Heidi Moawad, MD interviews Jori Fleisher, MD, MSCE, who provides preliminary evidence about the effect of karate on patients with PD.
The idea for a pilot study by Principal Investigator Jori E. Fleisher, MD at Rush University Medical Center1came directly from one of her patients who had a Parkinson disease (PD) diagnosis. As someone who has done a number of different aerobic forms of exercise, Pilates, yoga, and resistance training, the patient wanted to know whether anyone had studied karate for PD, as this discipline seem to pull together so many of the other activities that have shown benefit.
There is little research on karate for PD in the literature. The small, 10-week long pilot study investigated the feasibility and patient-centered outcomes of twice-weekly karate classes and individuals with early- to mid-stage PD.1 We measured retention in the program, adherence (attendance at classes), quality of life using a PD-specific instrument (PDQ-39), and several measures of gait, balance, and mobility. We also conducted pre- and post-intervention focus groups to explore expectations and concerns about karate before the classes began, and then to better understand the subjective benefits the participants appreciated post-intervention. From these focus groups, our qualitative data reflect a theme of camaraderie amongst the participants that was nearly universal, quite surprising, and very beneficial.
Based on the promising results from a pilot study, we designed a more rigorous, randomized controlled trial to better understand this intervention.2 In phase 2, subjects all attended a group baseline study visit, during which time we assessed their baseline physical activity, depression, anxiety, and quality of life. We administered several cognitive tests, the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr stage, and then measured several gait and balance parameters using wearable sensors through a collaboration with Dr Joan Ann O'Keefe. At that baseline group visit, we also provided participants with an update on the state of the science regarding exercise for PD delivered by an outstanding colleague, Joellyn Fox, DPT. Then, armed with a number of options for improving their baseline exercise routines, participants were randomized into either immediate-start—six months of twice weekly karate—or delayed-start—six months of being on the waiting list. After six months, we will repeat the baseline evaluations for all participants, and then the delayed-start arm will enter active karate classes twice weekly for the following six months. The immediate-start participants will have the option to continue their participation in classes, however, they will have to pay for classes on their own after this for six months. This gives us a chance to examine the real-world efficacy of this intervention as well.
Safety concerns. Our fantastic karate instructors understood that some of our participants might have balance impairments, and so we made sure that the teacher-to-student ratio was sufficient to provide individualized attention. The instructors were also aware of our participants' fear of falling, and they addressed it head-on. Rather than avoid the topic of falls, the instructors taught our participants HOW to fall safely, and then how to get up off the ground. This was something that came up over and over again in the post-intervention focus groups that participants found so helpful.
1. Fleisher JE. Rush University Medical Center. Karate Intervention to Change Kinematic Outcomes in Parkinson's Disease. ClinicalTrials.gov. https://ichgcp.net/clinical-trials-registry/NCT03555695. Accessed June 18, 2019.
2. Fleisher JE. Rush University Medical Center. Karate Intervention to Change Kinematic Outcomes in Parkinson's Disease. KICK OUT 2: A Phase Two, Randomized Trial of a Karate Intervention. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03882879. Accessed June 18, 2019.