Feasibility of Instituting Graduated High intensity exercise Training for Parkinson Disease-FIGHT-PD

Intervention and duration: A supervised exercise program of non-contact boxing utilizing a boxing machine, with instruction by a professional boxing coach and neurological physiotherapist, and oversight by exercise physiologists and a neurologist. The program includes a detailed warm up to sequentially prepare the upper body, trunk, then legs with movements, stretching and balance exercises, and then a series of aerobic exercises. The first warm up exercise is; "Raised elbows and arm extension, to the side and the front"; the subject stands and the arms are held in a T position with the feet parallel, the legs shoulder width apart; one arm remains extended, then the other is brought close to the head, with each side alternating. The arms are then positioned straight to the front, and alternately flexed and extended. This warms up shoulders, wrists and elbows, Key point is to fully extend the elbow, "locking it out"; this is to counter the rigid, flexed posture typically seen in PD. A mid-body warm up exercise is "Finger Lock Hook Twists". The starting position is with feet parallel, legs just further than shoulder width apart, the fingers are locked together in a "monkey grip" with the elbows kept high. The body is twisted from side to side, rotating as far as possible. The aim of this is to enhance flexibility and trunk control. Aerobic exercises include jogging on the spot star jumps and twist jumps. This is followed by rounds of boxing using standardised sequences of punches and body movements utilising the machine. The attached document summarises the sequences, with the numbers representing the target numbers on the Fightmaster machine corresponding to the style of punch. The program will be administered in a groups of 4 in a large room at the Perron Institute which is also used as a Movement analysis laboratory, but will be functioning as a "gymnasium" for the purposes of this study.The 15 week program will include three, five weeks blocks. The first block will focus on development of boxing technique, with low intensity, approximately 8-10/20 on the Borg RPE scale. Exercise physiology students will quiz participants on their Borg RPE at regular intervals during each workout in order to measure in detail the demands of each component. A modified scale of cognitive demand (1-10) will also be used.The second block will escalate the intensity starting at approximately Borg RPE 12-13, ultimately building towards 18-19, as form and conditioning allow. The third block will consolidate the intensity level, adding in additional cognitive challenges to the physical workout. The cognitive challenges include; 1. Switching from "orthodox" right handed stance, to "Southpaw" (ie left handed), which requires the boxing sequence targets to be the mirror image. 2.Interruption of bimanual sequences by inserting sequences requiring several consecutive left or right punches; this is a surprisingly difficult "inhibitory" task. 3. Learning random sequences " on the fly", typically comprising of 4-7 different punches. Three workouts per week will be performed, ranging from 45-60 minutes duration. Each five week block will include a week with non-workout sessions allocated for assessments and review. Subjects will wear portable heart rate (Polar) monitors that will quantify heart rate during each workout. Subjects will rate their perceived level of physical and mental exertion using the Borg scale at multiple points during the workout. Subjects will complete a questionnaire in a logbook at the end of each workout, assessing the tolerability of each workout and documenting the development of any musculoskeletal pain or change in PD symptoms. The logbooks will provide a record of attendance. The Borg RPE will provide a standardised method of measuring the exertion, and will be correlated with heart rate recordings.