Steve Osborne comes to tire himself out.
The 61-year-old suffers tremors and balance issues from Parkinson's disease. But they don't stop him from spending 90 minutes once or twice a week jabbing boxing bags, banging out pushups and working his core with plank exercises.
He takes part in Rock Steady Boxing, an international program aimed at helping to ease the symptoms of the neurodegenerative disorder that leads to tremors and movement problems. The class guides participants through intense and high-energy boxing drills designed to strengthen the body mentally and physically.
"I'm worn out at the end, but I move a lot better," he said.
It was once thought that exercise was too stressful for those with Parkinson's and would further deplete their levels of the chemical dopamine. Dopamine, which transmits signals between areas in the brain that coordinate muscle movement, declines in people with Parkinson's.
In the last decade or so, research has shown that intense exercise, like that at Rock Steady Boxing, is instead beneficial.
A study by the Parkinson's Foundation found that people with the disease who exercised at least 2½ hours a week experienced slower declines in quality of life than those who didn't exercise at all. A Cleveland clinic study found that when people with Parkinson's cycled on a stationary bike 30 percent faster than their comfort level, they showed an improvement in motor function.
"Now we say work out hard to get yourself sweating, get your heart rate going and get your blood pumping," said Elena Isaacson, a physical therapist with Sinai Hospital in Baltimore who refers people to the boxing program. "Just because you see tremors doesn't mean that someone is weak. They have the full capability to participate in a workout just like you or I would."
Rock Steady Boxing was founded 12 years ago by Scott C. Newman, a county prosecutor in Indiana looking at ways to improve his health after being diagnosed with Parkinson's at age 40. He took private boxing lessons and noticed a quick and dramatic improvement in his quality of life.
There are now 536 Rock Steady Boxing programs around the world, including 12 in Maryland. Osborne takes classes at Lorien Mays Chapel nursing home in Timonium.
When boxers work out, they condition for agility, speed, endurance, accuracy, balance and strength — many of the same functions that decline in people with Parkinson's.
"Boxing works so well because it is really intense and vigorous exercise," said Patricia Wessels, a physical therapist at Mind Body Physical Therapy & Wellness Center Inc. and a Rock Steady coach. "Boxing requires some of the very things Parkinson's takes away — rotational movement, power, a lot of twisting. Twisting is one of the things that fades away during Parkinson's."
During the Rock Steady Boxing classes, participants rotate through stations that each feature a different exercise that works on a specific skill. One stop may feature a combination of punches on a bag to work on strength and hand and eye coordination. Another may feature the bear crawl, or moving across the floor on their hands and feet. This helps with coordination and being able to perform everyday functions like getting in and out of bed.
The classes usually include exercises that make people stand up straight and open their chests because people with Parkinson's tend to hunch over as their bodies weaken. Some instructors egg their participants into making loud noises to help them through tough exercises, and also to strengthen their vocal cords. Weakened vocal cords tend to cause those with Parkinson's to speak softly or suffer from vocal cord spasms. They may also have trouble swallowing.
"We want to hear them grunt," said Dara Alicando, director of rehab at Lorien Mays Chapel, who also teaches the boxing class there.
Boxing and other exercises don't cure the disease or reverse damage, but can improve movement and a person's quality of life. Some studies have also found staying active doesn't necessarily stop the decline of dopamine, but may help those with Parkinson's more efficiently use what they have left of the chemical.
The exercises can be modified for people with all stages of the disease, including those in wheelchairs. People can do pushups against the wall if they are not able to get on the ground.
Rock Steady Boxing is one of the exercise programs supported financially by the Maryland Association for Parkinson Support Inc. They also help support a biking program in Ellicott City, choirs made up of people with Parkinson's and a workout program at the Brick Bodies Padonia gym.
"The research shows that exercise is as important as the medicine in quality of life with people with Parkinson's," said Rona Rosenbaum, founder and president of the organization. "We want to get people involved in exercise as soon after diagnosis as we can."
Wessels pushes participants hard during classes she teaches at Coppermine Fieldhouse.
"I know it's tiring," she howled during one recent class. "Do not get tired."
After sparring with Wessels, Larry Walsh, 53, bent and placed his hands on his knees, his chest rising up and down with heavy breathing.
"Woo!" said Walsh, who was diagnosed with Parkinson's 1½ years ago. "I am glad that is over." He later said he loves the class because he feels like it helps him deal with the loss of strength. The challenge of the class is invigorating, he said.
Rock Steady Boxing is part of an exercise regimen for Len Schwartz that also includes swimming, yoga and tai chi. The former attorney, 58, was diagnosed with the disease 15 years ago. His tremors are visible when he sits in a chair, but he looked strong during a class at Lorien Mays Chapel with little indication of tremors.
"It's intense," he said of the class. "My body doesn't like it after I get home, but it makes me stronger."
Instructors and supporters of the class said they see improvements in participants the more classes they take. They start to punch the bags harder and faster. They are able to do a larger number of pushups and become more flexible. Some stand up straighter.
Others become more empowered and self-confident because they are not sitting at home.
"The best thing is the community and friendship," said Gwen Kucner, 71, who was diagnosed three years ago and takes the classes at Lorien Mays Chapel. "It's like you're part of a Parkinson's family."
Kucner's daughter bought her a robe with a G on the back for Super Gwen. JoAnn Presbitero, who recruits for Lorien Health Services and helped bring the boxing program to the Baltimore County facility, said all of the participants leave class feeling stronger.
"They all walk out of here like they are superheroes," she said.