Punching Out Parkinson's

The thud of heavy bags echoes across the gym as the guitar notes of Free Bird by Lynyrd Skynyrd play through the speakers.

“Right hook! Duck! Double jab! Block low!”

“WHAAMMMM! Wham, wham, WHAM!”

In the center of the ring, boxing gloves snap against the leather pads as combinations are called out.

In one corner of the room, participants roll their fists across a speed bag in a steady rhythm, the rapid patter echoing like a drumbeat.

“Whap-whap-whap, whap-whap-whap, whap-whap-whap.”

In another corner, someone ducks and weaves beneath a swinging slip bag.

Large fans buzz, jump ropes slap the ground, and every sound in the room blends into a constant rhythm of movement.

On the wall, a painted sign reads, “Never Ever Give Up. One Round at a Time – Punching Out Parkinson’s,” with photos of boxers lining the space around it.

The room smells of old leather and sweat-soaked canvas as everyone pushes themselves to their limit until the round-ending buzzer cuts through the noise.

Each person in the gym carries a different story, but they all share the same fight beyond the workout – pushing back against Parkinson’s Disease.

An Evidence-Based Program

As participation increased, so did interest from the medical community.

Dr. Michael Salvatore and Dr. Vicki Nejtek, along with their research team at the University of North Texas Health (UNT Health), began working with Punching Out Parkinson’s with a shared goal: to better understand how exercise could impact the progression of Parkinson’s Disease.

That connection, however, had been years in the making.

According to Dr. Nejtek, Dr. Salvatore was first introduced to the program in 2016, shortly after relocating to Fort Worth to continue his Parkinson’s research. At the time, his work focused primarily on animal models, studying how exercise could affect motor function and brain activity.

During a Punching Out Parkinson’s fundraiser that year, he met members of the boxing class community and was introduced to Paulie Ayala. Two years later, he returned as a guest speaker at another fundraiser, this time with a clearer vision of how the program could fit into his research.

“I was looking for a way to connect what we were seeing in the lab with real people,” said Dr. Salvatore. “Punching Out Parkinson’s was already doing something meaningful – people kept coming back – so the question became, how do we measure that?”

That question ultimately led to a collaborative research effort beginning in 2018, with findings published in 2022.

In their UNT Health study, Dr. Salvatore, Dr. Nejtek and their team tracked over 40 Punching Out Parkinson’s participants engaged in non-contact boxing workouts and found that the training consistently elevated heart rates to moderate intensity levels, a range considered both safe and effective for individuals in the early stages of PD.

Rather than requiring extreme or high-intensity exercise, their research showed that consistent, moderate activity was enough to produce meaningful results.

Those who took part in the program also showed measurable improvements in mobility and cognitive performance compared to those who did not exercise. Parallel testing in laboratory rat models reinforced the idea that this level of aerobic activity can play a meaningful role in slowing motor decline, helping bridge the gap between controlled scientific research and real-world application.

“In our pilot, preliminary studies, we found that patients with PD who participate in at least three months of aerobic exercise where their heart rate increases at least 35% above resting levels, and when they participate at least three times a week, have significantly better cognitive flexibility on standardized tests than those patients who do not exercise regularly or those who do not meet the metrics I just described,” said Dr. Nejtek.

While the physical benefits for POP participants are measurable through research, the program’s impact extends beyond clinical data.

“Motivation to participate regularly is significantly increased with the social aspect of like-minded people who are facing the same struggles,” said Dr. Nejtek. “There is a certain camaraderie within the group – it is a community banding together for the common good of everyone who participates. They lift each other in ways no one else can fully appreciate.”

That feeling of connection is a central part of what keeps participants coming back.

Hear from the Participants

Steve P. is a perfect example of the impact POP has had on all participants involved.

A healthcare executive who has spent his entire professional career in medicine, Steve was diagnosed with Parkinson’s Disease in 2017 after initially fearing he may have ALS, also known as Lou Gehrig’s disease.

“I was relieved that I didn’t have ALS, but obviously really concerned that I did have Parkinson’s,” said Steve. “My wife and I decided we needed to do everything we could to understand the disease and figure out what steps I could take to manage it moving forward.”

Shortly after his diagnosis, his neurologist recommended Punching Out Parkinson’s as a way to stay active and slow the progression of his symptoms.

“The more I learned about Parkinson’s Disease, the more I realized that exercise is medicine,” said Steve.

When he first arrived at the gym in 2018, Steve sat off to the side and watched a class before joining in.

He remembers seeing participants at all different stages of the disease, some struggling through movements while others moved confidently through the stations.

Still, something about the class immediately stood out to him.

“The thing I need to say about Paulie is that he’s literally a world champion, but he’s got a heart for Parkinson’s that’s amazing. He’s patient, supportive, and it’s clear that he’s genuinely invested in helping people here,” said Steve.

Although Steve had previously completed 17 marathons before his diagnosis, boxing was entirely new to him. But over time, the combination of physical challenge and working out with other PD patients kept him coming back.

“The thing about Parkinson’s is there’s a tendency to feel isolated and alone,” said Steve. “When you find people who are walking in those same shoes, there’s an instant sense of community. You compare symptoms, medications, struggles – but more than anything, you realize you’re not going through it alone.”

Now, after more than eight years with the program, Steve says the workouts have helped him maintain both his independence and confidence despite living with a progressive disease.

“If you asked my kids, they’d tell you I look and act younger than I did before I started,” said Steve. “Before this, I was moving slower and becoming increasingly limited. Now I feel stronger, more comfortable, and like I still have some control instead of just being carried along by the disease.”

As for Tito Espinosa, the program became part of a much larger effort to maintain the independence and lifestyle he had built over a lifetime of movement and problem-solving.

Born and raised in Colombia before eventually settling in Fort Worth, Espinosa spent decades working as an aerospace engineer on projects ranging from commercial aircraft to military programs.

About five years ago, however, he began noticing subtle physical changes that were harder to explain away.

During a routine neurological visit, his doctor noticed that Espinosa had started slightly dragging his feet while walking. At the time, the symptoms were still mild, but the concern eventually led to further testing and an official Parkinson’s diagnosis.

“The following year it became evident,” said Espinosa. “I didn’t really know much about Parkinson’s other than hearing about people like Michael J. Fox or Muhammad Ali, so it was all very new to me.”

Not long after his diagnosis, Espinosa came across information about Punching Out Parkinson’s through his neurologist and joined the program in 2019.

Like many participants, he initially viewed the boxing classes as another way to stay active. Over time, however, the workouts became something far more important.

“It got me going in the sense of, ‘Well, I’ve got to do it. I can’t delay it,” said Espinosa.

Espinosa quickly became part of the core evening class group, where participants rotate through stations together and build close relationships through the shared experience of living with Parkinson’s Disease.

For him, one of the most meaningful parts of the program has been the relationship he developed with Ayala.

“He has always been there,” said Espinosa. “Questions asked, questions answered. He’s been really influential in helping not just me, but everybody here.”

While the workouts challenge participants physically, Espinosa says the classes have also helped improve symptoms beyond simple movement and coordination.

“Balance has been a big thing for me,” said Espinosa. “But even talking has improved. Before, I used to ramble really fast. Now I’m steadier. I know what I want to say in my mind, and this program has helped me slow down and communicate better.”

Though some exercises still frustrate him, particularly the heavy bag that barely moves no matter how hard he punches, Espinosa says the in-ring mitt work with Paulie remains his favorite part of every class.

“It feels good getting in the ring,” he said. “You’re moving, reacting, thinking. It keeps you going.”

For Espinosa, “fighting back” against Parkinson’s means continuing to do the everyday things many people take for granted.

“The fact that I can still walk, talk, and do things on my own means everything,” said Espinosa. “That’s what fighting back looks like for me.”

And for Mike Warren, the hour-long classes are part of a much larger adjustment. A 67-year-old former juvenile probation officer, Warren spent nearly four decades working in Tarrant County Juvenile Services before a Parkinson’s diagnosis in 2020 forced him to rethink how he would stay active and maintain his sense of routine. A lifelong ice hockey player, Warren began noticing subtle changes on the ice long before he had a diagnosis to explain them.

What he once recognized as small physical changes, like lower movement while skating, declining balance, and a small loss of control over the left side of his body, eventually became impossible to ignore.

“I played hockey with guys much younger than me so it was easy to just attribute my slowness to my age," said Warren. “But after a while I wasn’t getting the same push off of my left side that I used to and it was getting harder and harder to keep up. You could simply touch me and I’d fall over.”

After receiving his official PD diagnosis, Warren spent the first six months adjusting to a reality that could not be changed or traced back to anything he had done. He describes that period as extremely difficult, not because of any single moment, but because of the process of coming to terms with the disease itself.

“I took the news pretty hard at first. But eventually you have to accept the fact that it's not something you caused or could control,” said Warren. “It just happens. I still don’t know why, but eventually I had to decide I was going to do what I could with it.”

Unfortunately, he was forced to give up his lifelong ice hockey hobby last October.

That acceptance eventually shifted his mindset toward action and movement, something he had already spent much of his life prioritizing as a hockey player.

Warren doesn’t recall if he or his wife found the POP program, but regardless, he took it to his neurologist, who approved it as a way to stay active and manage the disease on top of his normal medications.

He joined the program in 2021. From the jump, Warren knew he was a great fit.

“Even though I’d never boxed, I've always been a competitive person,” he said. “It’s challenging but I love that I can push myself and make it as intense as I please.”

Over time, the shared experiences between POP participants have created a sense of connection that extends beyond the workout itself, turning the class into a place where participants support one another through the challenges of Parkinson's.

That environment, Warren says, starts at the top with Paulie and the foundation he has built within the gym.

“I’m really appreciative of what Paulie has built,” said Warren. “It wasn’t something he set out to do, but he saw a need and followed it. He’s taken what he knows from boxing and turned it into something that really benefits people with Parkinson’s. It doesn’t stop the disease, but it helps slow it down, and that makes a real difference.”

One of the mottos at the POP program is, “Fighting back against Parkinson's one round at a time.”

But Warren looks at the saying a bit differently.

“I don’t really like to think of it as ‘fighting back’ against Parkinson’s when I’m at boxing class. Instead, for me, it’s a way to keep the competitive nature I’ve always had while pushing myself and getting better with the people around me.”