Dr Nan Bahr
Maintenance of an active lifestyle and engagement in coordinated physical activities such as ballroom dance, bowling, yoga, and tai chi have been reported by others to temporarily and partially relieve or delay the progression of symptoms for those with Parkinson’s Disease. However, available reports only consider relatively low impact, uncomplicated, and very mildly strenuous pursuits. This paper provides an experiential account of the impact of regular vigorous and high impact martial arts training, specifically Taekwondo and Hapkido, for an individual diagnosed with Parkinson’s Disease over a five year period. This brief auto-ethnographic account provides some evidence that regular engagement in complex and energetic physical activity may contribute protective factors diminishing symptomatic escalation of the disease.
I was diagnosed with Parkinson’s Disease 5 years ago at the age of 53. With respect to the diagnostic criteria I presented with stiffness in my right arm and a sense that I was pushing my arm through treacle when manipulating my computer mouse (Bradykinesia), resting tremor in my right hand, loss in my sense of smell, and a general feeling of depreciated core balance. I was otherwise well and reasonably fit with respect to my age, with no known chronic health conditions.
Engagement in Martial Arts
At my initial clinical consultation, my neurologist emphasised the benefits of daily walking for 30 minutes, but this has not always been possible. However, across the five-year period since diagnosis, I have sustained my engagement in active martial arts training for traditional Taekwondo and Hapkido. I train for three to four times a week for a cumulative total of about 10 hours. There are 10 competency levels, or Gups, from beginner (white belt) to Cho Dan Bo (provisional black belt). At the start of the period I was rated as a Blue Belt (6th Gup) and have progressed to 2nd Dan Black Belt, or six steps through an increasingly difficult and rigorous curriculum. Figure 1 shows the belt progression.
Figure 1 Belt order from novice (white belt) to 2nd Dan Black Belt
Five year milestone
Five years after initial diagnosis, my condition is almost the same as at the start with a very slight persistence of the resting tremor. I continue to manage a demanding job as a University Professor and member of the Executive, and I am a competent musician. My medication has not changed over this time and I have not noticed any cognitive decline. I do not yet suffer from mental fogginess, or difficulty with comprehending complex problems. My musicianship, handwriting, speech, sleep patterns, and general metabolism seem unchanged. I have kept detailed notes of my own, and from comments made in my clinical sessions with the specialist, regarding my handwriting, gait, strength, and balance over these five years to enable a longitudinal trend evaluation my progression.
Progression of Parkinson’s Disease at 5 years
Research into the progression of Parkinson’s Disease, using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MD-PDRS) report that 95% of sufferers experience an annual increase of symptoms of 4.68 points attaining an overall change of 54.89 points (of 100) +/-23.36 on the MD-UPDRS over 60 months (Holden et al, 2018). The general research literature suggests that at five years since diagnosis I could reasonably expect to have moved toward stage 3 on the progression steps for Parkinson’s Disease. This would see me at the five year milestone exhibiting impaired dressing and eating capabilities, significant loss of balance, noticeably slower movements, some cognitive impact, and an increase in the incidence of falls.
I can report that I feel that I have had no change in my symptoms over the five years.
I maintain a notebook with all my business notations for each year. This is handy because I have an authentic record of my hastily written hand notes across these years. Handwriting excerpts from 2015 through to 2020 are shown in Figure 1.
Figure 2: Handwriting examples from notebooks 2015 through to 2020
I have also graded for Taekwondo regularly across the period and Figure 2 shows actions at sequential testing points since 2015.
Figure 3: Photographic diary of gradings since diagnosis.
What does Taekwondo/Hapkido entail?
A typical training session incorporates stretching, vigorous form/pattern demonstrations that incorporate whole of body actions (kicks, punches, blocks, balancing, sparring), and self-defence actions involving fine motor control (hand grabs) coordinated with gross motor control. Apart from general coordination and quick response demands, the whole enterprise requires a level of unhesitating fearlessness with respect to committing to challenging complex action sequences (spinning kicks, jumping kicks) and particularly in the performance of patterns and technical elements.
A common observation of Parkinson’s sufferers is a tendency to be hesitant in their movements especially where balance is required. Martial arts do not forgive hesitations, requiring practitioners to act instinctively and to anticipate their responses to potential attack scenarios. This places a degree of cognitive demand unmatched by a program for regular walking. The kicking requirements, especially the spinning kicks, require the constant attention to balance. Unique to Taekwondo is the amplification of power in any strike or kick through the employment of perpendicular rotational force. That is, movement into a kick relies upon winding the body up and swiftly releasing the hips so that the strike engages with the potential force as well as the basic contribution of core strength. Another feature of Taekwondo is the folding of joints so that the strike is assisted by a springlike release. Most other actions for Taekwondo have a great deal of similarity to many other martial arts. This probably extends from the shared origins of most contemporary forms.
Taekwondo is strategic, complex, coordinated, and builds fitness. If you do not want to be struck by an opponent then you need to anticipate their approach, and to quickly get out of the way while setting yourself up for a dominant response; and you do not have time to deliberate. This may well be the essence of success for stalling the progression of symptoms for Parkinson’s disease, at least in the early stages.
Based on my experience, and I do understand that it is a sample of one, I thoroughly recommend Taekwondo for people living with Parkinson’s and perhaps for other neurologically based mobility and balance disorders.
Some relevant references:
Crizzle, A. M., & Newhouse, I. J. (2006). Is physical exercise beneficial for persons with Parkinson’s disease? Clinical Journal of Sport Medicine, 16(5), 422-425.
Goodwin, V. A., Richards, S. H., Taylor, R. S., Taylor, A. H., & Campbell, J. L. (2008). The effectiveness of exercise interventions for people with Parkinson’s disease: A systematic review and meta‐analysis. Movement disorders, 23(5), 631-640.
Hackney, M. E., & Earhart, G. M. (2008). Tai Chi improves balance and mobility in people with Parkinson disease. Gait & posture, 28(3), 456-460.
Hirsch, M. A., & Farley, B. G. (2009). Exercise and neuroplasticity in persons living with Parkinson’s disease. Eur J Phys Rehabil Med, 45(2), 215-29.
Holden, S. K., Finseth, T., Sillau, S. H., & Berman, B. D. (2018). Progression of MDS‐UPDRS scores over five years in de novo Parkinson disease from the Parkinson’s progression markers initiative cohort. Movement disorders clinical practice, 5(1), 47-53.
Wąsik J, Ortenburger D, Góra T. (2016). The kinematic effects of taekwondo strokes in various conditions the outside environment. Interpretation in the psychological aspect and perspective of application in sport, health-related training and survival abilities. Archive of Budo; 12: 287-292.