Study will examine taekwondo's physical effects on participants

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

So much of what we do requires good balance, and balance is crucial if we want to maintain our mobility. A pair of physical therapists at Upstate have launched a study that examines whether martial arts practice can build and maintain balance and mobility. With me to talk about their work and how you can get involved are Dr. Bokkyu Kim and Dr. Molly Torbitt. They're both assistant professors in Upstate's College of Health Professions.

Welcome to "The Informed Patient," both of you.

Molly Torbitt, DPT, PhD: Thank you for having us, Amber.

Bokkyu Kim, PT, PhD: Thank you so much.

Host Amber Smith: Now, I've seen flyers for your study online. Why is it called Kick Silver Program? Dr. Kim?

Bokkyu Kim, PT, PhD: So actually, I brought this name from a Marvel comic character, which is Quicksilver, which is moving really fast. And I'm using the martial arts, specifically taekwondo, which is using fast kick movement in order to improve your physical function as well as your cognitive and other body functions.

Host Amber Smith: I see. Now from a physical therapy point of view, just how important are balance and mobility? Dr. Torbitt?

Molly Torbitt, DPT, PhD: Balance and mobility are super important, especially as individuals get older. We know that there are some age-related changes that can affect how well our muscles fire, how quickly they fire, and it makes it easier to not move when things aren't functioning properly.

So, this study in particular, we're using kind of a novel intervention to deliver balance and strength training in terms of being able to be on a single-leg stance -- you know, being on one leg -- building the strength and the mobility that people need to function throughout their later years.

Host Amber Smith: So these age-related changes, is this a natural occurrence that happens for everyone as they age, balance is more of a challenge, mobility may be more of a challenge?

Molly Torbitt, DPT, PhD: Yes. So as people get older, just from an aging standpoint, we lose muscle fibers, right? So they're not recruited as quickly, so we can't call on them to do their jobs as well. But what's nice is that we know that, through training, things can be reversed so that people can stay functional for longer periods.

Host Amber Smith: So there is a way to try to prevent or stave this off a little if you are active or training.

Molly Torbitt, DPT, PhD: Correct.

Host Amber Smith: Well, let's talk about your study. What made you choose martial arts to examine? Dr. Kim?

Bokkyu Kim, PT, PhD: So I've been training taekwondo about one year and nine months now. As a physical therapist, we always tell our patient, you have to move more. You have to be active, you have to use your strengths, you have to use your muscles to move, right? And as a physical therapist myself, I want to do something in order to say to my patient that you have to move.

And then the exercise that I chose was taekwondo because I was able to do this with my son, who is a second grader. And then I want to do something that I can do with my family. And my son was practicing taekwondo for a year at the time, and then they had some family class, so I joined as a trial, and then I really enjoyed it. It was really fun. And then I was able to feel that I regained my muscles and then, even, I don't have any, like, physical disability or any conditions, but that I was not active enough.

So I was able to feel that I am regaining more muscles. I was able to feel that. And then, I want to share the feeling with others, especially older adults, who are losing their muscles.

And recently I read an article saying that 1 kilogram, which is about 2.2 pounds of muscle mass, is worth about $10,000 for older adults because if you have more muscles, you maintain your balance. You don't have any falling, which is consequently forcing you to pay for medical care. But if we have a decent amount of muscles, we can prevent these falls, and then we can save our money.

Host Amber Smith: That's an interesting way of looking at it. Your study, how is it designed, and what type of people are you looking for to participate?

Bokkyu Kim, PT, PhD: This is more like a feasibility study. As of now, we are looking for five healthy, non-disabled older adults who are aged between 65 and 85, and also people with Parkinson's disease, especially those with mild to moderate severity of Parkinson's disease. As a feasibility study, we want to demonstrate that this taekwondo exercise program is safe and also effective to improve their balance and mobility, in all the older adult population, as well as people with Parkinson's disease.

Host Amber Smith: So the people who volunteer will all be taking a martial arts-type of training class over a period of time. Is that right?

Bokkyu Kim, PT, PhD: Yes. This is designed as a crossover design. In other studies, you may have, like, control groups who don't receive the treatment or exercise, and the experimental group, where they get these treatments or exercise.

But in our study, we have crossover design. So, the first two months they don't get any exercise, but we have some assessment of their balance and mobility at two different time points with two months' time difference. And then they're going to participate two months in a taekwondo exercise program.

And then we are going to have another assessment of their balance and mobility, so we can compare, within the same group, whether they have any improvement in their balance and mobility -- without exercise or with exercise.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking about a study of balance and mobility with two physical therapists at Upstate, Dr. Bokkyu Kim and Dr. Molly Torbitt.

So you'll have 10 participants, five who maybe have Parkinson's and five who are considered healthy adults, for comparison's sake. And for how long will this trial of martial arts extend? How many months or weeks will this take?

Molly Torbitt, DPT, PhD: The actual taekwondo bit of it will be over 16 sessions, so participants will attend two weekly sessions over eight weeks, and then when they're done with that, we will reassess everything that we did when they initially joined the study, and then two months after prior to starting the taekwondo. And then we'll reassess everything at the end.

And we also plan on doing interviews with people to get their viewpoint, right? So not only do we want to know, is it feasible, right? So can it be done, but we also want to know, do people enjoy it?

And then from there, we want to do it on a larger scale to really flesh out, like, how often is it needed to actually see those changes and improvements? How intensely do people have to exercise to see those improvements? Those are the kind of things that we'll be looking to, moving forward.

Host Amber Smith: Now, who teaches the classes?

Bokkyu Kim, PT, PhD: We are in partnership with Master McDowell's taekwondo school in Manlius. There are amazing taekwondo instructors in there. And then participants will be joining regular adult classes in the taekwondo school. So they will be practicing taekwondo with other students, adult students in taekwondo school, but it will be more individualized. In taekwondo school, everyone gets more individualized instruction based on their level, then based on their physical capability.

So even (though) they are joining the regular classes, it will be more modified in order to meet their requirements, meet their physical capability.

Host Amber Smith: Well, that's what I wondered. When people are applying to be participants in this, are you going to look at their fitness level? Because you may get people who haven't been very active, and you may get people who run marathons. So does it matter, for the purposes of your study, what sort of fitness background that people have?

Molly Torbitt, DPT, PhD: No, it doesn't matter, right? Because when we are doing our pre- and post-testing, we're looking at it within each individual person. And a lot of these tests that we're doing have what they call a minimum detectable change, where that person has to improve by such and such amount, and so what it looks like in maybe a more trained individual, they still have to improve by the same amount that an untrained individual would. So it's all relative to that individual person.

Host Amber Smith: Well, let's tell listeners where they can go to learn more. They can send an email to Dr. Kim at [email protected], and then you can respond to people with more information about how to sign up, or apply.

Now, why would you say that people should consider joining the study?

Bokkyu Kim, PT, PhD: Taekwondo exercise has a lot of benefits. First of all, in textbooks of taekwondo, it says taekwondo spirit is to overcome your limits and benefit the world.

And if you have any physical limitations, you tend not to move, but we want those people to challenge themselves using a taekwondo exercise program, so they can feel that actually they can improve their physical function to prevent further falls or to be more engaged in physical activities, and then to be more participating in community activities, et cetera.

So, that is the priority of our purpose. And also taekwondo exercise, you know, many older adults, they are doing a lot of physical activities, and then sometimes they start some of those activities, and then they stop because it is getting boring.

And some exercises, we need to motivate those people to continue. And then taekwondo, they have a belt system. You are starting with white belt, and then as you progress, you can get yellow belt, green belt, blue belt, red belt and even at the end, you can get the black belt. And that system can motivate you to pursue further advances in your journey of physical activity. And so there could be more benefits.

And then there are a lot of different components of taekwondo exercise, like they are using a lot of loud shouting, which is also beneficial for your physical function and especially people with Parkinson's disease.

And then, as Dr. Torbitt mentioned, it is using a lot of one-legged stances, so it is challenging your body to maintain your balance. Even with one leg, it would be more beneficial to maintain your balance while you are walking or while you are doing some other activities.

Host Amber Smith: I wanted to ask you a little bit more about the actual workouts. Is it a full-body workout? Are you working mostly on kicks in the lower body, or is there some upper body as well?

Bokkyu Kim, PT, PhD: Yes. In taekwondo you do a lot of punches. It is a different style of punching compared to boxing, but still you have to maintain your balance. And then you do a lot of punches with your upper extremities or upper body, not just practicing those techniques and skills, but also doing some high-intensity interval training, which is beneficial to improve your cardiovascular function.

And also there's another specific curriculum of taekwondo, which is called poomsae. Poomsae is more like a choreographed movement pattern, so you can think this is kind of similar to tai chi, but it is using more dynamic, powerful kicking and punching motions. So it is more beneficial, especially in people with Parkinson's disease, to amplify the brain activities. It is more theoretical; we have to prove scientifically whether this poomsae practice could be beneficial to boost your brain activity. But sometimes people with Parkinson's disease, they have that reduced activity of the brain, and using this exercise in taekwondo poomsae, we can actually enhance brain activity. And also it is using a sequential movement pattern, so it can be also challenging to their cognitive function, so it can be also beneficial for improving their cognitive function.

Host Amber Smith: It sounds like you'll get a cardio workout, and it sounds like there's some flexibility. Would you consider this is also some strength training, body-weight strength training?

Molly Torbitt, DPT, PhD: Yes. So there is definitely a strength training component to this, right? We need to be able to support ourselves in single-legged stance to do these kicks and to do these punches.

And we need to be able to maintain the proper stance -- position -- right? The base of support that they're using. You need to be strong and stable in that so that you can do these movements and progress through those sequences. So, depending on the nature of the course that day, there might be a designated strength-training component.

I spent a couple years training in karate, and there were times where we would pick up weights, and we would do our punches and our kicks with weights in our hand. And while it's not necessarily part of the actual choreographed sequences, it has its own place in the course to make your movements more crisp, to make them more powerful.

So yes, there is, depending on the nature of the course that day, there can be a strength component as well.

Host Amber Smith: Now, do the volunteers in the study, do they pay for the training class, or is that included -- because they're volunteering, is the fee waived?

Bokkyu Kim, PT, PhD: We have a small funding for now, so we can pay for their, tuition for taekwondo school.

So it would be completely free for our participants to join the class for two months, and then after two months, if they want to continue, maybe they can pay by themselves. But for this two-month time period with us, we will be paying their taekwondo school tuition. And also there's a belt test (advancement test) at the end of the two-month program, and if they are eligible to get belt test, we are going to pay the belt test fee as well.

Host Amber Smith: Do they need any special equipment or special clothing, or how do they need to dress to come to the classes?

Bokkyu Kim, PT, PhD: Every taekwondo school, you have to wear a special uniform, which is called dobok, and then we will be providing these uniforms for our subjects, and also, if you need any protective equipment, we will be providing these to our participants.

Host Amber Smith: Well, I'll remind listeners again to send an email to Dr. Kim at [email protected] if they want to learn more about this or participate. I appreciate both of you making time for this interview, Dr. Kim and Dr. Torbitt.

Molly Torbitt, DPT, PhD: Thanks again Amber. We really appreciate you having us on today.

Bokkyu Kim, PT, PhD: Thank you so much.

Host Amber Smith: My guests have been Dr. Bokkyu Kim and Dr. Molly Torbitt. They're both assistant professors in Upstate's College of Health Professions.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

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