New research provides evidence that a high-intensity boxing program is a safe and feasible intervention for those with Parkinson’s disease (PD). The study, which was published in PM&R, suggests that further evaluation is needed to determine the therapeutic effects of the program, particularly on disease progression outcomes.
“I have PD myself, and have been aware that exercise is the most promising intervention to hopefully slow progression of the symptoms,” said lead author David Blacker, the medical director of the Perron Institute in Perth. “The evidence supporting this is steadily growing, although we need to learn more.”
“I oversee a clinic program that sees more than 3,000 neurological patients per year, and at any given time is undertaking up to 15 clinical trials. My main focus has been on stroke treatment and research; I am retiring from clinical practice very soon, to focus on a stroke trial of a neuroprotective drug developed by the scientists at Perron, and now backed by a Perth-based small biotech company, Argenica Therapeutics. Along with that, I hope to expand the boxing training for PD program described below and research it further.”
The boxing training program came about when a mutual friend connected the CEO of Perron with Rai Fazio, a former Golden Gloves Boxing Champion and fitness trainer. Rai had invented boxing training devices and had encountered a physiotherapist, Josefa Domingos, who was using the device as a training tool for people with PD. Rai wanted to provide more formal training and approached Blacker for collaboration.
“Rai was introduced to me at the Perron Institute at the end of 2019, and he demonstrated his training techniques, which I immediately could see had the potential to benefit people with PD; not only because of the high intensity workout it provides, but also, the specific postures and movements for boxing are almost the exact opposite to the problems those with PD have,” Blacker told PsyPost.
“So Rai put me through a 12 week program around the start of COVID and I could feel myself moving much more freely, and quite often, after a vigorous session I almost felt like PD wasn’t there. We made some minor adjustments to the program to maximize benefits for PD, and reduce some risks.”
“Then we had an exercise physiologist, Travis Cruickshank, from Edith Cowan University join us to help create a sports medicine based training program, and also quantify the exercise with formal measures; I had previously worked with Travis, and he was familiar with Domingos’ earlier work, so it was quite a ‘coming together’ of forces.”
The researchers conducted a 15-week feasibility study with participants with idiopathic PD. The study design was a single-arm, open-label design, where participants underwent a periodized boxing training program.
The study had a low recruitment rate of 12%, which means that only a small percentage of eligible participants agreed to participate. This lower recruitment rate could be attributed to the study being conducted during the COVID-19 pandemic when public health measures restricted recruitment efforts. Although the recruitment rate was low, it still enabled the inclusion of ten participants to examine the feasibility of the program.
The intervention was delivered three times per week by a professional boxing coach using the FIGHTMASTER boxing unit device. The devices are “essentially sturdy metal stands with a series of padded targets to aim punches at.” The program consisted of three training blocks: boxers’ development, boxers’ cardio, and boxers’ brain, each focusing on different aspects of training.
During the program, participants completed rounds lasting two to three minutes. In these rounds, they had to strike the different pads on the boxing unit in various sequences. After each round, there was a maximum of two minutes of rest before the next round began. The program aimed to provide a combination of physical and cognitive challenges to the participants.
“We used heart rate monitors throughout the intervention so we could see the cardiovascular load on our participants, we used scales that measured their perceived levels of exertion from both a physical and cognitive standpoint,” Cruickshank explained in a news release.
The intervention was found to be feasible, with good adherence to the prescribed training sessions. The adherence rate was 96.7%, meaning that participants followed the program as instructed, and the retention rate was 100%, indicating that all participants completed the study. Compliance to training targets was achieved, as measured by heart rate and ratings of perceived exertion.
“This was a very vigorous training program, and I had fully expected that in the middle section where we were ramping up the workload that we would have to ‘ease off’; but they just kept going, an were fitter and fitter,” Blacker said.
Safety measures showed no significant adverse events, and participants reported improved fatigue and sleep health. “I had also thought we might have seen some worsening fatigue scales, and perhaps some issues with disturbed sleep (two of the three sessions were in the late afternoon), but this was not the case; in fact measures of fatigue and sleep improved,” Blacker said.
The treatment effects were assessed using the Unified Parkinson’s Disease Rating Scale Part III, and the results showed a trend towards improvement. However, these improvements were not statistically significant, likely due to the small sample size of the study.
“The key finding was that the participants were able to complete a high intensity program with no major injuries, excellent compliance, and it was possible to make continual heart rate recordings and measures of exertion during training,” Blacker told PsyPost. “The subjects were carefully selected, all underwent cardiac stress testing as a requirement before enrollment, and had very close supervision by experts during the training. This may be a factor in the lack of injuries.”
The study identified some barriers and motivators related to boxing training for individuals with PD. Barriers included factors such as travel distance, accessibility of toilets, and floor firmness. On the other hand, motivators for participants included the camaraderie and positive relationships formed with fellow participants.
“The camaraderie developed by the group appeared to be another surprising factor; that seemed to add to the physical benefits,” Blacker said.
The study has several limitations. It did not examine participants’ exercise history and measures of fitness and strength before the study, which could have influenced their ability to adhere to the prescribed physical intensity. The study only included individuals with early-stage PD and involved close supervision of training. Therefore, the findings may not be generalizable to individuals with more advanced stages of PD or applicable in community settings where close supervision is not feasible.
Further research, such as additional phase II clinical trials, is needed to determine the effects of boxing training on UPDRS values and to explore its applicability in individuals with more advanced stages of PD or in community settings.
“It should be noted that this was a feasibility and safety study that was not designed to make comparisons with a control group,” Blacker explained. “It provides plenty of data and guidance upon which the design of future, higher phase efficacy studies can be based. It also shows that this protocol can be performed safely with the above mentioned caveats.”
The study, “FIGHT-PD: A feasibility study of periodised boxing training for Parkinson disease“, was authored by David J. Blacker, Raimondo Fazio, Claire Tucak, Phillip Beranek, Connor Pollard, Tegan Shelley, Sanathraj Rajandran, Georgina Holbeche, Mitchell Turner, and Travis Cruickshank.
