Boxing vs Sensory Exercise for Parkinson's Disease: A Double-Blinded Randomized Controlled Trial

Balance exercise interventions in Parkinson's disease: A systematic mapping review of components, progression, and intensity

BACKGROUND

Rehabilitation in individuals with Parkinson's disease (PD) often includes balance training, but knowledge about optimal training content remains limited.

OBJECTIVES

To describe the design, content, delivery, and reporting of balance training for individuals with PD, and furthermore, to map the systematic use and reporting of methods monitoring intensity in balance training interventions for individuals with PD.

METHODS

Six databases were searched. Interventions with at least 50 % of exercises challenging balance control were included. Balance training types (exergaming, multi-modal, sensory-motor integrated, and task-oriented) were categorized based on specific balance exercise components: motor (limits of stability, anticipatory motor strategies, reactive motor strategies, and control of dynamics), sensory (vestibular, visual, and somatosensory systems), and cognitive (dual-tasking in motor or cognitive activities). Training Frequency, Intensity, Time, Type, Volume, and Progression (FITT-VP principles) were extracted.

RESULTS

In total, 114 studies (interventions n = 126) with 5335 participants (mean age: 67.5 years; mean PD duration: 6.8 years) were included. The highest mean number of balance components was found in the multi-modal (5.8), followed by sensory-motor (5.6), task-oriented (4.2), and exergaming (4.0). Intensity strategies were reported in 93 % of the exergaming interventions, which was superior to the other training types (multi-modal (18 %), sensory-motor (17 %), and task-oriented (6 %)).

CONCLUSIONS

Multi-modal and sensory-motor interventions had a greater focus on challenging balance components compared to other types of training, while exergaming interventions demonstrated superior reporting of intensity strategies. Future research is encouraged to prioritize implementing intensity strategies and aim to incorporate a broader range of balance components within balance training exercises.

Can boxing relieve symptoms of Parkinson's disease and improve quality of life? A qualitative study of the experiences of participants attending the Danish Parkinson boxing concept

PURPOSE

To explore how people with Parkinson's (PwP) experience the impact of attending Parkinson Boxing (PB) on their symptoms and quality of life.

METHODS

The authors NMAY and PeB conducted participant observations of four PB sessions and eight semi-structured interviews with PwP who participated in PB in Denmark. The empirical material was systematically analyzed using thematic analysis.

RESULTS

Four main themes arose. The participants experience a sense of community from being part of a group where they share the same diagnosis. They described various bodily experiences related to their physical and cognitive functioning and well-being, as well as emotional experiences including feelings of joy, gratitude, and mental well-being. They are motivated to participate in the training sessions, and participation further motivates them to retain their exercise practice.

CONCLUSIONS

The experienced impact of participating in PB relates to physical relief of symptoms and improved functioning in everyday life, as well as a mental lift, energy, and joy during and after training sessions. Participants described being motivated to attend PB and to continue their training practice. Thus, PB entails experiences of relief of symptoms and presumably improved quality of life for the participants.

The Efficacy of Boxing Training on Patients with Parkinson's Disease: Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to systematically review the available evidence on the effects of boxing interventions on people with Parkinson disease.

METHODS

Four electronic databases were searched systematically from their inception until December 2023. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database and Methodological Index for Non-Randomized Studies scales.

RESULTS

A total of 13 studies were included. Data synthesis indicated that participants who performed boxing programs did not have a significant effect in the polled data on functional mobility, balance, motor symptoms, gait and cardiorespiratory fitness Accordingly, for the effects of boxing on self-reported quality of life, the polled data showed a non-significant trend towards improving Hedges' g. Also, when the analysis was performed by comparing the experimental and control groups, the results remained non-significant.

CONCLUSIONS

The evidence regarding the use of boxing as a program exercise for patients with Parkinson disease remains uncertain. Preliminary findings indicate that participation in boxing does not demonstrate a substantial impact on either physical or mental health outcomes.

Current interventional model for movement in Parkinson's disease: network meta-analysis based on the improvement of motor ability

Aim

To identify optimally therapeutic exercise interventions for improving motor ability among patients with Parkinson's disease (PD), we conducted a network meta-analysis (NMA) of randomized controlled trials comparing different exercise regimens.

Methods

Relevant RCTs were retrieved by searching PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, and other databases from inception to July 9, 2023 is available in English as the primary language. Exercise outcomes as measured by Movement Disorder Society- Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) score change were evaluated and ranked using STATA software version 18.0. All included studies were assessed for methodological quality using the Cochrane Risk of Bias tool.

Results

The final NMA included 71 studies involving 3,732 participants, 87 intervention experiments, and 27distinct interventions. Although most exercise interventions showed some efficacy (reducing MDS-UPDRS-III score), cumulative ranking probability surface (SUCRA) values indicated that the best exercise interventions for motor function improvement were archery (95.6%), riding a bicycle (80.9%), and binary rhythm dance (80.8%).

Conclusion

An exercise intervention comprising archery, cycling, and(or) binary rhythm dance may yield superior improvements in motor function among patients with Parkinson's disease.

Parkinson's disease motor intervention patterns: a network meta-analysis based on patient motor function

Background

Parkinson's disease is characterized by symptoms such as bradykinesia and rigidity, which worsen as the disease progresses, significantly impacting patients' independence and quality of life. This study utilizes a network meta-analysis approach to quantify information gathered from randomized controlled trials (RCTs) regarding motor interventions that effectively improve the motor function of Parkinson's disease patients, aiming to provide evidence for selecting appropriate exercise intervention strategies for patients.

Methods

A systematic search strategy for randomized controlled trials (RCTs) restricted to English was constructed based on multiple biomedical databases. Databases searched included PubMed, Embase, Cochrane, Web of Science, CINAHL, CBM, China National Knowledge Infrastructure (CNKI), Wan fang, VIP, etc., with searches conducted from inception to July 9, 2023. Two authors screened all studies, extracted data, and used frequency domain analysis methods. Network meta-analysis was performed using STATA software version 18.0 to compare and rank exercises that could effectively improve the motor function of Parkinson's disease patients (measured by indicators such as MDS-UPDRS-III, TUG, BBS, Mini-BES Test, 6MWT scores). Additionally, a series of analyses and evaluations were conducted, such as assessing the methodological quality of included studies using the Cochrane risk of bias tool.

Results

The network meta-analysis included a total of 111 studies involving 5,358 participants, 133 intervention experiments, and 31 intervention measures. Although most exercise interventions showed effectiveness, cumulative ranking curves under the surface (SUCRA) values showed that archery exercise significantly improved patients' MDS-UPDRS-III scores (SUCRA = 95.6%), significantly superior to routine care [standardized mean difference (SMD = 16.92, 95%CI = -28.97, -4.87)]. High-intensity and agility exercise (High strength and agility) referred to as high-intensity exercise or agility training or a combination of both, collectively termed as high-intensity agility training, significantly improved patients' completion time for the time-up-and-go test (SUCRA = 99.7%), (SMD = -7.88, 95%CI = -9.47, -6.28). Dance and Tai Chi exercises significantly improved patients' balance abilities: Mini-Balance Evaluation Systems Test (SUCRA = 77.9%), (SMD = 5.25, 95%CI = -0.42, 10.92) for dance intervention and Berg Balance Scale (SUCRA = 94.7%), (SMD = 11.22, 95%CI = 3.26, 19.18) for Tai Chi intervention. Dance also significantly improved patients' walking ability in the 6-min walk test (SUCRA = 80.5%), (SMD = 71.31, 95%CI = 13.77, 128.84).

Conclusion

Compared to other exercises, archery, dance, Tai Chi, and high-intensity agility exercises demonstrate superior efficacy in improving the motor function of Parkinson's disease patients.

Effect of Boxing Exercises on the Functional Ability and Quality of Life of Individuals with Parkinson's Disease: A Systematic Review

Parkinson's disease (PD) is a neurological disorder caused by the loss of dopamine-producing cells in the substantia nigra and characterized by motor and non-motor symptoms. Boxing is a type of complementary therapy to improve symptoms in PD. The purpose of the present study was to examine the effect of boxing training on the functionality and quality of life of patients with PD. The literature search was performed on PubMed, Scopus, PEDro, Cochrane Library, and Google Scholar search engines. The PEDro scale was used to assess the methodological quality of the studies. This systematic review included three studies that examined disease severity, mobility, physical activity, balance, and quality of life. According to the PEDro scale criteria, the three articles included were of high methodological quality. Statistically significant improvements after the implementation of boxing training was shown for balance and quality of life in contrast to the other variables. Boxing training intervention programs had a positive effect on balance and quality of life in patients with PD; however, the results are conflicting regarding certain functionality variables. Therefore, it is necessary to conduct further research to examine the effectiveness of boxing training on the functionality and quality of life of patients with Parkinson's disease.

Interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults: A randomized controlled trial

BACKGROUND

Frailty is common among older adults, often associated with activity limitations during physical and walking tasks. The interactive boxing-cycling combination has the potential to be an innovative and efficient training method, and our hypothesis was that interactive boxing-cycling would be superior to stationary cycling in improving frailty and activity limitations in frail and prefrail older adults.

OBJECTIVE

To examine the impact of interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults compared to stationary cycling.

MATERIALS AND METHODS

A single-blinded randomized controlled trial. Forty-five participants who met at least one frailty phenotype criteria were randomly assigned to receive either interactive boxing-cycling (n = 23) or stationary-cycling (n = 22) for 36 sessions over 12 weeks. The interactive boxing-cycling was performed on a cycle boxer bike with an interactive boxing panel fixed in front of the bike. The primary outcomes were frailty status, including score and phenotypes. Secondary outcomes included activity limitations during physical and walking tasks. The pre- and post-intervention data of both groups were analyzed using a repeated measures two-way ANOVA.

RESULTS

Both types of cycling significantly improved frailty scores (p<0.001). Interactive boxing-cycling was more effective than stationary cycling in reversing the frailty phenotype of muscle weakness (p = 0.03, odds ratio 9.19) and demonstrated greater improvements than stationary cycling in arm curl (p = 0.002, η2=0.20), functional reach (p = 0.001, η2=0.22), and grip strength (p = 0.02, η2=0.12) tests. Additionally, interactive boxing-cycling exhibited a greater effect on gait speed (p = 0.02, η2=0.13) and gait variability (p = 0.01, η2=0.14) during dual-task walking.

CONCLUSION

In frail and prefrail older adults, interactive boxing-cycling effectively improves frailty but is not superior to stationary cycling. However, it is more effective at improving certain activity limitations.

REGISTRATION NUMBER

TCTR20220328001.

FIGHT-PD: A feasibility study of periodized boxing training for Parkinson disease

BACKGROUND

Boxing training has become a popular form of exercise for people with Parkinson disease (PD). There is a dearth of high-quality feasibility, safety, and efficacy data on boxing training for PD. Feasibility of Instituting Graduated High-intensity Training (FIGHT-PD) aimed to examine these features in a periodized boxing training program featuring high-intensity physical and cognitive demands.

OBJECTIVE

To conduct a feasibility study, aiming to address deficiencies in the current knowledge base and to provide data for future studies.

DESIGN

Single-arm, open-label feasibility.

SETTING

University department and medical research institute.

PARTICIPANTS

Ten people with early stage PD without contraindications to intense exercise, identified from a database of participants interested in boxing training.

INTERVENTIONS

A 15-week exercise program with three 1-hour sessions per week, with each session including warmup and then rounds of noncontact boxing using a training device. Three distinct blocks of 5 weeks including active rest. Boxers Development: focus on training technique Boxers Cardio: increasing intensity, including high-intensity interval training Boxers Brain: focus on cognitively challenging dual task training MAIN OUTCOME MEASURES: Process, resource, and management measures including recruitment and retention rates, timelines and costs, and compliance with prescribed exercise targets. Clinical outcomes were safety (adverse events), training intensity (using heart rate and perceived exertion monitoring), tolerability (pain, fatigue, and sleep scores), and pre- and postprogram Unified Parkinson Disease Rating Scale (UPDRS-III).

RESULTS

Among 10 participants from a pool of 82 (recruitment rate = 12%), there were no withdrawals; 348/360 workouts were completed (adherence = 97.7%); 4/348 (1.1%) workouts were missed due to minor injury. Nine of 10 participants showed improvement in UPDRS motor score.

CONCLUSIONS

FIGHT-PD provides a depth of feasibility and safety data, methodological detail, and preliminary results that is not described elsewhere and could provide a useful basis for future studies of boxing training for PD.

Long-term impact of a community-based adapted boxing program on physical functioning and quality of life of individuals with Parkinson's disease

BACKGROUND

Adapted boxing can help improve the physical functioning and health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD). Whether these benefits persist longitudinally is unclear.

OBJECTIVE

The purpose of this retrospective study was to evaluate the impact of a community-based adapted boxing program on the physical functioning and HRQoL of individuals with PD over 1-1.5 years.

METHODS

Twenty-six individuals with PD agreed to share their results on tests administered upon enrollment in the program (PRE) and ∼431 days later (POST). The tests included the Fullerton Advanced Balance scale, (FAB), the Timed Up-and-Go test (TUG), the 30-second Sit-to-Stand test (30-STS), and the PD questionnaire-39 (PDQ-39).

RESULTS

From PRE to POST, performance significantly improved on the TUG and 30-STS tests (both p < 0.001), but not on the FAB (p = 0.79). Over the same period, PDQ-39 scores significantly increased (p = 0.05). No PRE to POST changes surpassed the minimal detectable change threshold.

CONCLUSION

The results of this study suggest that adapted boxing is at worst non-detrimental and at best potentially beneficial for muscle strength, endurance, and functional mobility in individuals with PD. However, adapted boxing probably cannot fully counteract the HRQoL decrements that accompany PD progression.

Exercise Made Accessible: the Merits of Community-Based Programs for Persons with Parkinson's Disease

PURPOSE OF REVIEW

Many studies have identified positive effects of physiotherapy and exercise for persons with Parkinson's disease (PD). Most work has thus far focused on the therapeutic modality of exercise as used within physiotherapy programs. Stimulated by these positive findings, there is now a strong move to take exercise out of the clinical setting and to deliver the interventions in the community. Although the goals and effects of many such community-based exercise programs overlap with those of physiotherapy, it has also become more clear that both exercise modalities also differ in various ways. Here, we aim to comprehensively review the evidence for community-based exercise in PD.

RECENT FINDINGS

Many different types of community-based exercise for people with PD are emerging and they are increasingly being studied. There is a great heterogeneity considering the types of exercise, study designs, and outcome measures used in research on this subject. While this review is positive regarding the feasibility and potential effects of community-based exercise, it is also evident that the general quality of these studies needs improvement. By focusing on community-based exercise, we hope to generate more knowledge on the effects of a wide range of different exercise modalities that can be beneficial for people with PD. This knowledge may help people with PD to select the type and setting of exercise activity that matches best with their personal abilities and preferences. As such, these insights will contribute to an improved self-management of PD.

A meta-analysis of exercise intervention and the effect on Parkinson's Disease symptoms

Parkinson's disease (PD) is a progressive neurodegenerative disease that is distinguished by tremors at rest, bradykinesia, hypokinesia, and postural instability, resulting in a progressive decline in performance of everyday activities. The non-motor symptoms that occur can include pain, depression, cognitive dysfunction, sleep issues, and anxiety (among others). Functionality is tremendously impaired by physical as well as non-motor symptoms. Recent treatment has begun to incorporate non-conventional interventions that are more functional and tailored to the patients with PD. The purpose of this meta-analysis was to determine the effectiveness of exercise interventions at alleviating PD symptoms, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). Additionally, this review qualitatively explored whether endurance-based or non-endurance based exercise interventions were more beneficial at alleviating PD symptoms. Two reviewers screened the title and abstract records (n = 668) found in the initial search. Subsequently the reviewers completed full-text screening of the remaining articles for inclusion.. Following this, a total of 25 articles were considered to be eligible and included in the review and data was extracted for meta-analysis. The interventions lasted from 4 to 26 weeks. Results indicated a positive overall effect of therapeutic exercise on patients with PD, where the overall d-index was 0.155. Qualitatively no difference was observed between aerobic and non-aerobic forms of exercise.

A pilot study of a 12-week community-based boxing program for Parkinson's disease

INTRODUCTION

Community-based exercise programs for Parkinson's disease (PD) have gained popularity. Our understanding of such programs on non-motor features is limited. We characterized the effect of a 12-week community-based boxing exercise program on motor and non-motor symptoms in people with Parkinson's disease (PwPD).

METHODS

In this prospective observational study, PwPD underwent a 12-week community-based boxing program (2 sessions per week, for a total of 24 sessions). The following assessments were performed by a movement disorders neurologist at baseline and after completion of the program: MDS-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) in a modified version since assessments were performed virtually due to COVID-19 pandemic, MDS Non-Motor Rating Scale (MDS-NMS), Hamilton Depression Rating Scale (HDRS), Lilli Apathy Rating Scale (LARS), Parkinson's Disease Questionaire-39 (PDQ-39), and Schwab and England Activities of Daily Living scale (SE-ADL). Pre- and post-assessments were compared using Wilcoxon signed rank test; only participants who completed the program and both assessments were analyzed.

RESULTS

A total of 14 PwPD agreed to be a part of the study and completed assessments. All participants were ambulatory and functionally independent at baseline. Total non-motor feature severity (MDS-NMS, p = 0.0031), depression (HDRS, p = 0.015), and motor features (MDS-UPDRS PART 3 modified, p = 0.023) all improved significantly after the intervention. Scales on apathy (LARS, p = 0.29), Parkinson's disease-specific health related quality (PDQ-39, p = 0.093), and activities of daily living (SE-ADL, p = 0.32) did not demonstrate significant change.

CONCLUSION

PwPD who participated in a community-based, pilot boxing program showed improvements in motor exam and non-motor symptoms.

Prediction of Cognitive Degeneration in Parkinson's Disease Patients Using a Machine Learning Method

This study developed a predictive model for cognitive degeneration in patients with Parkinson's disease (PD) using a machine learning method. The clinical data, plasma biomarkers, and neuropsychological test results of patients with PD were collected and utilized as model predictors. Machine learning methods comprising support vector machines (SVMs) and principal component analysis (PCA) were applied to obtain a cognitive classification model. Using 32 comprehensive predictive parameters, the PCA-SVM classifier reached 92.3% accuracy and 0.929 area under the receiver operating characteristic curve (AUC). Furthermore, the accuracy could be increased to 100% and the AUC to 1.0 in a PCA-SVM model using only 13 carefully chosen features.

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

BACKGROUND

People with Parkinson's disease (PD) benefit from boxing exercise. Adding kicking variations to the boxing may provide additional benefit to improve balance. However, the benefits and adherence to such trainings is unknown.

OBJECTIVE

To explore the feasibility, safety, and benefits on balance of boxing training combined with kicking techniques in comparison to boxing without kicking in PD.

METHODS

Participants were randomized to group-based boxing training with kicking techniques (BK) or to group-based boxing alone training (BO). Both groups trained for one hour, once a week, for a period of 10 weeks. Participants were assessed at baseline and ten weeks post-intervention for difference in balance, fear of falling, balance confidence, walking ability, and quality of life.

RESULTS

Twenty-nine people with PD (median age 64 years; median disease duration 5 years) participated. Both interventions were feasible and acceptable for all participants. No adverse events occurred. Most participants (BK 80%; BO 75%) were satisfied with the training. We found no significant between group difference on either the primary (Mini-BEST) or secondary outcomes. The within group comparison showed that balance improved in both groups after the intervention (BK 22.60 (2.7) to 25.33 (2.64) p = 0.02; BO 23.09 (3.44) to 25.80 (2.39); p = 0.01 on the Mini BEST test).

CONCLUSION

Both types of boxing seem to be feasible and safe. Adding kicking techniques to boxing does not improve balance significantly more than boxing alone. Incorporation of kicking may be a valuable addition to the exercise therapy repertoire.

Longitudinal observational study of boxing therapy in Parkinson's disease, including adverse impacts of the COVID-19 lockdown

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.