Document Type


Degree Name

Master of Kinesiology (MKin)


Kinesiology and Physical Education


Faculty of Science

First Advisor

Dr. Quincy Almeida

Advisor Role



The overall purpose of the current thesis was to evaluate the effect of exercise on the progression of Parkinson’s disease (PD). While many studies exist that investigate the effect of exercise on PD, they focus on immediate improvements and rarely consider washout periods, or any prolonged effects of exercise interventions. Thus, while short-term benefits are achievable, the more valuable influences of exercise on disease progression are often overlooked. Interestingly, according to animal models, high intensity exercise and low intensity strategies such as sensory training have been argued to have the potential to delay disease progression. In humans, the most popular high intensity exercise program is boxing, while low intensity sensory exercise interventions such as PD SAFExTM show promise. Even though these exercise programs may have the ability to delay progression, previous studies have only assessed the short-term benefits of these programs.

In the current thesis, the first study employed a 40-week single-blinded randomized crossover trial to identify whether boxing (high intensity exercise) or PD SAFExTM had a greater influence on the progression of PD. To do this, individuals were randomized into boxing or a PD SAFExTM start group for 10-weeks, followed by a 10-week no exercise period. After this no exercise period, participants were crossed over to participate in the other intervention for 10-weeks. This again was followed by a final 10-week no exercise period. In this study, individuals who could not commit to the study were placed in a non-active control group. Disease severity was measured using the gold-standard Unified Parkinson’s Disease Rating Scale motor subsection III (UPDRS-III). UPDRS-III scores indicated that while the control group did not worsen, RSB worsened motor symptoms immediately post intervention. In contrast, PD SAFExTM improved motor symptom severity by 10 points. Interestingly, the group that started with PD SAFExTM did not ever return to baseline severity through the full 40-week study (T0 to T4 (MD=3.042, SE=0.723, pTM was introduced. Together, this suggests that PD SAFExTM was able to impact and alter the progression of PD.

The second study of this thesis was aimed at addressing issues associated with a pandemic such as COVID-19. The primary outcome measure for motor symptom severity in the first study was the UPDRS-III, which is typically completed in-person with a trained and certified examiner. However, due to restrictions imposed by COVID-19, it was not possible to conduct in-person testing. The shift to an online platform created many challenges as a full UPDRS-III score could not be derived. As a result, the second study aimed at developing a regression equation to predict full UPDRS-III scores from partial scores (n=232). The accuracy of this equation was subsequently used to predict full UPDRS-III scores on an independent sample (n=1168), which revealed a strong correlation between both the smaller and larger subset of scores (R2=0.96, p<0.0001). With this equation, researchers (and also clinicians) investigating the effects of exercise, medications or any other intervention have the ability to assess motor symptoms, even if not in person. The development of this equation has tremendous implications for research in pandemic situations, as well as outreach to rural communities in clinical settings.

Together, chapter two of the thesis will provide answers as to whether boxing or sensory training can delay the progression of PD and the regression equation derived in chapter three will allow full disease severity scores to be monitored aiding PD research to be conducted during a global pandemic.

Convocation Year


Available for download on Monday, April 29, 2024