Punching through Parkinson’s

Mike Horak balances one foot on a small foam rubber pad. He raises his boxing gloves and starts pounding the mitts in Sean Simonds’ hands.

Morning light hasn’t dawned yet outside Specialized Physical Therapy in South Asheville, but Horak, 53, is a devoted adherent of the rehabilitation program Simonds has designed: Knock Out Parkinson’s. Simonds’ 3-year-old program, which he says is based on “the highest-quality research in the field,” upends traditional models for treating patients of Parkinson’s disease, a neurodegenerative motor system disorder with no known cure.

The old standard of treatment was medication-heavy but light on exercise, Simonds says. Simonds’ regimen puts patients through intense, individually designed physical workouts. Exercise, body rotation, along with big and fast movements, all help improve mobility and independence among people with Parkinson’s, Simonds says.

Float like a butterfly

“Boxing alone covers a lot of those bases,” Simonds says. “We have also seen substantial psychological improvements. Just imagine being really mad, depressed — depression is common in almost everyone with the diagnosis — wouldn’t you feel better if you got to hit something for a full hour?”

“When you’re having a bad day, there’s something great about hitting a speed bag,” says Horak, who found out about four years ago that he has Parkinson’s. He looks at Simonds, who is wearing a tie despite the workout he is putting Horak through. Simonds puts up his mitts and moves them around as Horak pounds his gloves into them.

“For people with Parkinson’s, changing movements and directions when people ahead of them move is hard,” Simonds says, watching Horak’s balance and intensity. “Balance gets worse as the disease progresses. This exercise is for balance and coordination.”

As the sun begins to dawn, Simonds puts Horak through a variety of exercises, nearly all of which involve speed bags, heavy bags and reflex bags. Simonds’ clinic in Gerber Village looks like a really nice gym, with lots of equipment for strengthening and stretching muscles. Turning on some classic rock, Simonds starts the workout by tossing a heavy ball with Horak to get his heart pumping. Then it’s off to the first set of exercises, including hopping over low pylons and striking opposing bags. Each set that Simonds and Montana Fain, a physical therapy student there to learn from Simonds, put Horak through gets more intense. A set of two jumping jacks and four punches gets exponentially larger, so that by the end of it, Horak is counting as hard as he is hitting. The mental concentration looks as difficult as the physical work.

Talking trash

The more Horak works, the more focused he becomes, it seems. Staring hard at the bags, he starts sweating and breathing hard. Throughout, he remains enthused, engaging in playful banter with Simonds and Fain. He’s not above rolling his eyes at some of Simonds’ commands.

“I think this looks better on the other side of the room,” Simonds says, pointing to a heavy bag with a mobile base. Horak pushes it across the room. “No, I’m wrong,” Simonds says. “Do you mind helping?” Grunting, Horak pushes it back in place. And then grins. “What a way to start the day,” he says, smiling at Simonds.

“Now I’m going to test to see if you’re colorblind,” Fain teases Horak.

Horak seems glad to be working with her, happy to see Simonds break away to work with another patient. “Amateur hour is over,” he says, a friendly dig at Simonds.

“You’re going to sit right there,” Fain says, directing Horak to a chair she puts in the middle of the room among bags of various colors. “I call a color. You’re going to do five hard hits on whatever color I call, then sit back down.”

Horak sits, his gloves in his lap, waiting for Fain’s first command. “Blue!” she says, then watches Horak hit the blue bag and return to the chair. Red, yellow, black — the exercise goes on for several minutes. Horak is breathing hard and having fun.

Parkinson’s progress

Simonds, who is currently editing two Parkinson’s treatment case studies he hopes to publish, bases his program on research published in neurological and physical therapy publications. Other forms of exercise also show promise. “Forced-rate lower-extremity exercise” that pedaling a bicycle involves “has recently emerged as a potential safe and low-cost therapy for Parkinson’s disease,” according to research published by the National Center for Biotechnology Information, a division of the National Institutes of Health. (Supportive literature has also been produced by Indiana University and the Michael J. Fox Foundation, founded by the popular Back to the Future actor who publicly disclosed his Parkinson’s disease diagnosis in 1998).

Nearly 1 million people will be living with Parkinson’s in the U.S. by 2020, according to the Parkinson’s Foundation, a nonprofit organization that seeks to make life better for people with Parkinson’s by improving care and advancing research. Each year, about 60,000 Americans are diagnosed with the disorder.

Researchers aren’t sure what causes it, though genetics and environment may be factors. The central nervous system disorder causes the loss of cells in the brain that produce dopamine, a chemical that carries messages to various parts of the brain about body movement and coordination. The condition causes neurons to fire erratically, leaving sufferers less able to control their movements. Men are more likely to be affected than women.

Though exercise doesn’t increase the production of dopamine among people with Parkinson’s, it helps them use their remaining dopamine more effectively. A 2017 clinical trial conducted by Northwestern University Feinberg School of Medicine suggests that high-intensity physical exercise may help people with early-stage Parkinson’s delay the progression of symptoms related to motor abilities, according to an article at medicalnewstoday.com.

The effect of high-intensity workouts on people with Parkinson’s, Simonds says, is “bigger” than that of low-intensity workouts in the same way that running, rowing, biking and boxing at a fast clip are more beneficial to most people than walking.

“Just like your strength improves more when you lift heavier weights or your heart is stronger when you do more cardio,” he says. “The same type of process happens in the brain with dopamine and [a protein called] GDNF, which protects remaining dopamine neurons, thus reducing symptoms even more. Exercise literally results in the protection of the neurons in the brain, thus protecting dopamine and improving mobility.”

Knock Out Parkinson’s is a rehabilitation program covered by insurance and carried out by licensed physical therapists. All patients who come to Simonds’ clinic for the program — about 100 since 2015, he estimates — are evaluated by a doctor of physical therapy before a program is designed (and updated) specifically for them. Therapists work one-on-one with patients “as it allows us to carefully monitor any other issues that may be affecting our patients,” Simonds says.

But boxing?

“Boxing is more the mode of delivering the treatment in a fun and unique way,” he says.

For more info on Knock Out Parkinson’s, see the programs offered at specializednc.com.