Fighting for independence: The rise of martial arts in rehab

Martial arts classes are transforming the lives of people living with neurological conditions such as multiple sclerosis (MS) and Parkinson’s disease. NR Times editor Stephanie Price speaks to Adam Poulter, founder of Foundation Physio, to find out more.

Neurophysiotherapy service Foundation Physio is helping its clients to build strength, flexibility and co-ordination through a ten-week martial arts programme utilising boxing, muay thai and brazilian jiu jitsu.

The classes have been hugely successful, with participants seeing dramatic improvements of 8 to 15 per cent in functional measures.

Poulter, who founded Foundation Physio over 10 years ago to provide community-based services such as hydrotherapy and fitness classes, often in collaboration with charities, says that the programme’s success highlights the benefits of non-adaptive, high-intensity exercise for neurological rehabilitation.

Poulter also believes that the classes could offer an opportunity to be incorporated into the government’s new 10-year healthcare plan for preventative healthcare – improving long-term health outcomes and saving on healthcare costs.

Research has shown that physical exercise such as boxing classes for people with neurological conditions is beneficial for physical ability and quality of life, and researchers say that it is an important approach for slowing down the progression of neurodegenerative disease.

Foundation Physio works with Parkinson’s UK to provide fitness classes such as boxing for Parkinson’s patients, inspiring the team to open the concept to a broader range of neurological clients.

“One of our team members who runs our classes is called Amado, and he has always been into martial arts,” says Poulter.

“We thought about martial arts more generally, such as the benefits of floor work and kicking and decided to partner with a local gym whose owner had also experienced a brain injury.

“This meant that he really understood what we were trying to achieve by creating a higher level class that is accessible for people with neurological conditions.”

Poulter explains that the classes are adaptive where needed, but that the team wanted the classes to feel like they were attending a non-adaptive class.

Working with clients living with brain injury, MS and Parkinson’s, Foundation Physio began providing a small trial class, taking outcome measures at the start and the end of the course.

“People at this level often do not want a class that feels adapted,” says Poulter.

“We run plenty of condition specific classes, for example, classes that are Parkinson’s focused, so sometimes it helps to bring a mixed group together and let them learn at their own pace, as novices. It is the same as if you or I went to our first class and worked hard.

“We focussed on functional goals that we wanted people to achieve. Amado has people kicking, standing on one leg, getting on and off the floor and boxing with noodles.”

For the measurements, the team included exercises such as backward walking, timing movement on and off the floor, and how many sit-to-stands in one minute.

“We also took functional measures that are less traditional, such as measuring the length of a multidirectional lunge to see how far someone can step in any direction,” says Poulter.

“We tested at the beginning and after ten sessions. From the results everyone saw average gains of about eight to 15 per cent across the group, which is quite significant and the feedback has been excellent.”

Poulter says that participants have reported feeling stronger, and a number of Parkinson’s clients describe that they are walking taller.

“These are people already known to our service who have attended our classes for a while, so it is not just the effect of starting exercise,” says Poulter.

“Some have been with us for three or four years. We have simply increased the intensity and it has made a significant difference, which is very encouraging.”

Functional moves for improved outcomes

The high-intensity classes have focused on functional movements that can translate into everyday living, contributing to significant improvements.

Group participants saw 17 per cent improvement in left leg forward lunges, 15 per cent improvement in left leg backwards lunges, 15 per cent improvement in right leg backward lunges, and 10 per cent improvement in on/off floor movements, for example.

“Amado is trained in Muay Thai, which in simple terms involves punching and kicking,” says Poulter.

“He has also done additional training in Brazilian jiu jitsu, which is more floor based and includes holds.

“We put that jiu jitsu element into functional positions that people are likely to encounter day to day, such as floor based work – building confidence getting up and down.

“The class also challenges people to stand and box while moving their feet and arms together.

“Single leg standing is trained through kicking, and different kicks require different body movements, whether a front kick or something more rotational.

“The structure keeps the intensity high, so people are working continuously.

“Some of our other mixed ability classes become more like HIIT circuits, which are good and intensive, but if you want to push fitness and cardiovascular work, this format can be more challenging.

“It stimulates the nervous system as well as the cardiovascular system, which supports neuroplasticity and motor learning.”

These outcomes have translated into improved physical fitness as well as improved quality of life for the class participants.

“One client who struggled to stand on her left leg because of the tone in her foot has seen her balance and tone improve simply by standing on that leg to kick with the other,” says Poulter.

“We had a woman with MS who could not do a star jump, struggled to get off the floor, and her foot tended to roll out due to poor stability. She can now do full star jumps for over a minute and feels she has better control of her foot.

“That is a big change in stability, balance and control, and it reflects strength and motor output in a powerful, functional movement.

“Another woman with Parkinson’s reported improved trunk alignment. She had been very kyphotic and stooped, and noticed she felt more upright.

“With better posture she had better control of her legs, with less freezing and less shuffling.

“Those were two lovely pieces of feedback and a real boost in confidence.”

As well as improving muscle strength and co-ordination, Poulter highlights that barefoot work can help improve neurological mapping of the foot, with some research suggesting that sensory stimulation of the foot can facilitate the sensory system in improving motor output in people with Parkinson’s, for example.

“Sensory input matters. Shoes are designed to give support, but barefoot work can be very good for the intrinsic foot muscles,” says Poulter.

“People talk about barefoot running for that reason. When there are neurological impairments, doing exercise barefoot can be very helpful when it is safe to do so.”

The government’s 10-year Fit for the Future health plan is aiming to radically shift healthcare in the UK by changing focus from hospitals to community care, from analogue to digital care and from treating sickness to preventing sickness.

Poulter says this martial arts programme and similar exercise programmes that take place within community settings could be an untapped opportunity for the government’s plan.

“If you look at the ten year plan, it emphasises collaboration, health prevention and promotion of physical activity,” says Poulter.

“For people with neurological conditions, there is a recognised gap – people go into A&E, the acute problem is addressed, but function often declines.

“They may go straight back in, or return with falls.

“We are not reaching people at diagnosis. Parkinson’s UK has long pushed for people to be seen by a specialist physiotherapist at diagnosis to get the right advice.”

While plans to go digital healthcare can provide new opportunities in healthcare, Poulter says that there is not currently equitable access to healthcare technology.

“Technology is brilliant as an adjunct and some tools are very useful, however, not all technology is equally useful,” says Poulter.

“It is largely inaccessible unless you are one of the very big clinics, and then the patient needs the finances to access it.

“By running classes in combination with boxing gyms, personal trainers and local gyms, we can combine skill sets and locations.

“Neuro-specialist physiotherapists bring knowledge of the conditions, while gym and martial arts venues provide the environment.

“Personal trainers bring strength and conditioning expertise, and martial arts coaches bring their sport specific knowledge.

“It is a collaborative approach to long term public health for people with long-term conditions and complex disability.

“Technology is great, but it does not solve the problem on its own. The tech sector still has a way to go to deliver what is promised.”

This approach could contribute to huge cost-savings, says Poulter, and contribute to better long-term health outcomes.

“Many people we see have lost mobility and function and did not exercise before.

“They are more likely to have multiple comorbidities such as arthritis, diabetes and heart problems as a result of inactivity. We want to combine our knowledge with an underserved population in exercise.

“There is a lot for physically able people, such as Hyrox and CrossFit. Aside from programmes like PD Warrior – which is great for Parkinson’s – we want people to access exercise in a way that feels comfortable, safe and supportive.”

Foundation Physio’s martial arts programme is now a permanent class and the team continue to collect outcome measures.