The Use of Boxing Training as an intervention for Parkinson’s Disease

The Use of Boxing Training as an Intervention for Parkinson’s Disease

By, M. Julianne Runey, SPT

 

Background

Over the past three years, while being in the physical therapy program at UNC-Chapel Hill, I have seen multiple patients with Parkinson’s Disease (PD). During my neurological rotation at Carol Woods, I was able to get to know some amazing residents who had been diagnosed with this progressive and chronic disease. A question that continuously came up while treating these residents was directed towards the most appropriate use of therapy time to address the deficits that presented in each patient. As I researched appropriate treatment interventions for Parkinson’s Disease I also became friends with a fellow graduate student in the Clinical Rehabilitation and Mental Health Counseling program. This friend leads support group meetings for individuals in the community with PD as well as began a Rock Steady Boxing Program based out of a boxing gym in Cary, NC. As we got to know each other better, it became clear that this avenue of treatment for PD was an interest to me. I began going to Rock Steady Boxing Classes and assisting in teaching the classes to participants. I became comfortable with the moves and gained a better understanding of the principles behind the intervention leading me to the desire to implement boxing training in a clinical setting. I began working with my previous Clinical Instructor and another physical therapist at Carol Woods to implement the boxing training intervention as a treatment for Parkinson’s Disease.

As I researched the use of boxing training as an appropriate intervention for Parkinson’s Disease, I discovered there is very limited evidence available regarding the implementation of specifically boxing training to treat PD. I created an Evidence Based Table to look into the effectiveness of boxing training as an intervention for PD. Many studies have incorporated boxing training into agility exercises and can be used as guidelines for future interventions. The main component for treating PD is to treat the symptoms of the disease that present in the given patient. Boxing training has been found to be an appropriate intervention to treat the common symptoms of PD. The intervention should be performed at an appropriate intensity to result in an increase in the production of dopamine which diminishes the severity of the debilitating symptoms of the disease. The patients who have participated in boxing training have reported improvements in flexibility, upright posture, and overall well-being following the intervention. I have continued to use the boxing training intervention on my last clinical as well as investigating other high-intensity agility interventions to treat Parkinson’s Disease. The aim of the project is to provide future students of the UNC DPT program with evidence regarding the use of a nontraditional intervention to decrease the severity of the commonly seen symptoms of Parkinson’s Disease.

 

Overview

Boxing training is a nontraditional agility exercise intervention that can be used to treat the commonly seen motor symptoms of Parkinson’s Disease.^1,2 Boxing training has been used in combination with other nontraditional agility programs to improve the mobility of those with PD.³ Boxing training incorporates many of the principles of the famous Dr. Farley’s LSVT BIG platform which directs interventions to consists of large amplitude movements requiring the use of the patients entire body.⁴ The use of large amplitude movements leads to increased speed of movements which directly influence one of the most commonly seen symptoms of PD, bradykinesia.⁴

The Rock Steady Boxing program has more recently entered the spot light as an option for those with PD. In 2006, Scott Newman a prosecutor who had recently diagnosed with PD started Rock Steady to help individuals of all stages of PD improve their level of function and overall quality of life.⁵  Many individuals with PD are interested in nontraditional forms of exercise to keep moving and treat the common impairments of PD. Boxing training is a great option for individuals to stay active, improve balance, and continue to be mobile and functional for ADLs.

Project Products

Presentation: Boxing Training and PD powerpoint.pdf

Videos for Powerpoint:

• Dual Task Youtube video⁶:–https://www.youtube.com/watch?v=oUpNZfkuQ6k
• Video of movements⁷: https://www.youtube.com/watch?v=0nT82XjeFiQ
• M.I.: Initial Movements: https://youtu.be/6v6Zg2Iyv9E
• M.I.: Crossing Midline: https://youtu.be/Dj4kQ1PYJFI
• M.I: Combination Directions: https://youtu.be/gdAhAFJDQco
• M.I: Combos, Crossing Midline, and Dual Task: https://youtu.be/ZS9gidLgqvA

Evidence Table: Boxing Training and PD Evidence Table

Handout: Boxing Training and PD. handout

Evaluation: Pre-/Post testing for clinicians 

Evaluation & Self-Assessment

After completing my presentation, several of my classmates reviewed and assessed the language and content of my materials to determine if these were appropriate. Also, feedback was received from clinicians at Carol Woods and professors from UNC- Chapel Hill. Edits were made to all materials based on the feedback provided. The research and findings have been further implemented at Bodies in Balance in Wilmington, NC during my final rotation. The research and foundation behind boxing training have been implemented into treatments and has been carried over into the development of a community-based group exercise class for Parkinson patients which will begin in August 2017.

Limited evidence is available regarding the direct influence of boxing training, as a whole, on PD. The components of this nontraditional exercise intervention are appropriate for addressing the common motor symptoms of this progressive disease. Finding adequate and reliable evidence for this topic and intervention alone was a limitation to this presentation and research. Further research is being conducted on this topic but has not been published yet, leaving room for uncertainties and questions unanswered at this time. The use of high effort and high-intensity agility exercises is well supported. The limited amount of research and the strength of the studies created a barrier for my ability to explore the topic more in depth.

While researching this topic, I was able to significantly improve my efficiency and ability to search through databases and determine if evidence was appropriate to this very specific topic. I was also able to further improve my relationship with fellow clinicians of the community and my intervention pool for treating Parkinson Disease. I have gained a better understanding of the disease and intervention designs that will benefit this population as well as developed a strong interest in helping these patients in the clinic and in the community. My capstone has lead me to play an active role in starting a community-based exercise program for PD patients with boxing training being one of the key components to these classes.

Acknowledgements

First,  I would like to thank the clinicians at Carol Woods who have supported and helped me throughout my rotation and capstone project. I especially want to thank Ann Chamberlin, PT and Charlotte Pearce, PT who provided me with guidance and the opportunity to help assist with patients and were willing to use boxing training as a treatment for some of their patients. I would not have been able to complete this without these two amazing therapists. Also, I would like to thank Dr. Vicki Mercer PT, PhD and Dr. Prudence Plummer PT, PhD for their constant support and feedback throughout my time at UNC-Chapel Hill and along my Capstone journey. They have spent countless hours helping teach students how to properly and efficiently use databases to extract relevant and reliable evidence along with both being active contributors to the research regarding the neurological community. Lastly, I would like to thank my fellow classmates and family for their support, guidance, and feedback they have given me along this journey. I would not be where I am today with each and every one of you.

References

1. Rocha P, McClelland J, Morris M. Complementary Physical Therapies for Movement Disorders in Parkinson’s Disease: a systematic review. 2015;51(6):693-704.
2. Combs SA, Diehl MD, Staples WH, et al. Boxing Training for Patients With Parkinson Disease : A Case Series. 2011;91(1).
3. King LA, Horak FB. Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program. Phys Ther. 2009;89(4):384-393. doi:10.2522/ptj.20080214.
4. Farley BG, Koshland GF. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp brain Res. 2005;167(3):462-467. doi:10.1007/s00221-005-0179-7.
5. Rock Steady Boxing. https://www.rocksteadyboxing.org/.
6. Sterling K. Parkinson’s Disease: cognitive training for better dual tasking. https://www.youtube.com/watch?v=oUpNZfkuQ6k %0D. Published 2017. Accessed April 29, 2017.
7. WNYBJJKICKBOXING. Jab, Cross, Hook, Cross Combo. https://www.youtube.com/watch?v=0nT82XjeFiQ%0D. Published 2010. Accessed April 28, 2017.