The Role of Boxing in Parkinson’s Disease: Evidence, Benefits, and Future Directions

Over 10 million people worldwide are affected by Parkinson’s disease (PD), making the development of effective therapeutic approaches essential. Previously seen as an emerging trend, boxing training has now been integrated as a recognized alternative therapy approach for over a decade, gaining increasing attention in research and clinical practice. This systematic review critically examines the effects of boxing training as a therapeutic intervention in individuals with PD by synthesizing evidence from 13 relevant studies published between 2000 and 2024.

The findings suggest that boxing training can lead to improvements in motor symptoms, balance, and cognitive function while also positively impacting psychosocial well-being. However, methodological inconsistencies among studies—such as variations in sample size, intervention design, and outcome measures—limit the generalizability of results. A significant gap remains in the standardization of boxing protocols, particularly regarding intensity, frequency, and session duration, which complicates the ability to derive clear clinical recommendations.

To enhance the efficacy of boxing interventions for PD, future programs should incorporate individualized assessments and goal setting, progressive intensity levels, a focus on cognitive and emotional aspects, structured social engagement, and ongoing professional training for exercise facilitators. Standardized protocols and longitudinal studies are needed to further validate the long-term impact of boxing as a therapeutic modality in PD management. This review highlights the potential of boxing as an adjunctive therapy while underscoring the necessity for more rigorous and standardized research in this field.

Key Words: Boxing Training, Therapeutic Interventions, Physical Therapy, Systematic Review, Movement Therapy, Motor Rehabilitation

Parkinson’s disease (PD) is marked by the progressive degeneration of dopaminergic neurons in the substantia nigra, which results in a range of motor and non-motor symptoms (12). These symptoms, including motor impairments and non-motor issues such as depression and cognitive decline, profoundly diminish patients’ quality of life (2). While pharmacological treatments are the mainstay of PD management, they often lose efficacy over time and can have undesirable side effects (1). As a result, there is growing interest in complementary therapies, particularly physical exercise, which may help manage both motor and non-motor symptoms of PD (4).

Among the various forms of exercise, boxing has gained attention for its potential benefits. Boxing can improve motor functions such as balance, strength, coordination, and reaction time and has been shown to boost psychosocial well-being, including increasing self-confidence and reducing symptoms of depression (5). The qualitative findings on the benefits of boxing as a therapeutic approach for PD, such as physical benefits, psychological empowerment, and social interaction, are summarized in table 3. In the reviewed studies, “boxing training” is defined as structured, non-contact exercise programs tailored to harness the therapeutic potential of boxing for individuals with Parkinson’s Disease (PD). These programs aim to enhance motor skills, coordination, and psychosocial well-being, all within a safe and supervised environment. Unlike competitive boxing, these interventions avoid physical sparring and instead emphasize controlled movements, cognitive engagement, and skill development. Typically, the sessions are divided into three components: warm-up, main training, and cool-down. However, the specific details of the main training – such as the drills used, the progression of intensity, and the focus on biomechanics or cognitive tasks – are inconsistently reported across studies (7).

This inconsistency poses challenges for comparing findings between studies, as the term “boxing” may be interpreted differently depending on the intervention’s design. While most studies agree on the non-contact nature of the training, there is little clarity on whether core boxing principles, such as timing, defensive strategies, or reaction training, were consistently included. Without a clear standard, the reported benefits of “boxing” risk being overly generalized from interventions that might vary greatly in execution (11).

Additionally, the lack of detailed descriptions in intervention protocols limits the reproducibility of results and hinders the development of evidence-based recommendations. It is worth noting that while improvements in motor, cognitive, and emotional outcomes have been documented, there is minimal research on the neurobiological mechanisms underlying these effects. For instance, how boxing training influences neural pathways associated with gait or executive functions remains largely unexplored. This represents a significant gap in the current literature and highlights the need for future studies to investigate these mechanisms in depth (6).

To establish “boxing” as a reliable therapeutic approach for PD, future research must prioritize defining and standardizing the fundamental elements of these interventions. This includes specifying the duration, intensity, and types of exercises performed during each session. By addressing these gaps, researchers can build a stronger foundation for understanding and optimizing the therapeutic potential of boxing for Parkinson’s Disease (4).

Despite the encouraging results from individual studies, there is currently no comprehensive review that synthesizes the available evidence on boxing as a therapeutic intervention for PD. Existing research varies widely in terms of study design, training protocols, and outcome measures, and many questions remain regarding the long-term effects of boxing, optimal training parameters, and potential risks (10). External factors, such as the impact of the COVID-19 pandemic, have also influenced the implementation of exercise programs and need further exploration (11).

The aim of this systematic review is to critically assess the available evidence on the effects of boxing training in PD, focusing on both motor and non-motor symptoms, as well as quality of life and potential risks. The review will also compare boxing with traditional exercise therapies and explore its psychosocial benefits, with the goal of guiding future research and clinical practice. Parkinson’s disease (PD) is marked by the progressive degeneration of dopaminergic neurons in the substantia nigra, which results in a range of motor and non-motor symptoms. These symptoms, including motor impairments and non-motor issues such as depression and cognitive decline, profoundly diminish patients’ quality of life. While pharmacological treatments are the mainstay of PD management, they often lose efficacy over time and can have undesirable side effects. As a result, there is growing interest in complementary therapies, particularly physical exercise, which may help manage both motor and non-motor symptoms of PD.

Among the various forms of exercise, boxing has gained attention for its potential benefits. Boxing can improve motor functions such as balance, strength, coordination, and reaction time and has been shown to boost psychosocial well-being, including increasing self-confidence and reducing symptoms of depression. In the reviewed studies, “boxing training” is defined as structured, non-contact exercise programs tailored to harness the therapeutic potential of boxing for individuals with Parkinson’s Disease (PD). These programs aim to enhance motor skills, coordination, and psychosocial well-being, all within a safe and supervised environment. Unlike competitive boxing, these interventions avoid physical sparring and instead emphasize controlled movements, cognitive engagement, and skill development. Typically, the sessions are divided into three components: warm-up, main training, and cool-down. However, the specific details of the main training – such as the drills used, the progression of intensity, and the focus on biomechanics or cognitive tasks – are inconsistently reported across studies.

This inconsistency poses challenges for comparing findings between studies, as the term “boxing” may be interpreted differently depending on the intervention’s design. While most studies agree on the non-contact nature of the training, there is little clarity on whether core boxing principles, such as timing, defensive strategies, or reaction training, were consistently included. Without a clear standard, the reported benefits of “boxing” risk being overly generalized from interventions that might vary greatly in execution.

Additionally, the lack of detailed descriptions in intervention protocols limits the reproducibility of results and hinders the development of evidence-based recommendations. It is worth noting that while improvements in motor, cognitive, and emotional outcomes have been documented, there is minimal research on the neurobiological mechanisms underlying these effects. For instance, how boxing training influences neural pathways associated with gait or executive functions remains largely unexplored. This represents a significant gap in the current literature and highlights the need for future studies to investigate these mechanisms in depth.

To establish “boxing” as a reliable therapeutic approach for PD, future research must prioritize defining and standardizing the fundamental elements of these interventions. This includes specifying the duration, intensity, and types of exercises performed during each session. By addressing these gaps, researchers can build a stronger foundation for understanding and optimizing the therapeutic potential of boxing for Parkinson’s Disease.

Despite the encouraging results from individual studies, there is currently no comprehensive review that synthesizes the available evidence on boxing as a therapeutic intervention for PD. Existing research varies widely in terms of study design, training protocols, and outcome measures, and many questions remain regarding the long-term effects of boxing, optimal training parameters, and potential risks. External factors, such as the impact of the COVID-19 pandemic, have also influenced the implementation of exercise programs and need further exploration.

The aim of this systematic review is to critically assess the available evidence on the effects of boxing training in PD, focusing on both motor and non-motor symptoms, as well as quality of life and potential risks. The review will also compare boxing with traditional exercise therapies and explore its psychosocial benefits, with the goal of guiding future research and clinical practice. This systematic review aims to analyze and evaluate scientific evidence on the efficacy of boxing training in PD. Research suggests that various exercise modalities, including boxing, contribute to improved mobility, balance, and quality of life in PD patients (9, 18). This updated review integrates findings from validated sources to ensure a comprehensive analysis of the available literature.

Ethical Considerations
To uphold ethical standards, the review process included a focus on informed consent. For studies included in this systematic review, informed consent was reported where applicable. If explicit mention of informed consent was absent, it was presumed that data collection followed ethical protocols approved by institutional review boards or equivalent committees. When studies were exempt from requiring informed consent, this was assumed to align with the descriptions provided by the respective authors.

Search Strategy
This systematic review was registered in PROSPERO (registration number: CRD42024613885). To identify relevant studies on boxing as a therapeutic intervention for Parkinson’s disease (PD), a thorough search was conducted across several major academic databases, including PubMed, MEDLINE, Scopus, Embase, CINAHL, and the Cochrane Library. The search aimed to capture studies that evaluated both motor and non-motor outcomes of boxing training, along with its long-term effects on PD patients.

Search Terms
The search strategy utilized a combination of MeSH terms and free-text keywords, such as: “Parkinson’s disease,” “boxing,” “therapy,” “motor symptoms,” and “quality of life,” among others. This approach was designed to ensure comprehensive coverage of all relevant studies. The search was conducted in English, as most studies in the field are published in this language, and to align with the indexing practices of the databases.

Search Process
The systematic review selection process, including study identification, screening, and final inclusion based on PRISMA guidelines, is visualized in the Flow Chart (figure 1). The initial search returned 1,235 articles. After removing duplicates, 912 articles were screened based on titles and abstracts. Following a detailed assessment of these abstracts, 156 full-text articles were retrieved. After applying predefined inclusion and exclusion criteria, 32 studies were included in the final review. The selection process was carried out according to the PRISMA guidelines to ensure transparency and reproducibility (10).

Grey Literature and Manual Search
In addition to database searches, grey literature, including conference abstracts and dissertations, was reviewed through sources like OpenGrey and ProQuest Dissertations & Theses Global. Manual searches of reference lists from key articles were also conducted to identify any studies that may have been missed initially, helping to minimize publication bias (15).

Data Extraction
Data were extracted using a standardized form, which included details on study design, sample size, intervention characteristics, and key outcomes related to motor and non-motor symptoms. This process ensured that the review captured the most relevant studies and findings. This systematic review followed the PRISMA guidelines and included studies extracted from databases such as MEDLINE/PubMed, Web of Science, SPORTDiscus, and Scopus. The eligibility criteria comprised randomized controlled trials (RCTs), controlled non-randomized studies, and longitudinal observational studies that examined the effects of boxing interventions in PD patients (15, 17). Studies were excluded if they combined boxing with other forms of exercise without distinct analysis, lacked a control group, or were non-peer-reviewed case studies.

Table 2 provides an overview of various studies on boxing as a therapeutic intervention for PD, including details on study design, intervention duration, and key outcomes. Thirteen studies met the inclusion criteria, with various study designs assessing functional mobility, balance, motor symptoms, quality of life, and cognitive function:

Functional Mobility
Several studies reported significant improvements in functional mobility, assessed via the Timed Up and Go (TUG) test, particularly in structured, long-term interventions (9). However, some studies found no significant effects compared to traditional physical therapy (6). Meta-analytical assessments indicated a small effect size, with heterogeneity attributed to variations in intervention duration and intensity (18).

Balance
Findings on balance improvements were inconsistent. Some studies demonstrated a positive impact of boxing training on balance, measured using the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Berg Balance Scale (BBS), while others reported no significant differences from standard rehabilitation exercises (11, 13).

Motor Symptoms
The effectiveness of boxing training in reducing motor symptoms, assessed via the Unified Parkinson’s Disease Rating Scale (UPDRS-III), varied across studies. Some interventions showed mild symptom relief, particularly in early-stage PD patients (14), whereas others did not demonstrate significant improvements in symptom severity (8).

Quality of Life
Most studies evaluating the effects of boxing training on quality of life (QoL) using the Parkinson’s Disease Questionnaire (PDQ-39) indicated a positive trend in self-reported well-being, although statistical significance was not consistent across trials (16).

Cognitive Function and Mental Health
Preliminary evidence suggests that boxing training might enhance cognitive function and reduce depressive symptoms in PD patients. Several studies documented improvements in executive function and mental well-being following participation in non-contact boxing programs (see table 3 for an overview of qualitative themes related to psychosocial and cognitive benefits of boxing interventions in PD (17, 18)). However, due to limited sample sizes and methodological differences, these findings require further validation.

The discussion identifies several key limitations in studies that examine boxing as an intervention for Parkinson’s disease (PD). Common challenges include small sample sizes, varied study designs, and a lack of control groups, all of which reduce the reliability and generalizability of findings (3, 6). Additionally, studies differ significantly in terms of protocol details—such as session intensity, duration, and types of exercises—making it difficult to pinpoint the most effective approach (13, 15) This variation complicates the synthesis and comparison of data, limiting the overall strength of the evidence.

A detailed look at the existing literature shows that boxing interventions for Parkinson’s patients vary greatly in their structure, content, and implementation. While all included studies used non-contact boxing techniques, there are considerable differences in the frequency of sessions (two to five times per week), duration (30 to 90 minutes), and total duration of the interventions(four weeks to two years) (9, 17). Commonalities of the programs include footwork, punch combinations, reaction training, balance exercises, and cognitive challenges, such as movement combinations and dual-task exercises (18). However, few studies provide detailed information on the progression of sessions, intensity adjustments, and the specific motor or cognitive tasks (11). To strengthen the practical relevance of boxing interventions in therapy, more specific recommendations for physiotherapists and physicians are needed. While research highlights potential benefits, its clinical application remains unclear.

Suggested Improvements
- Practical Guidelines: Clear recommendations on session frequency, duration, and intensity tailored to different stages of Parkinson’s.
- PReal-World Examples: Case studies or best-practice approaches illustrating successful implementation in therapy.
- PCollaboration: Closer cooperation between neurologists, physiotherapists, and trainers to develop individualized treatment plans.
Providing more concrete guidance can help integrate boxing more effectively into clinical practice. The neurobiological effects of boxing training are theoretically discussed but have not been directly confirmed by studies. Currently, there appear to be no specific studies on this topic; however, future research should focus on systematically investigating the neurobiological mechanisms, including their impact on neuroplasticity, dopaminergic pathways, and cognitive function.
The neurobiological mechanisms underlying the effects of boxing training on Parkinson’s disease (PD) are still not fully understood. However, emerging evidence suggests that intensive physical activity, including boxing, may promote neuroplasticity by increasing the release of neurotrophic factors such as Brain-Derived Neurotrophic Factor (BDNF), which plays a crucial role in synaptic plasticity and neuronal survival (1, 7). Additionally, boxing training may positively influence dopaminergic pathways, which are progressively impaired in PD. Studies on other high-intensity exercise modalities indicate that physical activity can help stabilize dopamine production and release, potentially mitigating motor symptom progression (5, 11).

Furthermore, the cognitive complexity of boxing training, which requires rapid decision-making, coordinated movements, and reaction time adaptation, could have additional neuroprotective effects by engaging prefrontal and motor circuits more extensively than conventional exercises (14).

Despite these promising findings, there is still a lack of systematic investigation into the direct neurobiological mechanisms associated with boxing interventions in PD. Future studies should aim to assess biomarkers such as BDNF levels, dopaminergic activity, and functional neural changes using neuroimaging techniques to better understand the long-term effects of boxing on neurodegeneration in PD (8, 15). Integrating such findings into existing training protocols could further optimize the therapeutic potential of boxing and aid in the development of individualized interventions.

To optimize the implementation of boxing training in PD rehabilitation, the following recommendations are proposed:

1. Individual Assessment and Goal Setting: Healthcare professionals should assess each patient’s motor function, cognitive abilities, and emotional well-being before initiating a boxing program. This ensures that interventions are tailored to individual needs and capabilities, promoting long-term adherence (3).

2. Incorporating Progressive Intensity Levels: Given the variation in boxing protocols, a standardized framework should be established, defining core components such as footwork, punch combinations, reaction training, and cognitive exercises. A progressive intensity approach should be adopted, starting with low-intensity movements and gradually increasing complexity to enhance patient confidence while preventing injury (13). Recommended parameters: Frequency: 2-4 sessions per week; Duration: 45-60 minutes per session; Intensity: Gradual progression based on ability and fatigue; Core Components: Non-contact boxing drills, agility, balance, and cognitive tasks; Adaptability: Adjustments for different PD stages; Standardization will improve study comparability and optimize boxing as a therapeutic intervention.

3. Focusing on Cognitive and Emotional Dimensions: Boxing programs should incorporate cognitive training components, such as reaction time drills and strategic movement planning, to enhance both motor and cognitive function. Psychosocial aspects, such as stress management and mindfulness techniques, should also be included (18).

4. Emphasizing Group Dynamics and Social Interaction: Social engagement through group boxing classes has been shown to improve adherence and motivation while providing emotional support among PD patients. Encouraging participation in community-based programs can enhance outcomes (15).

5. Ongoing Training and Education of Trainers: Trainers and therapists should receive continuous education on PD pathology and rehabilitation techniques to ensure safety and maximize therapeutic benefits. Certification programs specific to PD-focused boxing interventions should be considered (17).

6. Promoting Family and Caregiver Involvement: Engaging family members and caregivers in the training process can reinforce motivation and support outside of structured sessions, facilitating continuity of exercise (9).

7. Regular Monitoring and Evaluation: Systematic assessments, such as UPDRS and gait analysis, should be integrated into boxing programs to track patient progress and adjust interventions accordingly. Standardized protocols can enhance comparability across studies (18).

By addressing the current limitations in boxing training studies, future research can further refine intervention protocols and expand our understanding of their long-term impact on PD symptoms. Integrating these recommendations into clinical practice may help establish boxing as an effective rehabilitation strategy for Parkinson’s disease.

Current evidence indicates that boxing training holds promise as an adjunct therapy for PD, particularly in improving quality of life and mobility. However, no clear evidence exists on the effects of boxing in Parkinson’s disease, as definitions of boxing interventions vary and structured protocols are lacking. To build a stronger evidence base, future research should develop standardized intervention models and provide detailed documentation of session content, intensity, and structure. For boxing to be recognized as a valid therapeutic intervention, studies need to specify essential factors such as training duration, intensity, and key movement components. A clear and consistent framework will help validate boxing’s role in Parkinson’s therapy and enhance its practical application. However, due to heterogeneity in study findings and methodological limitations, further high-quality investigations are necessary to provide definitive recommendations for integrating boxing training into PD rehabilitation protocols.

Conflict of Interest
The authors have no conflict of interest.

Funding 
No external funding was received for this study.

Ethical Approval
This systematic review adheres to ethical research standards. All included studies obtained informed consent or followed ethical protocols approved by institutional review boards where applicable.

Clinical Trial Registration
N/A

Systematic Review Registration
PROSPERO Registration Number: CRD42024613885

Acknowledgements
The authors recognize and appreciate the inclusion of studies that adhered to ethical standards, such as obtaining informed consent or complying with institutional approvals.

Boxing training has emerged as a recognized therapeutic approach for Parkinson’s disease (PD), showing benefits in motor function, balance, cognition, and psychosocial well-being. Despite promising results, methodological inconsistencies and a lack of standardized protocols limit clinical applicability. Future research should focus on standardization, individualized training programs, and long-term impact assessment to establish boxing as a reliable adjunctive therapy for PD.