Tai Chi and Square-Stepping Exercises in Women With Multiple Sclerosis

Pamukkale University

Status: Enrolling

Conditions: Multiple Sclerosis

Treatments: Behavioral: Home-based Frenkel Coordination Exercises; Behavioral: Square Stepping Exercise (SSE); Behavioral: Tai Chi

Study type: Interventional

Funder types: Other

Identifiers

NCT07461987

PU-FTR-MI-03

Details and patient eligibility

About

Tai Chi is an exercise approach consisting of slow and controlled movements, whereas square stepping exercises are an exercise method in which specific step patterns are followed. The aim of this study is to comparatively examine the effects of Tai Chi and Square Stepping Exercises on knee joint position sense, lower extremity muscle strength, and fatigue levels in women with multiple sclerosis.

Full description

Multiple Sclerosis (MS) is a chronic and demyelinating disease of the central nervous system observed in young adults. As the disease progresses, impairments occur in motor and sensory functions. Somatosensory inputs, such as knee joint position sense, which is particularly critical for balance and postural control, are frequently affected. In addition to these impairments, a decrease in lower extremity muscle strength and fatigue affecting the vast majority of patients restrict participation in activities of daily living.

Within the scope of this study, women diagnosed with MS will be randomized into one of three different intervention arms: a Tai Chi group incorporating postural stability exercises based on the Yang style; a Square Stepping Exercise (SSE) group consisting of coordinated step patterns aimed at improving sensorimotor integration; or a control group in which Frenkel exercises, representing traditional coordination approaches, are applied. Exercise interventions in all groups were planned for 8 weeks, twice a week.

The study aims to comparatively demonstrate the effects of Tai Chi and Square Stepping Exercises on knee joint position sense, lower extremity muscle strength, and fatigue levels, and to develop evidence-based strategies for these parameters in MS rehabilitation

Enrollment: 39 estimated patients

Sex: Female

Ages: 20 to 45 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Willing to participate and provide informed consent.
• Diagnosed with multiple sclerosis (MS) according to the McDonald diagnostic criteria.
• Relapsing-remitting MS (RRMS) phenotype.
• EDSS score < 3.5.
• Female, 20-45 years of age.
• No MS relapse within the past 1 month.
• No lower-extremity spasticity according to the Modified Ashworth Scale (MAS).

Exclusion criteria

• Any neurological disease other than MS.
• Experiencing an MS relapse during the study period.
• History of orthopedic surgery that may affect balance.
• Cognitive or psychiatric impairment that may interfere with study participation.
• Cardiovascular or pulmonary history that may prevent participation.
• Use of medications that may affect clinical assessment (e.g., antipsychotic use; continuous corticosteroid or immunosuppressive use within the past 1 month).
• Participation in any other exercise program

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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39 participants in 3 patient groups

Tai Chi

Experimental group

Description:

Participants in this arm will perform a supervised, group-based Tai Chi program. The program consists of selected movements from the Yang-style 24-form taught progressively, with emphasis on controlled weight shifting, postural alignment, and coordinated whole-body movement. Each session includes a warm-up period with general stretching, a main Tai Chi practice component with repeated form practice (with rest breaks as needed), and a cool-down period that includes stretching and controlled breathing techniques.

Treatment:

Behavioral: Tai Chi

Square Stepping Exercise (SSE)

Experimental group

Description:

Participants in this arm will receive supervised, group-based Square Stepping Exercise (SSE) performed on a 250 cm × 100 cm mat divided into 40 squares (25 cm each). Participants will practice predefined stepping patterns that include forward, backward, horizontal (lateral), and diagonal steps. Selected patterns will be repeated 3-5 times, followed by the mirrored version for the same number of repetitions. If a participant has difficulty with a pattern, it will be repeated until learned; progression will occur after the participant completes the pattern correctly three consecutive times.

Treatment:

Behavioral: Square Stepping Exercise (SSE)

Home Exercise Program (Frenkel)

Active Comparator group

Description:

Participants in this arm will follow a home-based program consisting of Frenkel Coordination Exercises (FKE), a coordination-focused exercise approach developed to address gait, balance, and coordination. The exercises emphasize slow, accurate, and well-controlled movements, typically supported by visual guidance and repeated practice to improve movement sequencing and coordination.

Treatment:

Behavioral: Home-based Frenkel Coordination Exercises