Boxing for Parkinson's Disease: Has Implementation Accelerated Beyond Current Evidence?

Abstract

Background: Exercise and physical activity are argued to promote neural plasticity in Parkinson's disease (PD), with potential to slow disease progression. Boxing for PD is rapidly growing in popularity.Objectives: (i) To evaluate evidence on benefits and risks of boxing exercises for people living with PD and (ii) to appraise websites for evidence of global implementation of this intervention.Data Sources: We searched AMED, CINAHL, Cochrane, EMBASE, EMCARE, Health and Medical Collection via ProQuest, MEDLINE, and PEDro electronic databases for the research literature. Websites were also searched for evidence of successful implementation of boxing for PD.Study Selection: Published research and websites were considered if they reported data on adults with PD and boxing as an intervention.Data Extraction: For the literature review, two reviewers independently extracted data on study characteristics and intervention content. Risk of bias was assessed with the PEDro scale and Joanna Briggs Checklist. We conducted a quality appraisal of websites using the QUality Evaluation Scoring Tool (QUEST).Data Synthesis: Two studies, with a total of 37 participants, met the review eligibility criteria for the literature review. Risk of bias was low in these trials. Balance confidence, mobility, and quality of life were reported to improve with community-based boxing training programs delivered in 24–36 sessions over 12 weeks. PD medications were not always documented and some elements of the boxing interventions were incompletely reported against the CERT (Consensus on Exercise Reporting Template). Nine websites advocating boxing programs for PD were also evaluated. The QUEST analysis showed low-level quality, and little scientific evidence verifying findings, despite positive reports.Limitations: In the published literature, findings were limited due to the small number of included studies and participants. Websites were numerous yet often lacked verifiable data.Conclusions: Despite the recent growth in the popularity of boxing for PD and some positive findings, there is limited evidence of efficacy. Risks and disease-specific modifications have not been reported. Safety guidelines and health professional training are key considerations for implementation.

KICK OUT PD: Feasibility and quality of life in the pilot karate intervention to change kinematic outcomes in Parkinson’s Disease

“…The number of participants excluded based on lack of interest may indicate the barriers faced by many with incorporating new exercise routines, or simply that karate may only interest a select few, Yet as of 2018, there were over 75,000 martial arts studios throughout the US, though we are unaware of many offering PD-specific classes beyond our pilot study [ 39 ]. We suspect that—similar to the growing implementation of boxing programs for individuals with PD across the globe—the provision of PD-specific instructor training and adapted class curricula could promote dissemination into communities, overcoming the logistical barriers encountered herein [ 40 ].…”

Enablers to Exercise Participation in Progressive Supranuclear Palsy: Health Professional Perspectives

“…This was particularly challenging for PSP due to the paucity of research and the absence of clinical guidelines for this progressive neurological condition. In the absence for this evidence-based resource, nurses, and allied health professionals often turn to the European Clinical Guidelines for Parkinson's Disease to help inform therapy content, dosage, and mode of delivery ( 9 , 10 , 20 , 27 ). There is an urgent need for global clinical guidelines for exercise and physical activity in PSP.…”

“…There is an urgent need for global clinical guidelines for exercise and physical activity in PSP. This needs to address the relative contributions of gait training ( 13 ), falls education ( 12 , 28 ), balance exercises ( 29 ), progressive resistance strength training ( 12 ), strategies to improve motor skills ( 30 ), and structured physical activities, such as dancing ( 15 ), aquatic therapy ( 31 ), cycling ( 16 ), boxing ( 27 ), virtual reality exercises ( 32 ), and online home exercises ( 33 , 34 ).…”

Longitudinal Study of Boxing Therapy in Parkinson’s Disease, Including Adverse Impacts of the COVID-19 Lockdown

“…Much of what has been published is qualitative in nature, describing overall satisfaction with BT programs by PD participants [ 3 , 4 ]. However, empiric data supporting BT in PD, especially its ability to reduce the risk of falls, is scarce [ 5 ]. Studies that do contain specific, rigorous, quantitative data on BT were based on cohorts of ~ 30 participants or less [ 6 , 7 ].…”