For Cheryl Karian, a 72-year-old retired physician assistant, is boxing. Ms. Karian, whose Parkinson’s disease was diagnosed in 2020, doesn’t compete or spar, 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 worked a demanding job for patients at MD Anderson Cancer Center. This all changed in the years leading up to her diagnosis in 2020, as 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 class.
Along with two other class participants, Ms. Karian was shadowboxing, or punching in thin air, under the direction of the professional boxer Austin Trout, known as No Doubt Trout. It was part of a program called Rock Steady Boxing, which specializes in no-contact boxing training for Parkinson’s patients.
As Mr. Trout called out instructions – “One, two! One, two, slip! ” – Ms. Karian threw different punches, dodging and rolling her head, all the while maintaining a boxer’s wide-legged stance.
No-contact boxing training has grown more popular over the last decade or so, with 4,000 new gyms popping up before the pandemic hit and more than five million Americans strapping on gloves in 2020, even while the country loses interest in professional boxing. Boxing’s varied and high-intensity workouts offer a blend of strength and cardiovascular conditioning that improves agility, coordination and balance, and which may be especially beneficial for people with neurological disorders such as Parkinson’s disease.
Parkinson’s is a chronic deficiency in dopamine, which triggers increasing muscle stiffness, tremors, difficulty speaking, fatigue, dizziness and a loss of coordination and balance. Patients’ movements often get very slow and small. Falling is a big problem, especially as symptoms progress. And while there is no cure, or even a way to halt the symptoms, no-contact boxing training seems to offer a way to slow down the effects and improve patients’ confidence.
“If you train for boxing, you’ll see that your coordination is better, your agility is better, your balance is better,” said Mr. Trout, a former light middleweight world champion who has been teaching Rock Steady classes for four years. “This is a way to physically back up against Parkinson’s.”
A Counterintuitive Idea
Rock Steady Boxing was founded in 2006 by Scott Newman, a prosecutor in Marion County, Ind., Who discovered that boxing workouts helped him manage his symptoms of early-onset Parkinson’s disease. In the beginning, it was just him and five other patients training with a former professional boxer, Kristy Follmar.
The strangeness of boxing therapy was not lost on them – the sport has the highest rates of concussion and brain injury. While it’s not clear that a lifetime of concussions can cause Parkinson’s, it can increase the risk. Muhammad Ali, one of the sport’s most iconic figures, developed a condition after a professional career in which he famously wore out the hardest-hitting heavyweights of his time taking punch after punch.
In Rock Steady’s classes, participants don’t take punches; They only throw them. Ryan Cotton, chief scientific officer at 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 overexertion. The wide-legged stance of a boxer and the shifting center of gravity when throwing a punch seem perfect for training balance and posture.
“There was theory to work, but there was no scientific evidence,” Dr. Cotton said. “Really, science has caught up to us and now supports a lot of the things we were integrating.”
In the years since, research has shown that many forms of high-intensity exercise, and especially boxing, may slow down 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 programs in 17 countries, with coaches for training and certification programs like Mr. Trout, who wants to offer training for people with Parkinson’s disease with varying severity symptoms.
When Ms. Karian’s illness was diagnosed, she knew what her future could look like if she was proactive. She watched her mother, who also had Parkinson’s disease, for years as her quality of life declined. But she has found that boxing helps her balance, coordination and mental functioning. “I’m going to do as much as I can, for as long as I can,” Ms. Karian said
Around half of all Parkinson’s patients will fall in a given year, most of them more than once. Mr. Trout, like many boxing coaches, maintains a stable stance on his students while keeping his hands and their hands tucked in to protect the body and face.
“This is exceptional training for fall prevention,” said Ben Fung, a physical therapist based in San Diego who specializes in helping patients, including those with Parkinson’s, falling and has a background in mixed martial arts.
Many falls occur when a person is either reaching for something or changing direction or velocity. Learning a boxer’s stance can help maintain balance, while keeping the hands up can protect the body and face from injuries 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 people with Parkinson’s,” said Dr. Cotton, whose father was diagnosed with Parkinson’s disease a few years later, started working with Rock Steady. “Our boxers still fall, they’re just not paralyzed by fear.”
Less fear may mean fewer falls. “One of the biggest factors is whether or not someone is at risk for falling if they are frightening,” said Rebecca Martin, a professor of physical therapy at Hanover College. Dr. Martin is not affiliated with Rock Steady Boxing, but seeing his effectiveness has led him to incorporate boxing techniques into his work, which includes leading weekly exercise classes for people with Parkinson’s disease.
A recent study of boxing therapy found that Parkinson’s patients who underwent twice-weekly training reported falls, with the number falling off during Covid-19 lockdowns and going back down once the restrictions were lifted and they were able to resume training. This is something Mr. Trout saw firsthand, as many of his participants – or “fighters,” as he calls them – came back from lockdowns stiffer and shakier than before.
Outside the Ring
Parkinson’s disease also has psychological effects. As patients lose coordination and balance, many start to second-guess their abilities and pull into a shell, withdrawing from friends and family and limiting trips outside the home, because of falling fears.
“Parkinson’s takes away your confidence,” Ms. Karian said. “You have to work on keeping it up.”
In a recent survey of more than 1,700 people with Parkinson’s disease, nearly three-quarters of Rock Steady Boxing participants reported that the program improved their social lives, and more than half said it helped with fatigue, fear of falling, depression and anxiety.
“Parkinson’s disease is not just a condition that affects motor symptoms, such as how you move, walk and talk. Parkinson’s can also affect people’s moods, making them feel lonely or isolated, “said Danielle Larson, a neurologist at Northwestern University and one of the researchers to conduct 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 are often the only time they get out of the house each week. Kathy Smith, a retired schoolteacher, said she often felt self-conscious about her abilities in exercise classes. In Rock Steady Boxing, “they understand, and they help us adjust to our different abilities,” she said.
As Mr. Trout’s class reached its end, finishing with a round of core exercises, Ms. Karian and the others were quiet, focusing on doing as much as they could, while Mr. Trout encouraged them. Dealing with the effects of Parkinson’s can be overwhelming, he said, but “they get a fight back every time they come to my class.”