"Are you ready boxers!" shouts the trainer.

"Ready!" shout back the boxers.

An exchange like this could be any boxing gym, but instead, it is Rock Steady Boxing, a physical therapy fitness program designed to treat Parkinson's Disease (PD).

In 2006 Scott Newman, a former county prosecutor, was diagnosed with early-onset Parkinson's at age 40. Newman's friend, Vince Perez, a Golden Gloves boxer, had the idea to use boxing training to help Newman maintain as much function as possible. Together they built Rock Steady Boxing into a worldwide program with over 900 affiliates.

Parkinson's patients have specific challenges, and Rock Steady Boxing is a strategy to correct and delay the onset of some of the debilitating symptoms of Parkinson's disease.

PD is the second most common neurological disease, affecting balance, gait, coordination, and the activities of daily living.

A large body of research supports vigorous exercise focused on gross motor skills, balance, core strength, and rhythm can help people diagnosed with PD stay active, maintaining their gait, balance, and flexibility.

Rock Steady Boxing is a non-contact boxing-style workout that provides quality of life benefits and emotional support for people with PD.

The 'Boxing" part of the name sounds might be intimidating, but most of the program focuses on the 'Rock Steady' part.

A typical workout starts with balancing exercises, slyly designed as warmups, then a mix of bodyweight calisthenics and more balancing moves timed with the ringside bell.

Boxers then line up next to the trainer as she shadow-boxes in front of a wall mirror. She yells out, "Right Jab, Left Hook, Right Hook, Left Jab, Right Uppercut, Left Hook"; all the boxers are laughing at the impossibility of following the speed of the sequence of punches, but they do their best.

Next, boxers rotate through the boxing apparatus. Heavy bags, speed bags, a reflex ball, a core bag, and a station called a sparring partner that is more like a Bozo Bop Bag from the 60s that would spring right back upright when knocked over.

Lastly, the sessions end with a cool down and stretching.

Therapies designed to help PD patients not interested in group exercise or intimidated by boxing include aerobic exercise, strength training, yoga, Tai Chi, and varieties of dancing.

There are four crucial areas where Rock Steady Boxing helps.

• First, Rock Steady Boxing swings at PB with slow progressive cardio and weight training with stretching and workups.
• Second, it stresses socializing with others with PD in a fun environment.
• Third, it provides a sense of purpose which may be lacking in the life of someone with PD.
• Fourth, Rock Steady Boxing instills determination and confidence.

Rock Steady Boxing is associated with less fatigue, depression, anxiety, and fear of falling.

This exercise regime is scientifically proven to improve life satisfaction. Over 2000 patients with PD participated in a Health-Related Quality of Life Assessment, and the results reported patients with PD improved their aerobic capacity, strength, core stability, balance, and flexibility. They reported improvement in fine motor skills and coordination.

Mary Jo Penberthy, a certified Rock Steady Boxing trainer and Clinical Coordinator at Gritman Medical Center's Jeff Martin Wellness Center, said in an interview that mindset determines if someone with PD signs up for Rock Steady Boxing.

Penberthy said, "A lot of people that come out here are already willing to fight back, so they are willing to do where it takes. It takes a special mindset. They are going to fit back."

When people are hesitant, she said she lets them "Visit a class to see what it is about. They see everyone in the class is fighting the same battle. So, there is no judgment. It's helpful to know that they are not alone."

If you've been diagnosed with Parkinson's Disease, your only opponent in the ring is PD.

What should you do if you know someone who has been diagnosed with PD? The caring and loving thing would be to help get them in the ring, letting them counterpunch their arch-nemesis, Parkinson's Disease.