Boxing therapy may improve gait stability and reduce the risk for falls in patients with Parkinson disease (PD), according to study findings published in BMC Neurology.
Motor impairment and gait instability in PD can increase the likelihood of falls and thus the risk of developing head trauma, fractures, and immobility. Physical therapies and exercise can help mitigate the risk for falls in patients with PD by improving balance and gait.
In the current study, the researchers assessed the effects of boxing therapy in patients with PD. The participants worked with a trainer twice a week to perform boxing therapy-related exercises aimed at improving their overall coordination, gait, and balance.
The risk for falls was the primary endpoint, and quantitative and semiquantitative gait and balance performance evaluations were secondary endpoints.
Because the study was conducted during the COVID-19 pandemic lockdown in 2020, the researchers also assessed the associated temporary cessation of boxing therapy during that period.
A total of 98 participants were included in the study, with an average age of 70.6 years; 22% were women. Participants self-reported an average of 0.86±3.58 falls per month at baseline.
The average follow-up interval during boxing therapy was 16.0 months, and the mean average number of self-reported falls per month per patient decreased from 0.86±3.58 at baseline to 0.11±0.26 during therapy.
During the COVID-19 lockdown period, when boxing therapy was temporarily stopped for an average of 3 months, falls increased from 0.11±0.26 falls per month during the initial interval to 0.26±0.48 falls per month. When therapy resumed after the lockdown, falls decreased from 0.26±0.48 falls per month to 0.14±0.33 falls per month.
During the monitoring period, 10% (n=44/404) of women and 7.7% (n=131/1690) of men reported a fall. During the COVID-19 lockdown, women vs men had a greater increase in the risk for falls per month — 84% increase for women (relative risk [RR], 1.84; 95% CI, 1.05-3.24; P =.0318) vs 49% increase for men (RR, 1.49; 95% CI, 1.23-1.81; P <.0001).
Participants were also stratified into groups of those aged younger than 65 years (n=20; 20%), 65 to 75 years (n=48; 49%), and older than 75 years (n=30; 31%) at the start of boxing therapy. During the pandemic lockdown, participants aged older than 65 years experienced the highest increase in number of falls over time — 85% greater falls per month were observed in those aged 65 to 75 years (RR, 1.85; 95% CI, 1.32-2.59; P =.0003) and 59% higher among those aged older than 75 years (RR, 1.63; 95% CI, 1.24-2.15; P =.0005).
Patients aged younger than 65 years did not have a significant change in the risk for falls during the lockdown (RR, 1.74; 95% CI, 0.92-3.28; P =.0903). However, participants aged 65 to 75 years had a significantly reduced risk for falls per month after boxing therapy resumed postlockdown (RR, 0.76; 95% CI, 0.61-0.93; P =.0085).
The quantitative performance results observed by a trainer, which included standing from a chair and standing on 1 leg, were comparable to the general patterns regarding falls.
The study had several limitations. Researchers noted that their main outcome of falls depended on self-reporting without any monitoring devices. Also, all participants were enrolled in 1 boxing therapy clinic, and the baseline frequency of falls among most participants was relatively low. Further, boxing therapy was not compared with other PD therapies or with a separate nonexercise control group.
“While other therapies also certainly have value, their ultimate utility depends greatly on the motivation and interest of the participant,” the researchers stated. “[Boxing therapy] might have a unique appeal because of its perceived novelty and association with a sport that has a very long history across numerous cultures.”
Horbinski C, Zumpf KB, McCortney K, Eoannou D. Longitudinal observational study of boxing therapy in Parkinson’s disease, including adverse impacts of the COVID-19 lockdown. BMC Neurol. Published online August 24, 2021. doi:10.1186/s12883-021-02359-6