For Cheryl Karian, a 72-year-old retired physician assistant, boxing is medicine. Ms. Karian, who was diagnosed with Parkinson’s disease in 2020, does not compete or spar, but trains for an hour every Tuesday and Thursday 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 MD Anderson Cancer Center. This all changed in the years leading up to her diagnosis in 2020, when she began to have cognitive problems and frequent falls. “I can no longer do what I used to do,” said Mrs. Karian one day after a boxing lesson.
Along with two other participants in the class, Ms. Karian was shadow boxing, or punching in the air, led by professional boxer Austin Trout, known as No Doubt Trout. It was part of a program called Rock Steady Boxing, which specializes in non-contact boxing training for Parkinson’s patients.
As Mr. Trout shouted instructions, “One, two! One, two, slip!” – Ms. Karian threw several punches, dodging and rolling her head, while maintaining a boxer’s straddling stance.
Non-contact boxing training has become increasingly popular over the past decade, with 4,000 new gyms emerge before the pandemic hit and more than five million Americans put on gloves in 2020, even though the country is loses interest in professional boxing. Boxing’s varied and intense workouts provide a blend of strength and cardiovascular fitness that improves agility, coordination and balanceand which may be especially beneficial for people with neurological conditions such as Parkinson’s disease.
Parkinson’s is caused by a chronic deficiency of dopamine, leading to increasing muscle stiffness, tremors, difficulty speaking, fatigue, dizziness, and loss of coordination and balance. Patients’ movements often become very slow and small. Falling is a big problem, especially as symptoms increase. And while there’s no cure, or even a way to stop the symptoms, contactless boxing training seems to offer a way to slow the effects and improve patient confidence.
“If you train for boxing, you will 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 for four years. “This is a way to physically fight back against Parkinson’s.”
A counter-intuitive idea
Rock Steady Boxing was founded in 2006 by Scott Newman, a district attorney in Marion County, Ind., who found that boxing workouts helped him manage his symptoms of early Parkinson’s disease. At first, it was just he and five other patients who trained with a former professional boxer, Kristy Follmar.
The strangeness of boxing therapy had not escaped them – the sport has one of the highest rates of concussion and brain damage. While it’s not clear that a lifetime of concussion can cause Parkinson’s, it can increase the risk. Muhammad Ali, one of the sport’s most iconic figures, developed the condition after a professional career in which he famously carried the heaviest hitting heavyweights of his time taking punch after punch.
In Rock Steady’s classes, participants don’t take punches; they just throw them. Ryan Cotton, Rock Steady Boxing’s scientific director, said that in the early days, Mr. Newman and Ms. Follmar were working on a conjecture. At the time, Parkinson’s experts advised focusing on mobility and balance while avoiding overexertion. A boxer’s wide-legged stance and shifting center of gravity when delivering a punch seemed perfect for training balance and posture.
“There was a theory that this should work, but there was no scientific evidence,” said Dr. cotton. “Really, science has caught up with us and now supports a lot of the things we integrated.”
Research in the following years has shown that many forms of high intensity exerciseand boxing in particular, can slow down the progression of Parkinson’s symptoms. Boxing also seems to help with other neurological conditions, such as: multiple sclerosis and stroke.
Rock Steady has grown to more than 850 partner programs in 17 countries, with training and certification programs for coaches such as Mr. Trout, who want to offer training specifically to people with Parkinson’s disease with varying severity of symptoms.
When Ms. Karian’s illness was diagnosed, she knew what her future would look like if she wasn’t proactive. For years she watched her mother, who also had Parkinson’s disease, as her quality of life deteriorated. But she has found that boxing helps her balance, coordination and mental functioning. “I’m going to do as much as I can, as long as I can,” said Ms. Karian
find balance
About half of all Parkinson’s patients fall in any given year, most more than once. mr. Trout, like many boxing coaches, trains his students to maintain a stable posture while keeping their hands near their faces and their arms tucked away to protect the body and face.
“This is exceptional fall prevention training,” said Ben Fung, a physiotherapist based in San Diego who specializes in helping patients, including those with Parkinson’s, to prevent falls and has a background in mixed martial arts.
Many falls happen when a person reaches for something or changes direction or speed. Learning a boxer’s stance can help maintain balance, while elevating the hands can protect the body and face from injury in a fall.
Participants practice falling as part of the Rock Steady curriculum. “Ending on the floor is more common in people with Parkinson’s,” says Dr. Cotton, whose father was diagnosed with Parkinson’s disease a few years after he started working with Rock Steady. “Our boxers are still falling, they’re just not paralyzed by fear.”
Less fear can mean less falls. “One of the biggest factors in whether or not you are at risk for a fall is: if they are afraid to fallsaid Rebecca Martin, a professor of physical therapy at Hanover College. dr. Martin is not affiliated with Rock Steady Boxing, but given its effectiveness, she has incorporated boxing techniques into her work, including teaching weekly exercise classes for people with Parkinson’s disease.
A recent study of boxing therapy found that Parkinson’s patients trained twice a week reported fewer falls, with falls increasing during Covid-19 lockdowns and falling again once restrictions were lifted and they could resume training. This is something Mr. Trout saw firsthand, as many of his participants — or “hunters,” as he calls them — came back from lockdowns stiffer and more shaky than before.
Outside the ring
Parkinson’s disease also has psychological effects. As patients lose coordination and balance, many begin to question their abilities and retreat into a shell, withdrawing from friends and family, and limiting outdoor travel for fear of falling.
‘Parkinson’s disease takes away your self-confidence,’ said Ms Karian. “You have to work to keep 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 isn’t 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 who conducted the study. She is also not affiliated with Rock Steady, but said she now often recommends boxing to her patients.
For some of Mr. Trout boxing class is often the only time they are out of the house every week. Kathy Smith, a retired schoolteacher, said she often felt insecure about her abilities during exercise classes. In Rock Steady Boxing, “they understand and help us adapt to our different skills,” she said.
When Mr. Trout’s lesson came to a close, ending with a series of core exercises, Mrs. Karian and the others were quiet and concentrated on doing as much as possible, while Mr. Trout encouraged them. Coping with the effects of Parkinson’s can be overwhelming, he said, but “they get a chance to fight back every time they come to my class.”