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Parkinson's causes his body to freeze up. Only one thing gets him moving again.
Monday May 09, 2016
Using boxing to help those with Parkinson's
I’m on the heavy bag, throwing left jabs, ignoring the relentless blare of Kanye’s “Drive Slow, Homie” played at a volume that would raise the dead. I punch to a one-two count: left jab, right cross. I’m working as hard as I’ve ever worked, and even in this unheated gym I sweat as if it’s a sauna.
Finally, the bell rings. It feels as if I’ve been at it for an hour; actually, three minutes have passed. The ensuing one-minute break seems to last four seconds. Let’s be clear: Boxing, even when the opponent is only a heavy bag, is a brutal sport. But brutality is needed, even welcome, when you’re facing a progressive, incurable neurological disease. I have Parkinson’s disease, and it causes my body to just freeze up. Weirdly enough, boxing helps me get unstuck.
All 12 of us in this class bear the unmistakable signs of Parkinson’s disease. I spot a dapper, cheerful white-haired fellow shaking like a leaf (tremor). Next, a balding, heavyset guy stumbling forward awkwardly on his toes (dystonia, or muscle cramping). Then I see myself in a mirror: a man in a white T-shirt, khaki shorts and Nike running shoes, standing still, seemingly paralyzed. I’m in the midst of a Parkinson’s freeze (an extreme form of bradykinesia, or slow movement).
Although Parkinson’s is generally thought of as an old-person’s disease, I was diagnosed with a young-onset version 18 years ago, at age 35. Since then, I’ve taken every sort of medication known to science. I’ve had brain surgery — two tiny electrodes were implanted deep in my brain to stimulate an area affected by Parkinson’s — which unquestionably have helped treat some of my symptoms. But medicine and surgery have not cured my freezing and falling, my gait and balance issues that worsen as my disease progresses: When walking across a busy street, I may suddenly, inexplicably come to a full stop as the light is about to change. Even the slightest downhill slope of a path causes me to fall forward.
Exercise, researchers have learned, is essential for Parkinsonians, and since being diagnosed I have embraced that therapy. But as time has gone on, my exercise options dwindled. After hundreds of falls, which left my knees more scar than skin, I gave up running. Frozen and jerky movements meant that tennis and skiing were no longer options.
So last year, when I learned about a boxing program for people with Parkinson’s, I had to investigate.
A decade ago, Scott Newman, an Indiana prosecutor and early-onset Parkinsonian, took up boxing and found it improved his agility and daily functioning. He eventually founded Rock Steady Boxing, a program for Parkinson’s patients that now operates in 89 sites around the country, including the one I discovered last year in Los Angeles.
Boxing demands balance, timing, gait speed and hand-eye coordination — all of which are challenged by Parkinson’s. The Rock Steady program also encompasses other exercises, such as squat jumps, heel walking, agility drills, raised-knee walking, trampoline work, jumping rope and skipping. The boxing portion is non-contact, thankfully, and includes work on heavy bags and speed bags, and aiming punches at the moving targets provided by a trainer’s padded “focus mitts.”
Does boxing actually improve Parkinson’s symptoms? A 2011 study in the journal of the American Physical Therapy Association looked at a small sampling of Parkinson’s patients who participated in two to three 90-minute Rock Steady training sessions per week for nine months. The researchers found that the patients showed “short-term and long-term improvements in balance, gait, activities of daily living, and quality of life after the boxing training program.” While these results can’t be considered conclusive proof, the reported improvements mirror my own experience. Although I have not stopped freezing or falling, I do so less frequently, and my balance and gait seem to have improved.
Exactly why boxing workouts may help people with Parkinson’s is not clear. The study noted that Rock Steady’s “whole body approach” might be the key to its success, due to its “dynamic balance activities and multidirectional reaching and stepping . . . agility drills within the circuit training regimen, such as jumping rope, and footwork activities, focused on the initiation of movement and fast-paced changes in direction.” All help parts of the body affected by Parkinson’s.
A 2013 review in Lancet Neurology made a compelling case for the role of exercise that incorporates “goal-based” components — where people need to pay constant attention to what their body is doing and make adjustments in response to external feedback. Boxing, tai chi, tango and similar activities, the review said, seem to improve the brain function of people with Parkinson’s, which improves movement.
Ordinarily, human movement relies on the interaction of unconscious (automatic) and conscious (cognitive) control. But in Parkinson’s, automatic control is diminished as nerve cells in an area of the brain that controls movement begin to die off and stop producing an important neurotransmitter called dopamine. This means that people with Parkinson’s must make a conscious effort to accomplish such simple tasks as walking or lifting an object — things that healthy people do automatically.
Parkinson’s medications, such as synthetic dopamine, alleviate some motor symptoms. But their effectiveness is limited and they do not address the cognitive problems that many Parkinsonians can develop, which range from becoming easily distracted and disorganized to having trouble focusing or remembering words when speaking.
The brain has a remarkable ability to adapt to damage caused by disease or injury by growing new brain cells, the review noted, and goal-based exercise facilitates this ability.
Boxing training is definitely goal-based. It forces my brain to think about and then make simple movements — such as walking, jogging, jumping, bending, reaching, stepping in all directions — that a healthy person does with no thought.
Pre-Parkinson’s, for instance, grocery shopping for me was a quick routine: I went to the store, picked a shopping cart, walked the aisles freely, pushing the cart and picking items from the shelves, then stood in line at the cashier, paid for my purchases and left the store. I did this on automatic pilot, my mind wandering elsewhere. With Parkinson’s, this same trip to the market is a series of challenges: Entering the store, I’m likely to freeze at the doorway, my feet feeling as if they’re glued to the ground; when I push the cart, I can take only small, shuffling steps with my weight on my toes, and I lean on the cart just to keep my balance; reaching out to pick a cereal box from the shelf throws me off balance; standing in a crowded, confined line at the cashier makes me freeze again.
But Rock Steady’s training program has given me regular, hands-on practice in dealing with these sorts of movement challenges, giving me more confidence. Now when I head out to the store, I know that the mobility required to perform my boxing agility exercises exceeds that required to avoid another shopper coming toward me. Picking an object from a shelf is easy compared with reaching out to hit a heavy bag. And the distractions provided at the gym by Kanye’s voice, our instructor’s commands and my classmates demand at least as much focus as waiting in the cashier’s line at the grocery. Boxing trains me to do things consciously that once came naturally: initiate movements from my core, move my legs and arms simultaneously, plan my next move, stay aware of my body’s alignment and position to maintain balance.
What Parkinsonians call “balance confidence” is critical. It is fear of falling, rather than the falls themselves, that most limits my ability to perform the activities of daily living — to go to a restaurant, volunteer at my kids’ schools, walk downhill. It is fear of falling that causes me to take tiny, rapid, uncontrolled steps or makes my feet freeze in place while my upper body keeps moving forward. It is fear that makes me do the very things that make me fall — and one does not need to have Parkinson’s to know that the psychology of fear can drive us directly into what we want to avoid.
For many years, the only perceived link between boxing and Parkinson’s was that the former caused the latter; in fact, Muhammad Ali, who took far too many punches, may be the world’s most visible Parkinsonian. Today, a neurologist might actually prescribe boxing training — with no contact, of course — as therapy for Parkinson’s.
So I pound away on the heavy bag, not training for a fight because I am already in the thick of one. It’s a fight for my life, and as long as there is no cure for Parkinson’s, the disease ultimately remains undefeated. But I and the other pugilists in my twice-weekly boxing class — all with the unmistakable tremors and awkward gaits of Parkinson’s disease — can at least make it an interesting, and maybe even fairer, contest.
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