Boxing-Based Training to Improve Balance and Mobility in Parkinson's Disease

Overview

The goal of this clinical trial is to learn if physical exercise that extensively and simultaneously challenges the brain's balance control network is effective in improving balance for people with mild to moderate Parkinson's disease. The study aims to test a specific hypothesis: that a physically demanding, "multidomain" program-which trains multiple areas of balance at the same time-will produce significantly better results than simple exercises that only partially address the balance network. To test this, researchers will use a specialized boxing-based program (EBA-B) as a model of challenging exercise. This will be compared to an active control group performing simple, low-intensity mobility movements in a chair. The main questions it aims to answer are: * Does exercise that simultaneously challenges multiple domains of balance (using boxing as a tool) produce superior global improvements compared to less demanding programs? * Is this extensive neural challenge more effective at reducing motor symptoms and improving functional mobility? Participants will: * Complete an 8-week "challenging" phase involving 50-minute group boxing sessions (EBA-B) 3 times per week, designed to challenge speed, agility, and coordination. * Complete an 8-week "simple exercise" phase involving 20-minute home-based mobility seated workout 5 times per week, along with weekly education talks. * Undergo clinical evaluations and balance tests at the start, middle, and end of the study to measure changes in their mobility

Background and Rationale Balance control is a complex function managed by a distributed neural network within the central nervous system, where the basal ganglia serve as a central node operating in coordination with the cerebral cortex, brainstem, and cerebellum. This network spans multiple neurochemical systems, including dopaminergic, cholinergic, and serotonergic pathways. In Parkinson's Disease (PD), this multi-level system is compromised early on, leading to symptoms like axial rigidity and progressive postural instability. Current standard treatments, such as Levodopa and Deep Brain Stimulation (DBS), often fail to address global balance dysfunction. While Levodopa may improve gait speed, it can paradoxically worsen postural sway and fails to significantly improve dynamic balance or dual-tasking. Therefore, there is a clinical need for interventions that target the balance network globally rather than in isolation. Study Hypothesis The core hypothesis of this trial is that physical exercise that extensively and simultaneously challenges the distributed neural network of balance control is significantly more effective at improving multiple domains of balance in people with mild-to-moderate PD than simple exercise programs. Researchers propose that to achieve global improvement, the intervention must mimic the simultaneous demands of functional mobility in daily life. In this study, the Boxing-Based Balance and Agility Training (EBA-B) is utilized as a specific tool to operationalize this high-intensity, multidomain neural challenge. Study Design This study is a randomized, crossover, controlled clinical trial. Participants are randomized into two groups (EF and EDU) which differ only in the order of the interventions received. The total study duration per participant is approximately 19 weeks, consisting of: * Phase 1: 8 weeks of intervention (EBA-B or AC). * Washout Period: 3 weeks of no study-related exercise to minimize carry-over effects. * Phase 2: 8 weeks of the opposite intervention. Intervention Protocols 1. Boxing-Based Training (EBA-B): The EBA-B program combines functional exercise with non-contact boxing techniques. * Structure: 24 sessions (50 minutes each, 3 times per week). * Progression: Organized into a Learning Block (Weeks 1-4) for habit formation and technical acquisition, and an Integration Block (Weeks 5-8) where exercises increase in volume, complexity, and intensity. * Session Layout: Each session includes a warm-up, three successive 12-minute work stations, and a cool-down. Stations focus on asymmetric postures, trunk mobility, coordination of punch sequences, and reaction to stimuli. * Intensity: Monitored via heart rate (pulse oximetry) and Rated Perceived Exertion (RPE), with a planned progression from 40% to 75% of maximum heart rate. 2. Active Control (AC): The AC intervention is designed to match the total weekly volume of 150 minutes but with lower physical demand. * Education: Weekly 50-minute in-person talks regarding PD pathology and quality of life to maintain group socialization. * Mobility: A 20-minute video workout of simple, seated (chair-based) mobility exercises to be performed at home 5 times per week. Monitoring and Safety Clinical evaluations are performed in the "ON" medication state at three time points: Baseline (0M), Mid-point/Washout (2M), and Study Completion (4M). Participants are instructed to maintain stable medication and daily activity levels throughout the study. Adverse events, such as falls or musculoskeletal injuries, are recorded via participant diaries and direct reporting during sessions.