Effects of Face-to-Face Versus Telerehabilitation-Based Circuit Training in People With Multiple Sclerosis

N/ANot Yet RecruitingNCT07770620

Istanbul University - Cerrahpasa36 enrolled

Overview

This randomized controlled study was planned to compare the effects of delivering the same exercise content face-to-face and through telerehabilitation in individuals diagnosed with multiple sclerosis. All participants will receive circuit training for 8 weeks. The program will consist of two sessions per week, each lasting approximately 60 minutes. Assessments will be performed before and after treatment. Participants will be divided into two groups according to the mode of delivery: face-to-face and telerehabilitation. Telerehabilitation sessions will be conducted synchronously (via live connection) twice a week. The study population will consist of adults aged 18-65 years with a diagnosis of MS who attend Istanbul University-Cerrahpaşa Hospital. Individuals who meet the eligibility criteria will be included in the study on a voluntary basis after being informed about the study. Participants will be allocated to the groups using stratified randomization based on EDSS scores. The circuit training program will consist of endurance-, resistance-, and balance-focused exercise components. The effects of the interventions will be evaluated in terms of walking endurance and speed, functional mobility, dynamic balance, lower-extremity functional muscle strength, perceived walking ability, fatigue, quality of life, and the physical and psychological impact of MS. All assessments will be performed before the intervention and at the end of the 8-week program.

Multiple sclerosis (MS) is a chronic disease characterized by inflammation, demyelination, and axonal loss in the central nervous system, affecting functions such as balance, walking, muscle strength, and fatigue, thereby reducing individuals' participation in activities and quality of life. Balance, coordination, strengthening, and aerobic exercise approaches are widely used in MS rehabilitation, and these methods are supported by a high level of evidence for improving functional capacity. One method that allows these approaches to be combined and structured around functional tasks is circuit training, in which exercises are organized as consecutive stations with short rest intervals. Circuit training is defined as a comprehensive exercise model that targets endurance, balance, strength, and motor control components within the same session. Straudi et al. demonstrated that supervised and home-based task-oriented circuit training improved walking endurance and had positive effects on walking speed, functional mobility, fatigue, and muscle oxygen consumption. Doğan et al. reported that telerehabilitation- and virtual reality-supported circuit training improved trunk control, upper extremity function, and ataxia severity. In a meta-analysis conducted by Du et al., circuit training interventions were reported to have positive effects on balance, walking, fatigue, and quality of life in individuals with MS. However, studies directly investigating circuit training in individuals with MS are limited. In recent years, telerehabilitation has emerged as a contemporary approach that provides access independent of distance; however, the need for further controlled studies to strengthen the level of evidence in MS has been emphasized. The aim of this study is to investigate and compare the effects of an 8-week circuit training program delivered face-to-face and through synchronous telerehabilitation on walking capacity, functional mobility, lower-extremity muscle strength, fatigue, activities of daily living, and quality of life in individuals with MS.

Interventions

Face-to-Face Circuit TrainingBEHAVIORAL

Participants will receive an 8-week circuit training program delivered face-to-face in a clinical setting. The program will be conducted twice a week, with each session lasting approximately 60 minutes. The circuit training program will include endurance, resistance, and balance exercises. Each exercise station will consist of 3 minutes of exercise followed by 2 minutes of rest. Participants will complete two circuits, with a 10-minute rest period between circuits.

Synchronous Telerehabilitation-Based Circuit TrainingBEHAVIORAL

Participants will receive the same 8-week circuit training program through synchronous telerehabilitation. The program will be conducted twice a week through live online sessions, with each session lasting approximately 60 minutes. The circuit training program will include endurance, resistance, and balance exercises. Each exercise station will consist of 3 minutes of exercise followed by 2 minutes of rest. Participants will complete two circuits, with a 10-minute rest period between circuits.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of multiple sclerosis Age between 18 and 65 years Expanded Disability Status Scale (EDSS) score between 2.0 and 5.5 Mini-Mental State Examination (MMSE) score greater than 24 No relapse within the past 3 months Ability to walk at least 100 meters with or without an assistive device Willingness to participate in the study and provision of written informed consent Exclusion Criteria: * Botulinum toxin treatment for spasticity or a surgical procedure within the past 6 months Participation in a regular physiotherapy or rehabilitation program within the past 3 months Presence of a secondary neurological, orthopedic, or systemic disease that prevents independent standing and walking Presence of severe peripheral vestibular dysfunction Presence of a medical condition that may prevent participation in exercise Failure to provide written informed consent

Outcomes

Primary Outcomes

Walking Endurance: 6-Minute Walk Test (6MWT)

Walking endurance will be assessed using the 6-Minute Walk Test. During the test, participants will be instructed to walk as far as possible for 6 minutes along a predefined, level course. At the end of the test, the total distance covered will be recorded in meters, and this value will reflect the individual's functional walking capacity and endurance. Any assistive device used by the participant, the need for rest, and the development of symptoms during the test will also be recorded.