Home

10%

Can Boxing Strike a Blow Against Parkinson's?

Harris College researchers will put data behind the idea that an exercise program can delay symptoms of the disease.

By TCU Magazine

May 12^th, 2022

by Trisha Spence

To a soundtrack of Van Halen and fists against speed bags, some boxers worked out in a ring while others shuffled their feet along the platform.

Dan Novak’s gloved hands pounded into the padded ribs of a 19-year-old.

Everyone in the room except Novak’s teenage challenger and world-champion boxer Paulie Ayala was an older adult who had been diagnosed with Parkinson’s disease.

At Punching Out Parkinson’s, a boxing-based exercise regimen Ayala started a decade ago, boxers such as Novak, 65, fight to delay symptoms of the incurable progressive disease.

Across Fort Worth, TCU’s Christopher Watts, the Marilyn and Morgan Davies Dean of Harris College of Nursing & Health Sciences, is leading a team that aims to measure how boxing with Punching Out Parkinson’s influences mobility, strength, balance and vocal health in people diagnosed with Parkinson’s. The researchers are giving hope to people suffering from a condition that causes muscles to deteriorate and affects walking, balance and speech.

“Physical exercise is probably the most important thing that a person with Parkinson’s disease can do for themselves,” Watts said. “Parkinson’s disease affects how muscles work. If you can actively engage those muscles, you’re using the same nervous system pathways that Parkinson’s disease is trying to destroy.”

Any exercise is helpful, Watts said, but Ayala’s boxing program works the entire body.

In the classes at Ayala’s University of Hard Knocks gym on the west end of Camp Bowie Boulevard, participants rotate from speed bags to stationary bikes to rowing machines. People as old as 88 do calisthenics and use cross-country ski machines.

“What Paulie has done is taken the expert knowledge that he has as both a boxer and a trainer of boxers and translated that to a program adapted to people with Parkinson’s disease,” Watts said. “He’s leveraging all of this knowledge and skill from the boxing world to create this program that is helping people with Parkinson’s.”

Christopher Watts created Endeavor Parkinsonology of Fort Worth, a web resource for a community of people diagnosed with Parkinson’s and their caregivers. Photo by Joyce Marshall

Watts’ interest in studying Parkinson’s started three decades ago during his doctoral studies at the University of South Alabama.

At TCU, the speech-language pathologist recruited Parkinson’s patients from the community for his research. As Watts got to know the people, he learned about Ayala’s boxing program.

Novak was one of those people.

In 2008, as a 51-year-old empty nester, Novak earned a PhD and was on the brink of a new career in teaching.

Dan Novak learned about Punching Out Parkinson’s four years after he was diagnosed. Now he goes to the gym three times per week. Photo by Joyce Marshall

Novak noticed that when he typed, his left pinky would jab the keyboard on its own. Then other issues such as balance problems and stiffness — his left arm didn’t swing while he walked — began to hinder his daily life.

A neurologist diagnosed the former adjunct professor of marketing for the Neeley School of Business with Parkinson’s.

The doctor told Novak he wasn’t going to die that day and his children wouldn’t inherit the disease directly from him, which was a relief to the father of two.

Novak was sent home with a handful of pill bottles and no clear long-term plan. “There’s a huge lack of support,” he said.

One of those bottles held a dopamine agonist with side effects including impulse control disorders and compulsive behaviors.

“I had one that caused major, major nightmares in our lives, in our marriage and everything else,” he said.

Novak turned to Punching Out Parkinson’s for help.

“I’ve never been a boxer, didn’t know anything about boxing, never been a fighter at all,” he said. “But we are fighting to take back control of our symptoms and, hopefully or perhaps wishfully, control of our lives.”

TCU Presents: Striking a Blow

July 19 at noon

Live on TCU's Facebook and YouTube pages

Hear from a group working to give Parkinson's disease a one-two punch through a boxing exercise program: the research perspective, boxer Paulie Ayala and two people whose lives have been changed by Punching Out Parkinson's.

For the last decade, Fort Worth Parkinson’s patients, including Molly Brown and Thomas Troup, have been fighting disease symptoms at boxer Paulie Ayala’s University of Hard Knocks gym. Photo by Joyce Marshall

Running the Gamut

A Parkinson’s Foundation study published in 2018 estimated that 930,000 people in the U.S. would be living with the disease by 2020, with an increase to 1.2 million people by the following decade. Researchers estimated that about 60,000 people are diagnosed with the neurodegenerative disorder every year.

Parkinson’s occurs when dopamine-producing brain cells stop working or die. The most telltale signs of the disease are movement-related: a tremor primarily in one hand or arm, rigidity, slowness and balance issues.

While Novak did not develop a tremor, his other common indicators included depression, problems sleeping, diminished sense of smell and cognitive impairment.

Being diagnosed with Parkinson’s is not a death sentence, Watts said. The life expectancy of someone with Parkinson’s is not that different from someone without it.

But the disease can cause swallowing problems that get progressively worse. Food entering the airway, combined with weakening of the muscles necessary to expel it, can lead to pneumonia and lung infection.

In later stages, people need help standing, dressing and eating. The most advanced stage of Parkinson’s is debilitating. Leg stiffness can cause people to be bedridden, and the constant assistance required for all activities means they can’t live on their own.

The cause of the disease is not known, but research indicates age, genetics and environment are contributing factors.

Though the disease is progressive and incurable, the Parkinson’s Foundation recommends exercise and physical activity to improve many motor and nonmotor symptoms.

Kevin Jackson fights the advancement of Parkinson's disease in a training regimen TCU researchers are now studying. Photo by Joyce Marshall

Ayala’s Punching Out Parkinson’s sprang from a single person seeking help. In 2010, three years into her diagnosis, Stacy Christopher was looking for the type of therapeutic boxing program that had been offered in other parts of the country since 2006.

“There were some dark times in the beginning,” said Christopher, who was diagnosed at age 38. “I was feeling alone and depressed about the whole thing.”

When Christopher asked if it was safe to continue her gym membership — not knowing how fragile the disease would make her — her neurologist didn’t have answers. The Parkinson’s-specific exercise programs Christopher found were for older people sitting in chairs, she said.

Ayala’s University of Hard Knocks was the only Fort Worth gym that offered training with a World Boxing Association titleholder. Christopher approached the southpaw about offering specialized training for people with Parkinson’s. He agreed.

From left: Stacy Christopher, Tina Hargrove, Paulie Ayala and Gary Schmitz built Punching Out Parkinson's a decade ago. Courtesy of Stacy Christopher

Through a partnership with the American Parkinson Disease Association of North Texas, class was in session.

“I was training [Christopher] the same way I’d train an athlete,” Ayala said. “When I train athletes, I’m not just trying to keep them in shape physically. I’m trying to get into their head — to get them to think, to get them to focus.

“Eighty percent of the fight — of any fight — is here,” Ayala said, pointing to his head. “If she could change her perception, she could change what she could do.”

Christopher and her neurologist started inviting other Parkinson’s patients to the gym in 2011. Tina Hargrove, who met Christopher at a support group, joined the class.

During an early session, Ayala asked Hargrove and her classmates to get in the ring. “We just looked at each other,” Hargrove said, and asked, “How do we get in the ring?”

Ayala taught the group how to wrap their hands, how to take an effective boxing stance, how to throw different punches.

“He’s so patient,” Hargrove said. “You would think he had worked with Parkinson’s people all along.”

Within a few sessions, Hargrove said, she was hooked. “I felt stronger.”

“I thought I was just going to help that group and they were going to go on their way,” Ayala said. “But the neurologist kept sending more people.”

Christopher later moved to Colorado, but the program she helped start now meets five days a week with daytime and evening options.

“The coolest thing to me was that these elderly men who felt so depleted and not valuable anymore because of their physical condition walked out with their shoulders back and chest puffed out,” Christopher said. “They were with other people in their same situation.”

Can Boxing Strike a Blow Against Parkinson's?

About 65 people work out during the week in Paulie Ayala’s Punching Out Parkinson’s exercise program. Participants include, top row, from left: Tina Hargrove, Tony Walker, Ana De Sousa, Mike Hale, Rita Maddux-Potter, Molly Brown ’64, Shirley Redmon ’85 and trainer Jake Reynolds; bottom row, from left: Kevin Jackson, Richard Keyer, Joe Browder, trainer Paulie Ayala, Thomas Troup, Suzanne Maxwell, Luke Ellis ’65 and Ralph Evans.

Ayala created a room devoted to Punching Out Parkinson’s where about 65 people exercise throughout the week.

The workouts were making a difference for people such as Hargrove, who said she was devastated by the diagnosis that forced her to retire. She said she believes Ayala’s classes are the reason her medication doses have not increased over the last decade.

Measuring the Punch

Watts has centralized his research findings into the online resource Endeavor Parkinsonology of Fort Worth. With the help of the website, he connects a community of people diagnosed with Parkinson’s and their caregivers with resources about the disease. He said his goal is to link patients and their families with evidence-based exercise programs to combat the effects of the disease.

“If you’re a local patient who has been diagnosed with Parkinson’s disease, there’s really no central resource in Fort Worth for you to get information about what to do about it — other than go to a neurologist to get medication,” Watts said. “And the reality is, there’s lots of resources, including exercise programs and support groups.”

Endeavor Parkinsonology was developed with help from community funds from the Parkinson’s Foundation. It is now completely supported by grants and gifts from the community.

Boxing isn’t the only exercise option. The Parkinson’s Foundation also recommends dance, yoga, aerobic activity, strength training, stretching and activities that incorporate multidirectional stepping and weight shifting.

Research comparing one exercise program for Parkinson’s with another is limited. Watts found recent research connecting boxing to improved walking ability, balance, quality of life and symptoms of depression, but researchers followed participants only for short spans of time. The TCU team is measuring changes over the course of a year.

“We know that other boxing exercise programs have shown promise for people with Parkinson’s disease. We first have to establish if science can show that this boxing exercise program, Punching Out Parkinson’s, is effective for improving the impairments caused by Parkinson’s disease,” Watts said. “We want to verify that Punching Out Parkinson’s is something that can be effective for Parkinson’s disease. We want to use science to demonstrate that this is effective.”

If the team can show that the program results in improvement in balance, muscle strength and speaking, the research would provide evidence-based support for other professionals who might be interested in providing this specific boxing exercise program to people with Parkinson’s disease in their communities.

Suzanne Maxwell joined the Punching Out Parkinson's program in 2015 after speaking with her neurologist. Photo by Joyce Marshall

To expand the research, Watts recruited TCU colleagues Joshua Carr, assistant professor of kinesiology, who is studying grip, walking ability and hand strength, and Adam King, associate professor of kinesiology, who is measuring reach and balance.

The research team is now studying people who have been diagnosed with Parkinson’s but have not boxed in the previous six months.

“One of the deeply ingrained common myths about exercise is that it’s dangerous,” Carr said. “It is a safe, highly effective way to improve your health and fitness and stay healthier longer.”

Carr said the project will lay the groundwork for a future study that will involve more participants over an extended period of time. The goal is to understand and offer evidence that engaging in exercise, specifically multimodal training such as boxing, slows the development and symptoms of Parkinson’s.

“We are hoping that we will be able to reverse some of the impairment — that is get them back to a level that they’re not at right now,” Watts said. “We hope that it will modify that deterioration over time.”

The Parkinson's Foundation found that 60,000 people are diagnosed with Parkinson’s every year. Photo by Joyce Marshall

Sucker Punch

Typically, the first stage of Parkinson’s disease is a so-called honeymoon period, which can last up to eight years. Treatment, including speech and physical therapy, is most effective during this time.

After the honeymoon phase, symptoms worsen: Speech begins to slur, medications lose efficacy, and patients have more problems with swallowing and balance.

Severity of the disease can vary between days or even within the same day.

Novak said that on good days he sleeps well, is less stressed and has more energy. On bad days he can’t get out of bed or stand up.

“It’s an absolute disaster because you feel like you’re at the mercy of medicine,” he said.

Novak said his life is shaped in four-hour bell curves between doses, with two possibly good hours in the middle and an hour on the way up and another on the way down. So he plans his life around his medication schedule. He also has undergone two brain surgeries, and he and his wife, Tamra, have moved to a one-story house to eliminate the risk of falling on stairs.

He estimated that he is between stages 2 and 3 of Parkinson’s. According to the Parkinson’s Foundation, stage 2 includes tremors, rigidity and other movement symptoms on both sides of the body. Walking and posture changes become more obvious, and daily tasks take longer.

Dan Novak said he thought he'd have a second career teaching business. Today he is a champion for the Parkinson's Foundation. Photo by Joyce Marshall

In stage 3, loss of balance and slowness of movement become bigger problems, and falls are common. Symptoms impair activities such as dressing and eating.

“It takes me five minutes to put my shoes on,” he said. Four years after he was diagnosed, Novak learned about Punching Out Parkinson’s.

“All I knew was it was an exercise class. It was hard work, it was competitive, you had a real coach and a real gym,” he said. “I went into it full speed.”

Novak started going to Punching Out Parkinson’s twice a week. Now he goes three times per week.

The grandfather said the drive to keep fighting is personal.

“I also know that I can’t stop. … Every morning at 7 a.m. I’m tempted to just not get up. It’s hard to do. But I can’t just stop exercising because the minute I stop is the moment I become much more of a burden to my wife.”

He said his balance, strength and movement are better because of boxing.

“It helps you feel like you’re fighting for something. You’re doing something about it,” said Novak, former chair of the People With Parkinson’s Council, part of the Parkinson’s Foundation.

Boxing skills can transfer to other parts of the daily lives of Parkinson’s sufferers, turning reaching into a closet or standing in line at a store into easier tasks.

King said postural control is important for day-to-day functioning, and boxing might improve that control. “We want to slow down the natural process of Parkinson’s disease and really try to give these individuals this quality of life.”

“All I knew was it was an exercise class. It was hard work, it was competitive, you had a real coach and a real gym,” Dan Novak said. “I went into it full speed.” Photo by Joyce Marshall

Baseline Study

The team designed the pilot study to gain a snapshot of the physical capabilities of Parkinson’s patients.

After participants start boxing at Ayala’s gym, they return for measurements at regular intervals for the next year.

In King’s lab, research participant Gus* stood and reached his right arm out as he leaned as far to the side as he could. The researcher was assessing mobility by measuring the distance between the starting point and the point Gus reached.

Gus moved to a different position for a reach that required a backward lean. Two short stumbles followed. Kuan Chen, a graduate student in kinesiology, was spotting the man to keep him from falling.

“I feel much better balance in my left side,” Gus said.

To measure balance, King asked Gus to stand on a force plate with his arms crossed against his chest, first with eyes open, then with eyes closed and finally atop a 2-inch-thick foam square to mimic uncertain footing.

The force plate, a flat blue square, is a measuring instrument that notes changes in postural sway. As Gus swayed, the plate sent data to the computer, which graphed changes in his balance.

Gus then moved to Carr’s lab. To measure controlled force, Carr asked Gus to apply pressure against a button with the side of his hand.

The research team asks participants to perform the same set of tasks on three different days. This enables them to find an average, which is especially important for a population with a malady marked by good days and bad days.

With participation in Ayala’s program, test subjects are likely to perform exercise tasks, such as force training, as well as or better than they did during earlier measurements.

“Strength training is health care,” said Carr, who specializes in neuromuscular physiology. “We have to identify the prescription for exercise to be a medicine.”

Thomas Troup, 77, was diagnosed with Parkinson’s disease more than a decade ago. Photo by Joyce Marshall

Two years ago, with the encouragement of his wife, Karen, Tony Walker started exercising at Paulie Ayala's gym. Photo by Joyce Marshall

Active Voices

Though he has the Harris College of Nursing & Health Sciences to run, Watts is committed to his Parkinson’s research.

Watts’ postdoctoral assistant, Zoë Thijs ’21 PhD, wrote in her dissertation about how people with Parkinson’s disease experience negative feelings, thoughts and actions regarding their voices. Their communication partners perceive this struggle, she found.

“Parkinson’s disease can dramatically impact how someone is able to communicate,” Watts said. “Typically, their words become slurred, their volume becomes very low. It becomes very difficult to understand them. But there are interventions that you can do.”

Thijs leads the speech pathology and respiration portions of the TCU study on Parkinson’s and boxing. To set a baseline, she measures how much pressure people with Parkinson’s can generate when blowing air out of their mouths.

Respiration is a driving force behind anything voice-related, she said, and a primary complaint about people with Parkinson’s is that they speak too softly.

In the lab, with his nose plugged and lips sealed around a blue mouthpiece, Gus breathed in as hard and as fast as he could and exhaled until no air was left.

“You’re better than your best one last time,” Thijs told him.

“Maybe today is just a really good day,” Gus said.

Thijs and Gus repeated the test four more times.

Gus then fit his nose and mouth into an oxygen mask-looking device that measured airflow as he repeated the prompt: “We were away a year ago.”

The exercise, which was also repeated four more times, allowed researchers to measure how much air he emitted during speech.

Next, with the same mask and the addition of a spaghetti-thin tube between his lips, he voiced, “Pah pah pah pah.”

The tube measured the pressure needed to generate voice.

“Air is the acoustic energy that people end up hearing,” Watts said. “Parkinson’s disease has an effect on breathing to support speech and voice and has an effect on how those vocal folds move, which has an effect on the airflow.”

An inability to speak clearly and be understood takes a toll on a Parkinson’s patient’s quality of life, Thijs said.

“My end goal is to improve their lives,” she said. “I just want to help them connect to people and stay connected.”

Joe Browder, among the oldest Punching Out Parkinson's boxers, was diagnosed with Parkinson's in 2015. His brother Jack Browder '60 attended class with him until his death at age 86. Photo by Joyce Marshall

Molly Brown said she was never an athlete, but Paulie Ayala’s positivity and encouragement led her to push herself physically and mentally. Photo by Joyce Marshall

Prize Fight

No matter the research results, Ayala has seen the evidence that vigorous workouts in his gym are helping people living with Parkinson’s.

He said he hopes that the work they do in the gym follows them home when they need the strength and balance to do a routine activity such as walking down a hallway.

“He calls us his champs,” said Molly Brown ’64, who has been attending Punching Out Parkinson’s since she was diagnosed a decade ago. “We believe it.”

People in the classes come from many professions. One man owned a mortgage company; another was a physician. Parkinson’s is indiscriminate.

Ayala, who retired from boxing in 2004, knows the name of each Punching Out Parkinson’s participant. He can easily talk about the people they are. He tries to catch people on their birthdays and leads the whole gym in song.

“This is a community, not just a workout facility,” he said. “These are my friends, and I want to make sure that I am doing everything I can to help them.”

“He is a kind-hearted soul,” said Brown, a former school administrator. “Whatever you need is what he gives you. He wraps everything with caring and concern and love. That gives you confidence.”

Ayala’s great-uncle started attending classes after his Parkinson’s diagnosis. The 92-year-old used a cane, but within a few months he wasn’t relying on it.

The pilot research study on the relationship between boxing and Parkinson’s will be instrumental in the next phase of work, Watts said. A future study will help differentiate changes happening in the body due to Parkinson’s versus aging.

“Physical exercise we know impacts how that disease progresses through the body,” Watts said. People “can be helped — that’s the important thing.”

A mural at Ayala’s gym reads “Never ever give up.” As people with Parkinson’s battle the seen and unseen, they have become fighters.

“Boxing is one of the best exercise programs to make us get up,” Novak said, “to win one round today and to fight again tomorrow.”

*Editor’s Note: Research participants cannot be identified by their real names.

Christopher Watts, the Marilyn and Morgan Davies Dean of Harris College of Nursing & Health Sciences, and boxer Paulie Ayala serve the same population of Fort Worth people suffering from Parkinson’s disease. Photo by Joyce Marshall

RECOGNIZING PARKINSON'S

Signs and symptoms of the disease

Compiled by Izzy Acheson

Can Boxing Strike a Blow Against Parkinson's?

Mental health and cognition

Parkinson’s patients may experience depression in early stages; a lack of motivation and interest in hobbies is possible. Later on, cognitive problems may occur; patients may experience hallucinations and delusions.

Posture and balance

Stooped posture is common in Parkinson’s patients; maintaining balance becomes more difficult. A drop in blood pressure caused by standing or changing position can result in lightheadedness and fainting.

Elimination

Parkinson’s may cause bladder problems, including the inability to control urine, and a slowing of the digestive tract, causing constipation.

Speech, swallowing and scent

Slurring words, hesitating before speaking and slower, monotone speech are common. Swallowing problems, which can lead to choking, can emerge as the disease progresses. Some patients may have a decreased ability to detect odors.

Automatic movements and sleep

The ability to perform unconscious movements such as facial expressions, blinking and arm movements while walking may decrease. Sleep issues can emerge, such as waking frequently at night or falling asleep during the day.

Fine motor

Tremors, usually in the form of shaky limbs or fingers, can occur while the body is at rest. Writing may become more difficult, and handwriting may become smaller.

Rigid muscles, slowed movement

Muscle stiffness may occur, making movement more difficult. Parkinson’s may slow movements, leading to smaller steps, dragging of feet and difficulty standing and sitting.

Sources: mayoclinic.org/parkinsons and michaeljfox.org/symptoms

Mike Hale, 74, was diagnosed with Parkinson's disease in 2021. Photo by Joyce Marshall

© 2026 TCU Magazine

Loading, please hold on.