By Colette Carr (Boxing vs Parkinson’s)

Boxing both inspires and distresses the masses.

Whether they go by boxer, fighter, bruiser or pugilist, the focus, skill and mental tenacity runs deep.

We often see images of boxers falling to their knees in defeat, crashing down from a pedestal they propped themselves upon before the bout, a literal and powerful depiction of pride before a fall.

But boxing can be empowering, and what if it can be used to raise people who are on the ropes up?

Former Under-19s British champion and Coventry Uni OT graduand Charles Delve is doing just that. Using a blend of evidence-based OT and non-combat boxing training, Charles is going for the jugular, aiming for the total knockout of Parkinson’s disease with the sweet science.

“I started boxing at fourteen and it instilled the importance of hard work and dedication in me. I began to help my coach, coaching non-contact boxing at schools and pupil referral units at 17 and this is when I first witnessed other people experiencing the same feelings of empowerment.

“As I learnt more about occupational therapy and grew in my role as an OT assistant I have been able to clinically reason why the meaningful activity of non-contact boxing can be used as a therapeutic intervention,” the 27-year-old explained.

While popular in North America and Australasia, the practice of infusing boxing training into occupational therapy in the UK currently begins and ends with Charles, who is the only qualified Counterpunch Parkinson’s coach in the country.

A Bristol gym hosts classes for those living with Parkinson’s, but it was down under where Charles was first exposed to it.

“I was aware that boxing was being used as an intervention for people with Parkinson’s in America,” the Bromsgrove native told.

“I saw on social media that sessions were being advertised for people with Parkinson’s in a gym that I was coaching at in New Zealand that were called ‘Counterpunch Parkinson’s’, the sister organisation of ‘Rock Steady Boxing’ in America. I contacted the Counterpunch director Lisa Gombinsky Roach who has over 20 year’s experience in prescribing exercise for people with Parkinson’s.

“While she was in the UK in October she put me through the training. Since then, I have been working with people with Parkinson’s disease and developed my knowledge and professional network, talking with other healthcare professionals specialising in Parkinson’s from around the world.”

Boxing serves as the perfect catalyst for OT intervention in those living with Parkinson’s disease, with Charles tailoring exercises to support functional and occupational performance as well as supporting boxers in other areas of meaningful occupation.

“The OT process has informed the programme planning. There is a Parkinson’s specific initial assessment. Goal setting will take place regularly and outcomes will be measured by re-assessing and using regular videos and boxing tests,” he told.

“The unique point of this is I will be a qualified OT providing a specialised service. Take the boxing stance for example – I can ask someone to set up in their boxing stance without giving instructional prompts. Already, I am carrying out an activity analysis, analysing their cognition – looking at whether they can remember the stance I have shown, analysing their co-ordination and I am also analysing their muscle strength and postural stability.”

Preparing to qualify in the summer has also been on the OT assistant’s mind. Setting up the Box Positive programme has opened up a post-studying pathway for him, but the hard work isn’t over yet.

“I am looking for other OTs interested in delivering the programme nationwide and partner venues particularly boxing gyms that would like to host it.

“I would like to combat problems with sedentary lifestyles and reduce the number of falls. Once the programme is well established I would like to work with the NHS to reach as many people as possible and I would like the programme to provide the opportunity to carry out further longitudinal research studies into the impact of non-contact boxing,” he shared.

Anyone interested in the programme can contact Charles by emailing

Sparring Parkinson’s

Charles talks us through boxing as an intervention



Overall, it promotes falls prevention, leading to potential savings to the NHS. Socially, participants are referred to as boxers not patients, taking a strength-based approach, while forming a community for people to engage with health care professionals and fight the condition alongside others sharing a similar experience.


Classes are aimed to maximise a person’s independence. People that engage in group boxing had an improvement in physical competence, confidence and ability to complete ADL’s independently.

I encourage explosive, fast punches requiring fast twitch muscle fibres to counteract bradykinesia/slowed movement. If a person is finding daily living activities difficult such as turning in bed, we focus on rotational strength, with over-exaggerating hooks, building strength and endurance in muscles and specific mobility enhancing movements in both the lower and upper body. 

Person – Physical

New research is proving there are many neuroprotective benefits of high intensity exercise. Exercise and mental activity can lead to increased blood flow and cerebral growth such as brain derived neurotrophic factor (BDNF). Boxing is rhythmic, and dancing is an effective activity for people with PD. Classes involve shadow boxing to music targeting gait pattern to reduce freezing.

Movements are designed to make participants stretch to the target to improve posture and the target can be moved to a higher position.

Physical competence can be measured easily with boxing specific tasks, shouting or talking whilst punching to exercise speech and the voice system. Soft voice disorders are common in people with Parkinson’s.

Person – Cognitive

The classes are also ‘cognitively complex’, so tasks require mental focus and multi-tasking. Footwork drills such as skipping or agility ladders improve balance, mobility, gait pattern and build confidence therefore reducing the risk of falls, while classes include tasks that aim to improve hand-eye co-ordination and reaction time.

Person – Affective

Relaxation strategies can also be taught if required such as diaphragmatic breathing which reduces cortisol levels and videos can also be an empowering outcome measure allowing people to see improvements. Boxing requires a positive mental attitude and Box Positive has a deep meaning. Low mood, apathy and chronic depression are some of the non-motor, neuro-psychiatric symptoms of the condition.