For some Parkinson's sufferers, boxing can be a therapy. Non-contact boxing is an excellent whole-body workout for anyone, but some experts say that people with neurological disorders may benefit most from it.
For Cheryl Karian, a 72-year-old retired medical assistant, boxing is medicine. Ms Karian, who was diagnosed with Parkinson's disease in 2020, does not compete or train, but every Tuesday and Thursday she trains for an hour at Main Street Boxing and Muay Thai in downtown Houston.
Before her diagnosis, Ms. Karian ran, played tennis and had a demanding job caring for patients at the MD Anderson Cancer Centre. Everything changed in the years leading up to her diagnosis in 2020, when she began experiencing cognitive difficulties and frequent falls. "I can't do what I used to do," Ms Karian said one day after a boxing lesson.
Together with two other class participants, Ms Karian was shadowboxing, or punching into thin air, under the direction of professional boxer Austin Trout, known as No Doubt Trout. He was part of a programme called Rock Steady Boxing, which specialises in non-contact boxing training for Parkinson's patients.
As Mr Trout shouted the instructions: 'One, two! One, two, slide! - Ms Karian threw several punches, dodging and turning her head, all while maintaining the wide-legged stance of a boxer.
Non-contact boxing training has become more popular over the past decade or so, with 4,000 new gyms popping up before the pandemic and more than five million Americans lacing up their gloves in 2020, even as the country loses interest in professional boxing. Boxing's varied, high-intensity workouts offer a blend of strength and cardiovascular conditioning that improves agility, coordination, and balance and can be particularly useful for people with neurological disorders such as Parkinson's disease.
Parkinson's disease is caused by a chronic dopamine deficiency, which results in increased muscle rigidity, tremors, slurred speech, fatigue, dizziness and loss of coordination and balance. Patients' movements often become very slow and small. Falling is a big problem, especially as the symptoms progress. And while there is no cure, or even a way to stop the symptoms, non-contact boxing training seems to offer a way to slow the effects and improve patients' confidence.
"If you train for boxing, you will see that your co-ordination is better, your agility is better, your balance is better," said Mr Trout, a former light middleweight world champion who taught Rock Steady classes for four years. "This is a way to physically fight Parkinson's."
A counterintuitive idea
Rock Steady Boxing was founded in 2006 by Scott Newman, a prosecutor from Marion County, Indiana, who discovered that boxing training helped him manage the symptoms of early-onset Parkinson's disease. Initially, it was just him and five other patients who trained with a former professional boxer, Kristy Follmar.
The strangeness of boxeterapy has not been lost on them: sport has among the highest rates of concussion and brain injury . Although it is unclear whether a lifetime of concussions can cause Parkinson's, it may increase the risk . Muhammad Ali, one of sport's most iconic figures, developed the condition after a professional career in which he famously wore down the toughest heavyweights of his time by taking punch after punch.
In Rock Steady classes, participants don't take punches; they just throw them. Ryan Cotton, the scientific director of Rock Steady Boxing, said that in the early days, Mr Newman and Ms Follmar were working on a hunch. At the time, Parkinson's experts recommended focusing on mobility and balance while avoiding over-exertion. The wide-legged stance of a boxer and the mobile centre of gravity when throwing a punch seemed perfect for training balance and posture.
"There was a theory that it should work, but there was no scientific evidence," Dr Cotton said. "Really, the science has caught up with us and now supports many of the things we were integrating."
In subsequent years, research has shown that many forms of high-intensity exercise, particularly boxing, can slow the progression of Parkinson's symptoms. Boxing also seems to help with other neurological disorders, such as multiple sclerosis and stroke.
Rock Steady has grown to over 850 affiliate programmes in 17 countries, with training and certification programmes for coaches like Mr. Trout, who want to offer specific training for people with Parkinson's disease with varying severity of symptoms.
When Mrs Karian's illness was diagnosed, she knew what her future would be like if she was not proactive. For years she watched her mother, who also had Parkinson's disease, as her quality of life deteriorated. But she found that boxing helped her balance, coordination and mental functioning. "I will do as much as I can, as long as I can," said Ms Karian
Finding the balance
About half of all Parkinson's patients will fall in a given year, most of them more than once. Mr. Trout, like many boxing coaches, teaches his students to maintain a stable stance by keeping their hands close to their faces and their arms tucked in to protect their bodies and faces.
"This is great training for fall prevention," said Ben Fung, a San Diego-based physiotherapist who specialises in helping patients, including those with Parkinson's disease, avoid falls and has a background in mixed martial arts.
Many falls happen when a person is reaching for something or changing direction or speed. Learning the stance of a boxer can help maintain balance, while keeping hands up can protect the body and face from injury in the event of a fall.
Participants practice falling as part of the Rock Steady curriculum. "Ending up on the floor is more common than not with people with Parkinson's," said Dr Cotton, whose father was diagnosed with Parkinson's a few years after he started working with Rock Steady. "Our boxers still fall, they're just not paralysed by fear."
Less fear can mean fewer falls. "One of the most important factors in determining whether someone is at risk of falling is whether they are afraid of falling," said Rebecca Martin, professor of physical therapy at Hanover College. Dr. Martin is not affiliated with Rock Steady Boxing, but seeing its effectiveness led her to incorporate boxing techniques into her work, which includes weekly exercise classes for people with Parkinson's disease.
A recent study on boxing therapy found that Parkinson's patients who underwent biweekly training reported fewer falls, with the number of falls increasing during Covid-19 blocks and decreasing once the restrictions were lifted and they were able to resume training. This is something Mr Trout has seen first-hand, as many of his participants - or 'fighters', as he calls them - returned from the blocks stiffer and shakier than before.
Outside the Ring
Parkinson's disease also has psychological effects. As patients lose their coordination and balance, many begin to evaluate their own abilities and close themselves into a shell, withdrawing from friends and family and limiting trips outside the home due to the fear of falling.
"Parkinson's takes away your confidence," Ms Karian said. "You have to work on it to continue."
In a recent survey of more than 1,700 people with Parkinson's disease, almost three quarters of the participants in Rock Steady Boxing reported that the programme had improved their social life and more than half said it had helped with fatigue, fear of falling, depression and anxiety.
"Parkinson's disease is not just a condition that affects motor symptoms, such as the way you move, walk and talk. Parkinson's disease can also affect people's mood, making them feel lonely or isolated," said Danielle Larson, a neurologist at Northwestern University and one of the researchers who conducted the survey. She is also not affiliated with Rock Steady, but said she now often recommends boxing to her patients.
For some of Mr Trout's fighters, boxing class is often the only time they leave the house each week. Kathy Smith, a retired teacher, said she often felt uncomfortable with her abilities during gym class. In Rock Steady Boxing, "they understand and help us adapt to our different abilities," she said.
When Mr. Trout's class came to an end, ending with a round of basic exercises, Ms. Karian and the others were silent, concentrating on doing as much as possible while Mr. Trout encouraged them. Dealing with the effects of Parkinson's can be overwhelming, he said, but "they have a chance to fight back every time they come to my class".
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