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

Abstract

Background: Parkinson’s Disease (PD) is a highly prevalent neurodegenerative disease whose incidence is increasing with an aging population. One of the most serious manifestations of PD is gait instability, leading to falls and subsequent complications that can be debilitating, even fatal. Boxing therapy (BT) uses gait and balance exercises to improve ambulation in people with PD, though its efficacy has not yet been fully proven. Methods: In the current longitudinal observational study, 98 participants with idiopathic PD underwent twice-weekly BT sessions. Primary outcome was self-reported falls per month; secondary outcomes were quantitative and semi-quantitative gait and balance performance evaluations. Statistical methods included segmented generalized estimating equation with an independent correlation structure, binomial distribution, and log link. Results: The average number of self-reported falls per month per participant decreased by 87%, from 0.86 ± 3.58 prior to BT, to 0.11 ± 0.26 during BT. During the lockdown imposed by COVID-19, this increased to 0.26 ± 0.48 falls per month. Females and those > 65 years old reported the greatest increase in falls during the lockdown period. Post-lockdown resumption of BT resulted in another decline in falls, to 0.14 ± 0.33. Quantitative performance metrics, including standing from a seated position and standing on one leg, largely mirrored the pattern of falls pre-and post-lockdown. Conclusions: BT may be an effective option for many PD patients.

Boxing with and without Kicking Techniques for People with Parkinson’s Disease: An Explorative Pilot Randomized Controlled Trial

“…These results may be a reflection of the complex interplay between the many different factors that are related to balance control in PD, and we presume that balance interventions for PD will most likely need to take a multiple systems approach [25,[39][40][41]. Additionally, typically boxing trainings incorporate multimodal exercises including different agility, strength, and aerobic activities [17][18][19][20][21] that would challenge balance. Even the boxing drills, shadow boxing and speedbag drills will ultimately require dynamic weight shifting and balance tasks.…”

“…Boxing is one such popular and novel alternative training methods. Just as in other medical conditions (i.e., obesity [15] or stroke [16]), preliminary studies have demonstrated the some positive effects of boxing on balance, mobility, and quality of life in people with PD [17][18][19][20]. Another study showed that self-perceived QOL improvements were maintained throughout 20 weeks of non-contact group-based boxing training, despite lack of improvements in disease severity [21].…”

“…Recent research also shows that offering groupbased PD-specific boxing programs that are adaptable, varied, open to input, and that encouraging social support and networking may be beneficial to increasing motivation for exercise and physical activity in PD [24]. Boxing classes commonly consist of a warm-up, boxing specific exercise (boxing drills, shadow boxing, speedbag drills, jumping jacks, and strength exercises) and a cool down with stretching at the end [17][18][19][20][21]. Balance-demanding exercises (e.g., weight shifting, dynamic changes in balance, and postural adjustments) may induce synergistic effects for balance gains [9,25].…”