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D. Miner1, S. Glass1, C. Byrum1, C. Gilmore1, C. Kolb1, P. Tarman1
1Radford University Carilion, Physical Therapy, Roanoke, United States
Background: Rock Steady Boxing (RSB) is a multi-modal exercise program aimed to improve motor impairments of Parkinson’s Disease (PD). Research for RSB is limited to small studies. Evidence supports exercise benefits for people with PD, but optimal exercise type based on PD severity is unknown.
Purpose: The purpose of this study is to investigate the impact of PD severity on comprehensive performance-based outcomes after an 8-week RSB training program.
Methods: Mild PD Group (Baseline UPDRS-III <34): n=7, 3 F, age=69±7.5, years since PD diagnosis=4.9±2.4, Hoehn & Yahr (H&Y)=2.1±0.3, Montreal Cognitive Assessment (MOCA)=25.4±3.5, UPDRS-III=27.4±4.8
Moderate-Severe PD Group (Baseline UPDRS-III ≥34): n=10, 4 F, age=79.2±8.3, years since PD diagnosis=9.9±6.0, H&Y=2.6±0.7, MOCA=24.7±3.3, UPDRS-III=47.6±16.0
Baseline Testing: All participants completed the UPDRS-III, MOCA, Mini Balance Evaluation Systems Test (MBT), Functional Gait Assessment (FGA), Timed Up and Go (TUG), TUG Cognitive (TUG-Cog), 5 Times Sit to Stand (5xSTS), 10-meter Walk Test, 6 Minute Walk Test, and 9 Hole Peg Test (9HPT).
Intervention: All participants completed an 8-week RSB training program, two 60-minute sessions/week
Post-test: All outcome measures above were reassessed following 8 weeks of training.
Time from last dose of levodopa was controlled to account for differences in performance attributable to medication effects.
Statistical Analysis: Dependent T-tests analyzed differences in pre- vs post-test scores for each group. Cohen’s d for effect size was interpreted as small (d=0.2), medium (d≥0.5), or large (d≥0.8).
Moderate-Severe PD Group (Baseline UPDRS-III ≥34): n=10, 4 F, age=79.2±8.3, years since PD diagnosis=9.9±6.0, H&Y=2.6±0.7, MOCA=24.7±3.3, UPDRS-III=47.6±16.0
Baseline Testing: All participants completed the UPDRS-III, MOCA, Mini Balance Evaluation Systems Test (MBT), Functional Gait Assessment (FGA), Timed Up and Go (TUG), TUG Cognitive (TUG-Cog), 5 Times Sit to Stand (5xSTS), 10-meter Walk Test, 6 Minute Walk Test, and 9 Hole Peg Test (9HPT).
Intervention: All participants completed an 8-week RSB training program, two 60-minute sessions/week
Post-test: All outcome measures above were reassessed following 8 weeks of training.
Time from last dose of levodopa was controlled to account for differences in performance attributable to medication effects.
Statistical Analysis: Dependent T-tests analyzed differences in pre- vs post-test scores for each group. Cohen’s d for effect size was interpreted as small (d=0.2), medium (d≥0.5), or large (d≥0.8).
Results: Significant improvements (p < 0.05) were observed in the following outcomes:
Mild PD Group: UPDRS-III (p=0.002, d=1.7), UPDRS-Tremor (p=0.012, d=1.1), MBT (p=0.008, d=1.2), MBT-Anticipatory (p=0.015, d=1.1), MBT-Reactive (p=0.032, d=0.9), MBT-Dynamic Gait (p=0.017, d=1.0), TUG-Cog (p=0.049, d=0.7), FGA (PRE=20.3±4.3, POST=24.6±2.9, p<0.001, d=2.1), 5xSTS (p=0.021, d=1.0).
Moderate-Severe PD Group: UPDRS-III (p<0.001, d=3.4), UPDRS-Bradykinesia (p<0.001, d=1.8), UPDRS-Tremor (p= 0.002, d=1.2), UPDRS-Rigidity (p= 0.022, d= 0.7), MBT (p= 0.003, d=1.9), MBT-Anticipatory (p=0.012, d=0.9), MBT-Reactive (p=0.006, d=1.0), MBT-Dynamic Gait (p= 0.05, d=0.6), FGA (PRE=17.2±7.0, POST=19.5±7.7, p=0.002, d=1.2), 9HPT (p=0.033, d=0.7).
Mild PD Group: UPDRS-III (p=0.002, d=1.7), UPDRS-Tremor (p=0.012, d=1.1), MBT (p=0.008, d=1.2), MBT-Anticipatory (p=0.015, d=1.1), MBT-Reactive (p=0.032, d=0.9), MBT-Dynamic Gait (p=0.017, d=1.0), TUG-Cog (p=0.049, d=0.7), FGA (PRE=20.3±4.3, POST=24.6±2.9, p<0.001, d=2.1), 5xSTS (p=0.021, d=1.0).
Moderate-Severe PD Group: UPDRS-III (p<0.001, d=3.4), UPDRS-Bradykinesia (p<0.001, d=1.8), UPDRS-Tremor (p= 0.002, d=1.2), UPDRS-Rigidity (p= 0.022, d= 0.7), MBT (p= 0.003, d=1.9), MBT-Anticipatory (p=0.012, d=0.9), MBT-Reactive (p=0.006, d=1.0), MBT-Dynamic Gait (p= 0.05, d=0.6), FGA (PRE=17.2±7.0, POST=19.5±7.7, p=0.002, d=1.2), 9HPT (p=0.033, d=0.7).
Conclusions: Following an 8-week RSB program, individuals with severe PD had significant improvements in bradykinesia and rigidity on UPDRS-III, and improved fine motor coordination on 9HPT. Individuals with mild PD improved lower extremity strength/power on 5xSTS, dual task performance on TUG-Cog, and FGA scores exceeded minimum detectable change thresholds. No significant improvements observed in gait speed or endurance.
Implications: Regardless of disease severity, all PwPD improved motor function on UPDRS-III, dynamic gait performance on FGA, and across multiple domains of balance on MBT suggesting RSB may reduce fall risk for PwPD. Those with mild PD severity may have greater improvements in balance, dynamic gait, strength/power, and dual task performance following an 8-week RSB program than those with more severe PD.
Funding acknowledgements: No funding was received for this project
Keywords:
Parkinson's Disease
Exercise
Wellness
Parkinson's Disease
Exercise
Wellness
Topics:
Neurology: Parkinson's disease
Health promotion & wellbeing/healthy ageing/physical activity
Neurology: Parkinson's disease
Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? Yes
Institution: Radford University
Committee: Institutional Review Board
Ethics number: 2021-474-OCS
All authors, affiliations and abstracts have been published as submitted.
