Follmer said that boxing is one of the most intense types of physical exercise that an athlete can endure. By focusing on different methodologies in one workout, including cardiovascular and strength training, agility, footwork and hand-eye coordination, trainers create a well-rounded training pattern to combat Parkinson's symptoms.
"Exercise of all kinds, in particular ones that focus on balance, aerobic conditioning and strengthening, has been shown beneficial for individuals with PD to promote general wellness and health, maintain functional independence, reduce the risk of fall and enhance psychological health," said Dr. David Cifu, medical director of the Rehabilitation and Research Center at Virginia Commonwealth University.
Because it is a no-contact program, the risks to patients are the same as with any other therapeutic exercise program, said Dr. Mark Stacy, professor of neurology at Duke University Medical Center.
"I assume this program is designed to help patients with balance, agility and physical strength and stamina," said Stacy. "We could all benefit from that."
Follmer said that the trainers constantly mix up the exercising, which creates muscle confusion that can benefit the strength training and balance Parkinson's patients need. For patients with more severe symptoms, trainers stand beside them to lessen the risk of falls.
"They're always moving from station to station," said Follmer. "It's very fun, and they're never going to become bored because we change workouts as much as possible, and we're constantly bringing in new exercises."
Follmer said that she grew up watching fights with her dad, who was a huge boxing fan. After her father died when she was 13 years old, things changed for her.
"I was an angry teen after that," recalled Follmer. "My mom bought me a heavy bag to vent my stress, and when I'd get upset, I'd just pummel the bag. I fell in love with the explosive nature of hitting that bag."
When she left for college at Ball State University in Muncie, Ind., Follmer joined a free boxing gym and learned that students had earned boxing scholarships through the fitness center.
After a two-year stint as an amateur boxer, Follmer turned professional in 2002 and went on to win three world championship titles.
While Follmer participated in full-contact fights, trainers and directors of Rock Steady emphasize that none of their workouts are violent in nature.
And interestingly, many doctors have suggested that the great heavyweight champion, Muhammad Ali, has Parkinson's disease caused, at least in part, from boxing.
"In the case of Mr. Ali, it remains possible that his disease was either caused by or exacerbated by boxing," said Tuszynski. "But … if there are no head blows and no regular falling, then I would not be concerned about this in Parkinson's patients."
The workouts are not, however, easy.
"We try to implement the idea of very tough love," said Follmer. "We want to push these people harder and beyond their perceived limits. But we are aware when too much is too much."
Follmer said the trainers learn as much as they can about the members' conditions and limitations before they start the program.
"We see people get so much stronger, and keep that strength," said Follmer. "Or their symptoms will plateau instead of going on a downward spiral."
Follmer was still competing professionally when she started creating workouts for Parkinson's patients at Rock Steady -- she trained side by side with members.
"It was very humbling and inspirational to go through the training alongside people with Parkinson's," said Follmer. "They pushed me as much as I pushed them. I had no excuse. As I trained for a championship, they trained just as hard to feel better and live longer."
Follmer and the rest of the staff at Rock Steady now look forward to expanding the program beyond Indianapolis.
As for Follmer, she said her boxing mentality has completely changed since her experience with Rock Steady.
"We fight for love and we fight for life now," said Follmer. "I don't think I could turn that violent switch on ever again."