# Exercise as it relates to Disease/How non-contact boxing affects functional mobility in people with Parkinson’s Disease

This wikibook is a critique on the research article A Retrospective Analysis of Group-Based Boxing Exercise on Measures of Physical Mobility in Patients With Parkinson Disease

### What is the background to this research

This wiki-page will inform readers about how Parkinson Disease patients can use non-contact boxing as a strategy to improve symptoms that affect their functional mobility. This research aims to contribute to the limited studies that have researched the benefits of independent and group exercise on Parkinson Disease patients motor and cognitive symptoms. However, this paper will focus on the improvement of functional mobility in Parkinson Disease patients as it is essential for an individual to be able to perform everyday tasks in a safe and independent manner.
Parkinson’s Disease is a progressive neurological condition that presents common symptoms such as body tremors due to the brain being incapable of producing sufficient amounts of dopamine. Non-contact boxing has become a popular intervention for Parkinson Disease in the recent years due to some studies demonstrating improvements in the symptoms associated with Parkinson Disease patients. Non-contact boxing involves the use of exercises that have been adapted from boxing drills and focus on improving components such as agility, coordination, muscular strength, and muscular endurance.

### Where is the research from

The research for this paper was conducted in Southern eastern United States at four different facilities that offered non-contact boxing classes.
Six authors contributed to this study:
* James W.H. Sonne- Who is an assistant professor and has contributed to 11 other studies.
* Kyle Joslyn- This research being their first published work.
* Katherine Reus- This research being their first published work.
* Michelle Angulo- Who has been affiliated with several other published works.
* Sarah Guettler- This research being their first published work.
* Morris C. Beato- Who is an assistant professor and a distinguished researcher with service awards and contributions to six other studies.
Due to the research being undertaken at four different locations offering a non-contact boxing program, there is a potential for bias among facilities as they may try to gain status or prove that their program Is more effective.

### What kind of research was this

The type of research conducted was a retrospective analysis that compared the severity of symptoms of Parkinson’s Disease and the impact these symptoms had on patients both before and after commencing the non-contact boxing program.
Due to the nature of a retrospective analysis all participants needed to have been diagnosed with Parkinson’s Disease, therefore, the high incidence of participants dropping out of the study was unable to be controlled.

### What did the research involve

This study required participants to take part in a non-contact boxing program which was run 2-3 times a week, with each class running for about 90 minutes. After 6, 12, 18 and 24 months each participant was assessed on 4 tests:
1. Timed Up & Go Test
2. 10 Metre Walk Test
3. 30-second Chair Stand Test
4. Fullerton Advanced Balance Scale Test
When considering the methodology of this study, the recruitment may have not been the best for the studies purpose. It may have been more beneficial to include patients who have never participated in a non-contact boxing program rather than those who have to gain a better insight into the comparison of data.
The two main limitations of this study were:
* The measures assessed were recorded by non-clinical staff, possibly allowing for error in procedures and recording results.
* For the Timed up and go test the instructions are subjective when the participant is told to walk at a ‘normal walking speed’ and the speed will differ between participants.

### What were the basic results

Important results found at each assessment period:
* 6 months: Significant improvement was demonstrated in all the tests except the 10 metre walk test.
* 12 months: This period of the study demonstrated further improvement in the same tests as the six-month period.
* 18 months: At 18 months, improvements were seen in the 30 second chair stand test and Fullerton advanced balance scale test.
* 24 months: The final assessment period showed no statistically significant changes in both the timed up and go test and the 30 second chair stand test. There was also no data obtained for the 10 metre walk test and Fullerton advanced balance scale at this stage of the study.
Percentage of change in the outcome measures :
| Outcome measure | 6 months | 12 months | 18 months | 24 months |
| Timed Up & Go Test | 7.2% (±3.4) | 13.7% (±3.2) | 20.5% (±6.1) | 19.2% (±7.6) |
| 10 Metre Walk Test | 8.2% (±5.0) | 8.6% (±10.2) | N/A | N/A |
| 30-second Chair Stand Test | 19.4% (±4.3) | 25.2% (±5.9) | 23.1% (±7.0) | 28.4% (±16.2) |
| Fullerton Advanced Balance Scale Test | 3.4% (±1.5) | 9.7% (±1.9) | N/A | N/A |
The results of the study were interpreted by the researchers’ using graphs and tables which outline:
* The percentage of improvement in the tests
* The percentage of change for each test and at the assessing period it occurred
* The P-values and significance of data
* The effect sizes for each test

### What conclusions can we take from this research

Through this study the non-contact boxing program has had a positive impact on the functional mobility of Parkinson Disease patients. The exercises prescribed in these programs seem to have a greater impact the longer the patients participated, due to the exercises aiming to improve agility, coordination, muscular strength, and endurance which are all essential to live an independent lifestyle.
Other studies/research have gathered evidence that remains consistent with this study. An article titled ‘Boxing Training for Patients With Parkinson Disease’ demonstrated similar evidence where boxing drills/exercises were incorporated into a program, resulting in an improvement of quality of life and Parkinson Disease symptoms such as mobility. Another study titled ‘High satisfaction and improved quality of life with Rock Steady Boxing in Parkinson’s disease: results of a large-scale survey’ also demonstrated the impact of non-contact boxing by demonstrating improvements in motor and non-motor symptoms in those patients who participated in the exercise program.

### Practical advice

Ultimately this study helps us draw conclusions on:
* Physical activity guidelines- This study incorporated various aspects of fitness such as strength, endurance, agility, and balance while also abiding by the recommended 30 minutes of moderate intensity exercise on most days. Therefore, this study helps demonstrates the benefits of physical activity on health.
* Delivery of exercise- This study has demonstrated the effectiveness of group exercise as it motivates participants and provides a social aspect.
Before following any practical advice provided it is important that any individual looking to participate in a non-contact boxing program or any exercise program should ensure they are aware of any underlying health issues they have and gain medical clearance from an appropriate health professional.

### Further information/resources

Interested in learning more about Parkinson's Disease, non-contact boxing programs and exercise guidelines? Take a look at the resources below:
https://www.parkinsons.org.au/about-parkinsons
https://www.rocksteadyboxing.org/
https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians#summary-by-age

### References

* 1 2 3 4 5 6 7 Sonne, J., Joslyn, K., Reus, K., Angulo, M., Guettler, S. and Beato, M., 2021. A Retrospective Analysis of Group-Based Boxing Exercise on Measures of Physical Mobility in Patients With Parkinson Disease. American Journal of Lifestyle Medicine, p.155982762110281.
* ↑ Bouça-Machado R, Maetzler W, Ferreira J. What is Functional Mobility Applied to Parkinson’s Disease?. Journal of Parkinson's Disease. 2018;8(1):121-130.
* ↑ About Parkinson's [Internet]. Parkinson's Australia. 2022 [cited 24 August 2022]. Available from: https://www.parkinsons.org.au/
* ↑ [Internet]. Rock Steady Boxing. 2022 [cited 24 August 2022]. Available from: https://www.rocksteadyboxing.org/about/
* ↑ Combs S, Diehl M, Staples W, Conn L, Davis K, Lewis N et al. Boxing Training for Patients With Parkinson Disease: A Case Series. Physical Therapy. 2011;91(1):132-142.
* ↑ Larson D, Yeh C, Rafferty M, Bega D. High satisfaction and improved quality of life with Rock Steady Boxing in Parkinson’s disease: results of a large-scale survey. Disability and Rehabilitation. 2021;:1-8.
* ↑ Physical activity and exercise guidelines for all Australians [Internet]. Australian Government: Department of Health and Aged Care. 2022 [cited 8 September 2022]. Available from: https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians#summary-by-age