Effect of Pilates and boxing in patients with Parkinson disease: a case study

Purpose: The most important predictors of the quality of life in patients with Parkinson disease (PD) are balance and gait. Treatments with levodopa aim to compensate for dopaminergic deficits, reducing bradykinesia and rigidity, but causing dyskinesia and greater speed of movement which increases the falls percentage. In addition to pharmacological and surgical therapy, rehabilitation through physical exercise has been re-evaluated in recent years: many studies show how rehabilitation, through balance and gait exercises, reduce falls and improves the quality of life. Pilates has been shown to improve axial stability and core muscle function through a performance of coordinated movement sequences, but the effect on balance and gait wasn’t evaluated with markerless pose estimation. Moreover we combine Pilates with boxing, which has shown to improve functional mobility. In these case study we investigated the effect of Pilates and boxing on balance control and gait through Time Up and Go test (TUG) and computerized static stabilometry, combined with markerless pose estimation of DLC. Methods: Three patients with PD performed Mat Pilates and boxing during two weekly session of 60 minutes for 6 weeks. The patients performed TUG test and static stabilometry at the beginning and end of the intervention. In the static stabilometry the subjects stood on a force plate, where signals were sampled at 200 Hz, and performed two trials of 30 s: with open and closed eyes. With the platform we calculated the descriptive center of pressure (COP) in time and frequency domain. During each test kinematic analysis was evaluated through markerless pose estimation of DLC. Results: The subjects showed an improvement in TUG, performing a reduced time and better gait parameters. In static stabilometry the balance control and the pattern of postural sway were improved. Conclusions: Pilates protocol presented some improvement on balance control including postural and dynamic components. Mat Pilates combine with boxing may be an effective strategy of rehabilitation to improve the quality of life in PD patients. Therefore, exercise in combination with pharmacologic and surgical therapy may be the most effective form of treatment for Parkinson disease.