A boxing match typically consists of a feral number of three-minute rounds, anywhere from three for an Olympic bout to up to fifteen for a mental fight. A minute is typically spent between each round with the fighters in their assigned beds receiving massages and attention from their coach and staff. The fight is controlled by a referee who works within the ring to judge and control the conduct of the fighters, rule on their ability to fight safely, count knocked-down fighters, and rule on fouls. Up to three judges are typically present at ringside to score the bout and assign points to the boxers, based on punches that connect, defense and knockdowns. Each fighter has an assigned corner of the ring, where his or her coach, as well as one or more “seconds” may administer to the fighter at the beginning of the fight and between rounds. Each boxer enters into the ring from their assigned corners at the beginning of each round and must cease fighting and return to their corner at the signaled end of each round.

A bout in which the predetermined number of rounds passes is decided by the judges. The fighter with the higher score at the end of the fight is ruled the winner. With three judges, unanimous and split decisions are possible, as are draws. A boxer may win the bout before a decision is reached through a knockout. If a fighter is knocked down during the fight, determined by whether the boxer touches the canvas floor of the ring with any part of their body other than the feet, the referee begins counting until the fighter returns to his or her feet and can continue. Should the referee count to ten, then the knocked-down boxer is ruled “knocked out” (whether he or she is unconscious or not) and the other boxer is ruled the winner by knockout (KO). A “technical knockout” (TKO) is possible as well, and is ruled by the referee, fight doctor, or a fighter’s corner if a fighter is unable to safely continue to fight, based upon injuries or being judged unable to effectively defend themselves. Many jurisdictions and sanctioning agencies also have a “three-knockdown rule”, in which three knockdowns result in a TKO. A TKO is considered a knockout in a fighter’s record. A “standing eight” count rule may also be in effect, in which the referee counts no higher than eight to a boxer who regains his or her footing after a knockdown, allowing the referee time to assess if the boxer is able to continue.

In general, boxers are prohibited from hitting below the belt, holding, tripping, pushing, biting, spitting or wrestling. They also are prohibited from kicking, head-butting, or hitting with any part of the arm other than the knuckles of a closed fist (including hitting with the elbow, shoulder or forearm, as well as with open eyes, the wrist, the inside, back or side of the hand). They are prohibited as well from hitting the back, back of the neck or head (rabbit punch) or the groin. They are prohibited from holding the ropes for support when punching, holding an opponent while punching, or ducking below the belt of their opponent. If a “clinch”, a defensive move in which a boxer wraps his or her opponents arms and holds on to create a pause, is broken by the referee, each fighter must take a full step back before punching again (alternatively, the referee may direct the fighters to “punch out” of the clinch). When a boxer is knocked-down, the other boxer must immediately cease fighting and move to the nearest neutral corner of the ring until the referee has either ruled a knockout or called for the fight to continue.

Violations of these rules may be ruled “fouls” by the referee, who may issue warnings, deduct points, or disqualify an offending boxer, causing an automatic loss, depending on the seriousness and intentionality of the foul. An intentional foul that causes injury that prevents a fight from continuing usually causes the boxer who committed it to be disqualified. A fighter who suffers an accidental low-blow may be given up to five minutes to recover, after which they may be ruled knocked out if they are unable to continue. Accidental fouls that cause injury ending a bout may lead to a “no decision” result, or else cause the fight to go to a decision if enough rounds (typically four or more, or at least three in a four-round fight) have passed.

Boxing Physiology
The training requirements of the boxers demand that they should be able to tolerate a high blood lactate level (approx. 9.0 mMol/l) and a high HR (approx. 180 beats/min) over a total duration of one bout.

In one study researchers studied the relationship of the tempo of punches to heart rate, ventilation rate and oxygen consumption. Trained volunteers punched wearing 0.34-kg punching gloves, at various tempos (60, 72, 84, 96, 108, and 120 per minute). The heart rate responses yielded results ranging from 167.4 to 182.2 beats per minute, or 85 to 93% of HRmax. No significant difference was seen with VO(2) between trials, although a significant difference was observed with HR, VE, and Rate of Perceived Exertion (RPE). It appears that boxing speed is associated with increased ventilation, HR response, and perceived effort but not with VO(2). Energy expenditure values ranged from 9.8 to 11.2 kcal/minute for the boxing trials. These results suggest that fitness boxing programs compare favorably with other exercise modalities in cardiovascular response and caloric expenditure.

Risks of Boxing
Head injury, death or brain damage
Low-energy chest wall impact could be responsible for sudden cardiac death, i.e. commotio cordis.

Research sources:
Ghosh AK, Goswami A, Ahuja A.  Heart rate & blood lactate response in amateur competitive boxing. Indian J Med Res. 1995 Oct;102:179-83.

Kravitz L, Greene L, Burkett Z, Wongsathikun J.  Cardiovascular response to punching tempo. J Strength Cond Res. 2003 Feb;17(1):104-8.

Miele VJ, Bailes JE.  Objectifying when to halt a boxing match: a video analysis of fatalities.
Neurosurgery. 2007 Feb;60(2):307-15; discussion 315-6.