Boxing for Parkinson’s Disease is a Life Changer

boxingmanWhile there are great anecdotal reports and TV stories about boxing programs for Parkinson’s Disease,particularly Rock Steady Boxing, I thought it would be interesting to learn whether or not these results have been quantitatively measured. Stephanie Combs-Miller, a professor at the University of Indianapolis Krannert School of Physical Therapy and director of research for the University’s College of Health Sciences, has been studying the effectiveness of boxing programs for Parkinson’s Disease for 9 years.

In 2011, her team published a study in the Journal of the American Physical Therapy Association titled “Boxing Training for Patients With Parkinson Disease: A Case Series” (available on-line at http://ptjournal.apta.org/content/91/1/132). It was a very limited study with six patients with idiopathic PD attending 24 to 36 boxing training sessions for 12 weeks, with the option of continuing the training for an additional 24 weeks. Very specific motor tests were assessed at regular intervals:

The outcome measures were the Functional Reach Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Timed “Up & Go” Test, Six-Minute Walk Test, gait speed, cadence, stride length, step width, activities of daily living and motor examination subscales of the Unified Parkinson Disease Rating Scale, and Parkinson Disease Quality of Life Scale.

I’d encourage reading the report for more details on these criteria. Key observations:

All 6 patients in this case series showed improvements on at least 5 of the 12 outcome measures over the baseline at the 12-week test. Except for patient 6, all patients showed improvements in every outcome category, including balance, gait, disability, and quality of life.

Interestingly, patients with mild PD showed improvements earlier than patients with moderate to severe PD, particularly in the gait-related outcome measures. … These early differences may have been due to the ability of patients with mild PD to tolerate and complete more repetitions during the circuit training regimen. … However, patients with moderate to severe PD did eventually show improvements in most outcome measures, suggesting that they required a longer training duration to acquire the necessary training capacity.

Another key observation of this case series was that all patients continued to make improvements in balance, gait, and quality of life… The majority of changes that achieved and surpassed the established MDC values were seen at the 36-week test, indicating that long-term training may be necessary to attain maximal gains.

Patient 6 attended only 3 boxing sessions after the initial 12 weeks of the case series but maintained or improved scores on most outcome measures at the 24-week test, indicating a sustained benefit of the boxing training program. However, at the 36-week test, patient 6 showed a decline in scores on 5 outcome measures, perhaps because he was no longer attending boxing sessions. (He cited travel distance, conflict with work schedule, and lack of interest in boxing as the reasons.) The 5 patients who continued to attend boxing sessions during the course of the case series showed persistent long-term benefits, lending support for their continued use of the boxing training program.

I feel sorry for Patient 6…Exercise may be the best medicine, but it requires a lot more effort than taking a pill.

In 2013, Professor Combs-Miller led a study comparing group boxing training to traditional group exercise on function and quality of life in persons with Parkinson disease (PD). The study period was limited to 12 weeks, which is interesting considering the first study showed that patients with moderate to severe PD required a longer training period. Results showed both groups improving with traditional exercise leading to better confidence in balance, and the boxing group showing more improvement in walking function (speed and endurance). An abstract of the study is available at http://www.ncbi.nlm.nih.gov/m/pubmed/23422464/.

Professor Combs-Miller has been promising a larger study with more patients over a longer period of time. Hopefully that study will be published soon. According to a recent interview of her by ESPN, this study followed 88 patients for 2 years:

Over two years, the professor and her team checked in with 88 Parkinson’s patients, half Rock Steady fighters and half who participated in other exercises, like walking or traditional calisthenics. Every six months, she checked in with them on function, walking speed, endurance, balance, strength, flexibility and overall quality of life. Not only weren’t the boxers getting worse — they were typically showing improvement. Walking faster, exhibiting sounder balance, and most importantly, reporting a higher quality of life. “The boxers were maintaining a higher level of function than those who didn’t box,” says Combs-Miller, “which is amazing.”

Combs-Miller has done numerous studies, and she says a paper documenting her findings is set to be published soon. But she can’t yet explain the correlation. She says it could be the boxing exercises, which are multimodal, simultaneously testing strength, endurance, balance and coordination. Or it could simply be the high-intensity interval training.

Or maybe it’s something else, something more intangible. One thing that popped up during Combs-Miller’s research was the fact that more than any other patients, Rock Steady boxers showed up on a consistent basis.

The full ESPN article is worth reading at http://espn.go.com/espnw/culture/feature/article/15416797/rock-steady-boxing-program-brings-empowerment-parkinson-patients. Hopefully, the study will be published soon.

It is interesting that the study does not appear to explore why it works, although that is probably not as important as showing that it does work. The possible reasons that she suggests are very good theories.

More info from Professor Combs-Miller:

https://news.uindy.edu/2015/02/24/provosts-lecture-to-feature-latest-pt-research/

In 2015, she presented some of these findings at the 2015 Combined Sections Meeting (CSM) of the American Physical Therapy Association. Slides from that presentation “Knocking out Parkinson’s: A Collaborative Community-Based Partnership” are available at: http://www.neuropt.org/docs/default-source/csm-2015-handouts/knocking-out-parkinson-s-a-collaborative-community-based-partnership.pdf

While we wait for the official study results, the anecdotal results are in…these Parkinson’s Boxing programs require a lot of effort from the participants, but at worst, they are delaying the progression of the disease…at best, participants are regaining lost strength and capabilities.

If you haven’t seen it, the CBS News report from Lesley Stahl, about a Parkinson’s boxing program attended by her husband is one of many great anecdotal stories about these programs: http://www.cbsnews.com/news/fighting-back-against-parkinsons-in-the-ring/

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