal high intensity exercise program may favorably influence both motor and non-motor symptoms in patients with mild to moderate PD.
  • “Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients,” Ridgel , Angela L., Vitek, Jerrold L., Alberts, Jay L., Neurorehabilitation and Neural Repair, vol. 23-No. 6, pp 600-608, (2009).
  • “Parkinson’s Disease and Forced Exercise: A Preliminary Study,” Abu Qutubuddin, Timothy Reis, Raed Alramadhani, David X. Cifu, Alan Towne, and William Carne, Rehabil Res Pract. (2013).
  • Muhlack et al 2007, Muller and Mutlack 2010, Bergen et al of 2002, Uygur et al of 2015

The Parkinson’s Outcome Project: The National Parkinson Foundation’s (NPF) Parkinson’s Outcomes Project shows that people with Parkinson’s disease (PD) who start exercising earlier experience a significant slower decline in quality of life than those who start later.

Endurance exercises improve dopamine efficacy and motor performance post-exercise (60-150 minutes after training vs. resting). Results include: Improved reaction time, improved complex movement/ability to sequence tasks, Increased speed of movement and decreased disease severity.

Boxing as a Source of Goal-Based Exercise:

Goal based exercises aim to stimulate the development of repairs to areas with deficits. These repairs come from Neuroplasticity – the formation of new connections-promoting neuro-restoration through adaptation of compromised signaling pathways between nerve cells (neurons) in the brain. Continuous deficit targeted intensive exercise can grant neuroprotection and thereby, may slow the progression of the disease.

Goal based motor skill training engages cognitive circuitry important in motor learning.  This helps with learning by instruction and feedback (reinforcement) and encouragement to perform beyond self-perceived capacity. PWP’s become more cognitively engaged with the practice and learning of skills that were previously automatic and unconscious.

Boxing and The Role of Community Exercise:

Activities that engage older individuals and sustain interest are especially needed, as approximately 60% of Americans older than 65 do not achieve the recommended daily amount of physical activity. Activity levels in individuals with Parkinson’s disease are reduced even further.  In a study with 699 people with PD and 1959 controls, those with PD were found to be 29% less physically active.

Several studies have investigated the feasibility and safety of community-based exercise programs. A 2012 study looked at a 10-month community-based exercise program for people with PD and found that the group exercise program resulted in improved endurance with maintained walking speed and balance.  Another 16-month community-based exercise program investigated 3 exercise approaches: flexibility/balance/function exercises, supervised aerobic exercises, and home-based exercises. At 4 months, the balance program improved overall function. The aerobic program was superior for improving economy of walking.