Cognitive and Motor Improvements Correlated with Sleep and Activity Following Community-Based Non-contact Boxing in Patients with Parkinson Disease

Abstract

Objective: To evaluate the feasibility of a 12-week community-based, non-contact rock-steady-boxing (RSB) program in individuals with Parkinson disease (PD) and to assess potential improvements in motor and cognitive functioning after intervention.

Method: Over 12 weeks, 26 PD participants completed 24 RSB classes. Motor and cognitive assessments were conducted at baseline and follow-up, with a sub-group (n = 14) wearing clinical actigraphy. Linear mixed-effects models investigated compliance and changes in motor and cognitive functions. Multiple linear regression assessed correlations of clinical changes with clinicodemographic factors and actigraphy variables (two-sided p < .05).

Results: PD participants showed significantly improved motor performance on the Mini Balance Evaluation Systems Test following RSB (p < .01, β = 0.69, 95% C.I. [0.40, 0.99]). No significant cognitive improvements were observed after false discovery correction, though higher scores with moderate effect sizes were suggested on HVLT-Total Recall (p = .23, β = 0.30, 95% C.I. [0.033, 0.58]), HVLT-Delayed Recall (p = .23, β = 0.25, 95% C.I. [0.03,0.46]), Stroop-Color (p = .23, β = 0.26, 95% C.I. [0.04, 0.48]), and Stroop-Interference tests (p = .15, β = 0.39, 95% C.I. [0.13, 0.64]). No significant changes were observed for actigraphy-based activity and sleep metrics. Exploratory analysis provided effect sizes and confidence intervals of associations between actigraphy variables and clinical assessments.

Conclusions: RSB intervention led to better motor functioning and potential, though uncertain, cognitive benefits independent of age, sex, or disease severity. Cautious interpretation of exploratory analyses suggests changes in activity and sleep may relate to motor and cognitive changes following RSB. Findings support compliance with RSB in PD and motivate larger, randomized trials investigating the role of exercise in facilitating PD symptom improvement.

Keywords: Actigraphy; Boxing; Cognition; Exercise; Parkinson disease; Sleep.