{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T22:27:28Z","timestamp":1788647248766,"version":"build-2803163510"},"reference-count":57,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health\/National Institute of General Medical Sciences under the Mountain West Center","award":["#U54GM104944"],"award-info":[{"award-number":["#U54GM104944"]}]},{"name":"Idaho Elks Rehab Societ","award":["#U54GM104944"],"award-info":[{"award-number":["#U54GM104944"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Persons with Parkinson\u2019s disease (PD) are at elevated risk of falling due to deficits in postural control, lower limb strength, and sensory integration. While community-based boxing programs (CBPs) have shown promise in improving strength and balance, their feasibility and potential role in addressing fall risk remain unclear. This preliminary, prospective cohort study explored the feasibility of a CBP enhanced with individualized balance training tailored to somatosensory deficits and explored early indications of potential impact on fall risk and related outcomes. Methods: Twenty individuals with mild-to-moderate PD participated in a 12-week exercise program consisting of group-based boxing, functional circuit training, and one-on-one balance training based on the Modified Clinical Test of Sensory Interaction in Balance. Self-reported falls were collected at baseline and 3 months post-intervention. Secondary outcomes included standard measures of balance, gait, and functional mobility. Results: Participants demonstrated significant improvements in balance and functional mobility including the Timed Up and Go (F(2, 40.85) = 24.83, p &lt; 0.001, \u03b72 = 0.580), Five Times Sit-to-Stand Test (F(2, 78.13) = 50.22, p &lt; 0.001, \u03b72 = 0.736), and Berg Balance Scale (F(2, 193.39) = 12.72, p &lt; 0.001, \u03b72 = 0.414), among others. 4 participants experienced a decrease in falls, 2 experienced an increase, and the remainder had no change. Conclusions: These preliminary findings suggest that integrating individualized balance training with a CBP is feasible and may positively influence functional mobility and balance in persons with PD. However, effects on fall reduction remain inconclusive. These results should be interpreted as exploratory and used to inform the design of future structured clinical trials.<\/jats:p>","DOI":"10.3390\/brainsci15080858","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T07:45:31Z","timestamp":1755071131000},"page":"858","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Feasibility of a Community-Based Boxing Program with Tailored Balance Training in Parkinson\u2019s Disease: A Preliminary Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5013-3018","authenticated-orcid":false,"given":"Evan V.","family":"Papa","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences, Tufts University School of Medicine, 800 5th Ave., Seattle, WA 98104, USA"},{"name":"Tisch College of Civic Life, Tufts University, 163 Packard Ave., Medford, MA 02155, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2315-8041","authenticated-orcid":false,"given":"Kathryn E.","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Tufts University School of Medicine, 800 5th Ave., Seattle, WA 98104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-5687","authenticated-orcid":false,"given":"James M.","family":"Smoliga","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Tufts University School of Medicine, 800 5th Ave., Seattle, WA 98104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pelicioni, P.H.S., Menant, J.C., Latt, M.D., and Lord, S.R. (2019). Falls in Parkinson\u2019s Disease Subtypes: Risk Factors, Locations and Circumstances. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16122216"},{"key":"ref_2","first-page":"362572","article-title":"Risk of falls in Parkinson\u2019s disease: A cross-sectional study of 160 patients","volume":"2012","author":"Contreras","year":"2012","journal-title":"Park. Dis."},{"key":"ref_3","first-page":"906274","article-title":"Recurrent falls in Parkinson\u2019s disease: A systematic review","volume":"2013","author":"Allen","year":"2013","journal-title":"Park. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s13760-023-02428-2","article-title":"Prognostic factors for falls in Parkinson\u2019s disease: A systematic review","volume":"124","year":"2024","journal-title":"Acta Neurol. Belg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/1545968313508470","article-title":"The relative contribution of physical and cognitive fall risk factors in people with Parkinson\u2019s disease: A large prospective cohort study","volume":"28","author":"Paul","year":"2014","journal-title":"Neurorehabilit. Neural Repair."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1002\/mds.20115","article-title":"Falls and freezing of gait in Parkinson\u2019s disease: A review of two interconnected, episodic phenomena","volume":"19","author":"Bloem","year":"2004","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/NPT.0b013e3181990fcc","article-title":"The effects of exercise on balance in persons with Parkinson\u2019s disease: A systematic review across the disability spectrum","volume":"33","author":"Dibble","year":"2009","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_8","first-page":"876","article-title":"A Community-based Boxing Program is Associated with Improved Balance in Individuals with Parkinson\u2019s Disease","volume":"14","author":"Moore","year":"2021","journal-title":"Int. J. Exerc. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1177\/1545968315613447","article-title":"Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson\u2019s Disease: A Meta-analysis","volume":"30","author":"Shen","year":"2016","journal-title":"Neurorehabilit. Neural Repair."},{"key":"ref_10","first-page":"193","article-title":"Regular Exercise, Quality of Life, and Mobility in Parkinson\u2019s Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data","volume":"7","author":"Rafferty","year":"2017","journal-title":"J. Park. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-0041-1725133","article-title":"Evidence for Early and Regular Physical Therapy and Exercise in Parkinson\u2019s Disease","volume":"41","author":"Ellis","year":"2021","journal-title":"Semin. Neurol."},{"key":"ref_12","first-page":"615","article-title":"Implementation of a Community-Based Exercise Program for Parkinson Patients: Using Boxing as an Example","volume":"9","author":"Domingos","year":"2019","journal-title":"J. Park. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.neubiorev.2014.09.009","article-title":"Dance as an intervention for people with Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"47","author":"Sharp","year":"2014","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1056\/NEJMoa1107911","article-title":"Tai Chi and Postural Stability in Patients with Parkinson\u2019s Disease","volume":"366","author":"Li","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_15","first-page":"117","article-title":"Community-based group exercise for persons with Parkinson disease: A randomized controlled trial","volume":"32","author":"Combs","year":"2013","journal-title":"NeuroRehabilitation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"P5.075","DOI":"10.1212\/WNL.90.15_supplement.P5.075","article-title":"Effects of Rock Steady Boxing on Activities of Daily Living and Motor Symptoms of Parkinson\u2019s Disease (P5.075)","volume":"90","author":"Larson","year":"2018","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"132","DOI":"10.2522\/ptj.20100142","article-title":"Boxing training for patients with Parkinson disease: A case series","volume":"91","author":"Combs","year":"2011","journal-title":"Phys. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6034","DOI":"10.1080\/09638288.2021.1963854","article-title":"High satisfaction and improved quality of life with Rock Steady Boxing in Parkinson\u2019s disease: Results of a large-scale survey","volume":"44","author":"Larson","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Morris, M.E., Ellis, T.D., Jazayeri, D., Heng, H., Thomson, A., Balasundaram, A.P., and Slade, S.C. (2019). Boxing for Parkinson\u2019s Disease: Has Implementation Accelerated Beyond Current Evidence?. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.01222"},{"key":"ref_20","first-page":"2585","article-title":"Boxing with and without Kicking Techniques for People with Parkinson\u2019s Disease: An Explorative Pilot Randomized Controlled Trial","volume":"12","author":"Domingos","year":"2022","journal-title":"J. Park. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1177\/15459683211023197","article-title":"Boxing vs Sensory Exercise for Parkinson\u2019s Disease: A Double-Blinded Randomized Controlled Trial","volume":"35","author":"Sangarapillai","year":"2021","journal-title":"Neurorehabilit. Neural Repair."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1016\/j.apmr.2013.02.020","article-title":"Using the Timed Up & Go test in a clinical setting to predict falling in Parkinson\u2019s disease","volume":"94","author":"Nocera","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1519\/JPT.0000000000000110","article-title":"Instrumented Test of Sensory Integration for Balance: A Validation Study","volume":"41","author":"Freeman","year":"2018","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"733","DOI":"10.2522\/ptj.20070214","article-title":"Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism","volume":"88","author":"Steffen","year":"2008","journal-title":"Phys. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"114","DOI":"10.2522\/ptj.20090126","article-title":"Minimal detectable change of the timed \u201cup & go\u201d test and the dynamic gait index in people with Parkinson disease","volume":"91","author":"Huang","year":"2011","journal-title":"Phys. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1093\/ptj\/81.2.810","article-title":"Reliability of measurements obtained with the Timed \u201cUp & Go\u201d test in people with Parkinson disease","volume":"81","author":"Morris","year":"2001","journal-title":"Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/ptj\/85.2.134","article-title":"Testing functional performance in people with Parkinson disease","volume":"85","author":"Brusse","year":"2005","journal-title":"Phys. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3138\/ptc.2009-08","article-title":"Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease","volume":"63","author":"Klassen","year":"2011","journal-title":"Physiother. Can."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/ptj\/77.1.19","article-title":"Reliability of impairment and physical performance measures for persons with Parkinson\u2019s disease","volume":"77","author":"Schenkman","year":"1997","journal-title":"Phys. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.parkreldis.2004.06.003","article-title":"Measuring gait and gait-related activities in Parkinson\u2019s patients own home environment: A reliability, responsiveness and feasibility study","volume":"11","author":"Lim","year":"2005","journal-title":"Park. Relat. Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/01.NPT.0000282569.70920.dc","article-title":"Predicting Falls In Individuals with Parkinson Disease: A Reconsideration of Clinical Balance Measures","volume":"30","author":"Dibble","year":"2006","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1053\/apmr.2002.30934","article-title":"Is the functional reach test useful for identifying falls risk among individuals with Parkinson\u2019s disease?","volume":"83","author":"Behrman","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1093\/ptj\/78.6.577","article-title":"Performance on clinical tests of balance in Parkinson\u2019s disease","volume":"78","author":"Smithson","year":"1998","journal-title":"Phys. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2522\/ptj.20100113","article-title":"Functional gait assessment and balance evaluation system test: Reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall","volume":"91","author":"Leddy","year":"2011","journal-title":"Phys. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.apmr.2011.04.008","article-title":"Five times sit-to-stand test performance in Parkinson\u2019s disease","volume":"92","author":"Duncan","year":"2011","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/mds.22924","article-title":"External validation of abbreviated versions of the activities-specific balance confidence scale in Parkinson\u2019s disease","volume":"25","author":"Lohnes","year":"2010","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_38","first-page":"141","article-title":"Reliability of real time motion analysis system VirtuBalance as compared to traditional measurement methods of functional reach and postural Sway","volume":"8","author":"Dodge","year":"2015","journal-title":"J. Stud. Phys. Ther. Res."},{"key":"ref_39","unstructured":"Dinglasan, V., and Landers, M.R. (2019, January 23\u201326). Reliability and concurrent validity of a portable infrared camera to assess gait. Proceedings of the American Physical Therapy Association Combined Sections Meeting, Washington, DC, USA."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"934","DOI":"10.70252\/SJCP5355","article-title":"Concurrent Validity of the VirtuSense\u00ae Gait Analysis System for the Quantification of Spatial and Temporal Parameters of Gait","volume":"11","author":"Strubhar","year":"2018","journal-title":"Int. J. Exerc. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1056\/NEJM198812293192604","article-title":"Risk factors for falls among elderly persons living in the community","volume":"319","author":"Tinetti","year":"1988","journal-title":"N. Engl. J. Med."},{"key":"ref_42","unstructured":"Portney, L.G., and Watkins, M.P. (2009). Foundations of Clinical Research: Applications to Practice, Pearson\/Prentice Hall. [3rd ed.]."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Permezel, F., Alty, J., Harding, I.H., and Thyagarajan, D. (2023). Brain Networks Involved in Sensory Perception in Parkinson\u2019s Disease: A Scoping Review. Brain Sci., 13.","DOI":"10.3390\/brainsci13111552"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/0165-0173(85)90010-4","article-title":"A consideration of sensory factors involved in motor functions of the basal ganglia","volume":"356","author":"Lidsky","year":"1985","journal-title":"Brain Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s13760-023-02420-w","article-title":"Proprioceptive and olfactory deficits in individuals with Parkinson disease and mild cognitive impairment","volume":"124","author":"Li","year":"2024","journal-title":"Acta Neurol. Belg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S1474-4422(13)70213-8","article-title":"Sensory aspects of movement disorders","volume":"13","author":"Patel","year":"2014","journal-title":"Lancet Neurol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4103\/NRR.NRR-D-23-01484","article-title":"Multisensory mechanisms of gait and balance in Parkinson\u2019s disease: An integrative review","volume":"20","author":"Roytman","year":"2024","journal-title":"Neural Regen. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.neuroscience.2007.01.052","article-title":"Impaired vertical postural control and proprioceptive integration deficits in Parkinson\u2019s disease","volume":"146","author":"Vaugoyeau","year":"2007","journal-title":"Neuroscience"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.gaitpost.2013.03.028","article-title":"The effect of moderate Parkinson\u2019s disease on compensatory backwards stepping","volume":"38","author":"McVey","year":"2013","journal-title":"Gait Posture"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e006095","DOI":"10.1136\/bmjopen-2014-006095","article-title":"Trunk muscle exercises as a means of improving postural stability in people with Parkinson\u2019s disease: A protocol for a randomised controlled trial","volume":"4","author":"Hubble","year":"2014","journal-title":"BMJ Open"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1136\/jnnp.2003.016550","article-title":"Repetitive training of compensatory steps: A therapeutic approach for postural instability in Parkinson\u2019s disease","volume":"75","author":"Heuschkel","year":"2004","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1002\/mds.23790","article-title":"Balance and falls in Parkinson\u2019s disease: A meta-analysis of the effect of exercise and motor training","volume":"26","author":"Allen","year":"2011","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1212\/WNL.0000000000001155","article-title":"Exercise for falls prevention in Parkinson disease: A randomized controlled trial","volume":"84","author":"Canning","year":"2015","journal-title":"Neurology"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Moll\u00e0-Casanova, S., Pedrero-S\u00e1nchez, J., Ingl\u00e9s, M., L\u00f3pez-Pascual, J., Mu\u00f1oz-G\u00f3mez, E., Aguilar-Rodr\u00edguez, M., Sempere-Rubio, N., and Serra-A\u00f1\u00f3, P. (2022). Impact of Parkinson\u2019s Disease on Functional Mobility at Different Stages. Front. Aging Neurosci., 14.","DOI":"10.3389\/fnagi.2022.935841"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.1519\/JSC.0000000000000539","article-title":"Changes in exercises are more effective than in loading schemes to improve muscle strength","volume":"28","author":"Fonseca","year":"2014","journal-title":"J. Strength Cond. Res.\/Natl. Strength Cond. Assoc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0001-4575(99)00066-4","article-title":"Validating recall of falls by older people","volume":"32","author":"Peel","year":"2000","journal-title":"Accid. Anal. Prev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1590\/bjpt-rbf.2014.0095","article-title":"Prospective monitoring and self-report of previous falls among older women at high risk of falls and fractures: A study of comparison and agreement","volume":"19","author":"Garcia","year":"2015","journal-title":"Braz. J. Phys. Ther."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/8\/858\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:26:08Z","timestamp":1760034368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/8\/858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":57,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["brainsci15080858"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15080858","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]}}}