An interventional study of Ai-Chi exercise and Land-Based Exercise in Multiple Sclerosis, sponsored by Kirsehir Ahi Evran Universitesi. Completed at 1 site in Turkey (Türkiye). Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-10-19.
Sponsored by Kirsehir Ahi Evran Universitesi · Not applicable, Interventional, and Treatment
The subject of this study is to examine the effects of Ai Chi-an aquatic exercise method-on balance, mobility, muscle strength, quality of life, depression, fatigue, and cognitive functions in individuals diagnosed with Multiple Sclerosis (MS), in comparison with land-based exercises. Developed to address the physical and cognitive symptoms associated with MS, this study aims to evaluate the effectiveness of Ai Chi exercises-performed in water-as an alternative and/or complementary rehabilitation method alongside traditional land-based exercises. In this context, the research seeks to offer an innovative approach to enhancing the quality of life and functional capacity of individuals with MS.
Multiple Sclerosis (MS) is a chronic neurological disease affecting the central nervous system and has a multidimensional negative impact on individuals' physical, cognitive, and psychosocial functioning due to its progressive and heterogeneous clinical course. The exact cause of MS remains unknown. Genetic factors, environmental factors, and the interaction between these factors are generally thought to play a role in the development of MS. Race, sex, low vitamin D levels, limited exposure to sunlight, Epstein-Barr virus infection, and smoking have been identified as major risk factors for the development of MS.
Clinical signs and symptoms of MS vary depending on the regions of the brain and spinal cord affected by the disease. Although MS is associated with a wide range of clinical signs and symptoms, motor, sensory, and autonomic dysfunctions are among the most common manifestations. The most common motor impairments observed in MS include muscle weakness, spasticity, tremor, ataxia, and visuomotor deficits. These impairments negatively affect balance and walking function and may lead to falls. Individuals with MS also demonstrate reduced muscle contraction strength, decreased endurance, reduced total muscle mass, and increased muscle atrophy.
Balance impairments are among the most common symptoms experienced by individuals with MS. Postural instability occurs as a result of impaired neural connections within the somatosensory, visual, and vestibular systems, which play important roles in maintaining balance in individuals with MS. Walking problems are another common symptom in individuals with MS. Reduced walking speed, step length, and cadence, as well as increased step width and double-support phase duration, have been reported. These walking impairments have been particularly associated with muscle weakness, spasticity, and reduced postural stability and balance. Sensory disturbances are also common in individuals with MS. Hypoesthesia, hyperesthesia, and loss of proprioception may negatively affect postural control and walking, thereby limiting individuals' activities of daily living. Fatigue is experienced by approximately 90% of individuals with MS and has a substantial negative impact on their quality of life. Cognitive dysfunction is observed in approximately 20% of individuals with MS within the first five years following disease onset, and this proportion increases as the disease progresses. Depression and anxiety are also common in MS and occur at higher rates than in the general population.
Muscle weakness, balance and mobility impairments, fatigue, cognitive problems, and depression experienced by individuals with MS restrict independence in activities of daily living and lead to a substantial reduction in quality of life. Therefore, in addition to pharmacological treatments, the development of effective, safe, and sustainable rehabilitation approaches is of great importance.
Physical activity decreases as the disease progresses in individuals with MS. Appropriate exercise programs for individuals with MS can lead to significant improvements in aerobic capacity, muscle strength and endurance, flexibility, balance, mobility, fatigue, and quality of life. In addition, systematic analyses investigating the effects of exercise have demonstrated that exercise may promote the production of neurotrophic factors, neuronal growth and proliferation, and improvements in cognitive functions such as learning and memory. Exercise has also been shown to increase the production of Brain-Derived Neurotrophic Factor (BDNF).
Treatment approaches for MS are generally classified into pharmacological and non-pharmacological interventions. Although there is currently no definitive cure for MS, pharmacological agents used in its management modify or suppress the immune system and thereby alter the course of the disease. These agents are generally used to reduce the frequency of relapses, slow physical deterioration, and alleviate MS-related symptoms. In addition to pharmacological treatment, physiotherapy and rehabilitation are among the most important approaches for improving quality of life and maintaining independent mobility in individuals with MS.
Exercise-based rehabilitation approaches are known to have positive effects on functional capacity, balance, walking, and quality of life in individuals with MS. However, land-based exercises may be limiting for some individuals due to MS-specific factors such as heat sensitivity, rapid fatigue, and changes in muscle tone. In this context, the buoyancy of water reduces body weight and increases the range of motion, while the greater density of water compared with air provides natural resistance. Hydrostatic pressure contributes to reducing edema and provides proprioceptive feedback, while the thermal properties of water may reduce muscle spasms at an appropriate temperature and promote circulation. Aquatic exercises offer several advantages for individuals with MS, including facilitating thermoregulation, providing a pain-free and supported movement environment, improving balance and coordination, increasing muscle strength and endurance, reducing spasticity and muscle tension, promoting psychological well-being, and improving functional ability and quality of life.
Aquatic exercises have been used for many years in the treatment of various diseases. The aquatic environment possesses several properties, including buoyancy, turbulence, hydrostatic pressure, and resistance, which facilitate various therapeutic exercise benefits. Buoyancy reduces body weight and helps individuals who have difficulty moving on land to move more easily. Turbulent water provides a suitable environment for static and dynamic balance training with minimal risk of injury. Resistance is also important for strength training in water. Aquatic exercises are widely used in various therapeutic settings. Individuals with MS are frequently referred to physical therapy to benefit from aquatic exercises. However, the literature indicates that research in this field remains limited. Studies in the literature suggest that aquatic exercise approaches are effective, safe, and feasible methods for improving balance, fatigue, pain, functional mobility, and quality of life in individuals with MS. In particular, mind-body-based aquatic approaches such as Ai-Chi and WATSU appear to be effective in improving fatigue and psychosocial symptoms. Ai-Chi is a holistic exercise approach performed in water that combines Tai Chi- and Qigong-based slow and controlled movements with breathing awareness. Ai-Chi focuses on balance, strength, relaxation, flexibility, and breathing. Through these characteristics, Ai-Chi has the potential to simultaneously target physical, cognitive, and emotional components in individuals with MS. However, studies systematically and multidimensionally investigating the effects of Ai-Chi exercises in individuals with MS remain limited. This highlights the need to scientifically clarify the role of Ai-Chi in MS rehabilitation.
Research Question
In individuals diagnosed with Multiple Sclerosis, are Ai-Chi exercises, as an aquatic exercise method, more effective than land-based exercises in improving balance, mobility, muscle strength, quality of life, depression, fatigue, and cognitive functions?
Research Hypotheses
H1: Individuals with MS who participate in Ai-Chi exercises demonstrate significantly greater improvements in balance and mobility compared with individuals who participate in land-based exercise programs.
H2: Ai-Chi exercises are more effective than land-based exercises in reducing fatigue and improving quality of life in individuals with MS.
H3: Ai-Chi exercises have more positive effects on depression levels and cognitive functions in individuals with MS compared with land-based exercises.
H4: Ai-Chi exercises result in a significant increase in muscle strength in individuals with MS.
3,524 studies on the registry are indexed under Multiple Sclerosis; 668 are open to participants now.
This study's enrollment of 20 is below the median of 50 across 2,386 interventional studies indexed under Multiple Sclerosis.
Browse Multiple Sclerosis studies →Kirsehir Ahi Evran Universitesi is the lead sponsor of 136 studies on the registry; 56 are open to participants now.
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Exclusion Criteria:
Participants in the aquatic exercise group will participate in an Ai Chi exercise program. The exercises will be performed in a group setting for 45 minutes per session, five days per week for five weeks, resulting in a total of 25 sessions. Ai Chi utilizes the properties of water to facilitate movements that primarily focus on balance, muscle strength, flexibility, and breathing control. The sessions will be conducted in a pool with a water depth of 1.2 m and a temperature maintained between 28 and 30°C. Appropriate environmental conditions and safety measures will be ensured throughout the intervention. Before each session, participants will be informed about the aquatic exercise program and the precautions to be taken during the sessions. All sessions will be supervised by a physiotherapist experienced in neurological rehabilitation and Ai Chi.
Other: Ai-Chi exercise
Participants in the land-based exercise group will participate in 45-minute exercise sessions, five days per week for five weeks. During the first five minutes of each session, participants will perform warm-up exercises consisting of light aerobic activities, including upper and lower extremity swings, low-intensity walking, and stretching. The subsequent 35 minutes will be devoted to balance, mobility, and strengthening exercises. Balance exercises will include single-leg standing, forward-reaching exercises, and standing on a balance board. Mobility exercises will include sit-to-stand transfers from a chair, lateral walking, heel-to-toe walking, and walking over obstacles. Strengthening exercises will include upper and lower extremity exercises using a yellow resistance band, mini-squats, and elbow flexion and extension exercises using light weights.
Other: Land-Based Exercise
Participants in the aquatic exercise group will participate in an Ai Chi exercise program. The exercises will be performed in a group setting for 45 minutes per session, five days per week for five weeks, resulting in a total of 25 sessions. Ai Chi utilizes the properties of water to facilitate movements that primarily focus on balance, muscle strength, flexibility, and breathing control. The sessions will be conducted in a pool with a water depth of 1.2 m and a temperature maintained between 28 and 30°C. Appropriate environmental conditions and safety measures will be ensured throughout the intervention. Before each session, participants will be informed about the aquatic exercise program and the precautions to be taken during the sessions. All sessions will be supervised by a physiotherapist experienced in neurological rehabilitation and Ai Chi.
Participants in the land-based exercise group will participate in 45-minute exercise sessions, five days per week for five weeks. During the first five minutes of each session, participants will perform warm-up exercises consisting of light aerobic activities, including upper and lower extremity swings, low-intensity walking, and stretching. The subsequent 35 minutes will be devoted to balance, mobility, and strengthening exercises. Balance exercises will include single-leg standing, forward-reaching exercises, and standing on a balance board. Mobility exercises will include sit-to-stand transfers from a chair, lateral walking, heel-to-toe walking, and walking over obstacles. Strengthening exercises will include upper and lower extremity exercises using a yellow resistance band, mini-squats, and elbow flexion and extension exercises using light weights.
Lower Extremity Strength Assessment
A handheld dynamometer will be used to assess lower extremity muscle strength. Participants will be informed about the test procedure before testing. Each test will be performed three times with maximal effort, and the mean value will be recorded in Newtons. The quadriceps femoris, hamstrings, hip flexors, hip extensors, hip adductors, and hip abductors will be evaluated. Each test will be repeated three times, with a 30-second rest period between measurements. When necessary, the therapist will stabilize the relevant extremity during testing. For the assessment of the quadriceps femoris, the participant will sit at the edge of a treatment table with the hip and knee flexed at 90°. The dynamometer will be placed approximately 1-2 cm proximal to the malleoli on the distal tibia. The participant will then be instructed to perform knee extension with maximal force, and the results of the three maximal trials will be recorded.
Time frame: Baseline and immediately after the 5-week intervention
Upper Extremity Strength Assessment
The Jamar hand dynamometer will be used to assess upper extremity muscle strength. Participants will be seated in a chair with their back supported. The tested shoulder will be positioned in adduction, with the elbow flexed at 90°, while the forearm and wrist will be maintained in a neutral position. Prior to testing, participants will be informed about the procedure. The test will be performed three times with maximal effort, and the mean value will be recorded in kilograms.
Time frame: Baseline and immediately after the 5-week intervention
Balance Assessment
The Berg Balance Scale (BBS) will be used to assess balance. The scale consists of 14 items, each scored from 0 (unable to perform) to 4 (normal performance). The test includes tasks such as forward reaching, standing with the eyes open and closed, and standing on one leg. A total score of 0-20 indicates a high level of balance impairment, 21-40 indicates a moderate level of balance impairment, and 41-56 indicates a low level of balance impairment.
Time frame: Baseline and immediately after the 5-week intervention
Fatigue Assessment
The Fatigue Impact Scale (FIS) will be used to assess fatigue severity. The FIS is a self-report scale consisting of 40 items covering physical, psychosocial, and cognitive domains. Each item is scored from 0 (never) to 4 (almost always). The total score ranges from 0 to 160, with higher scores indicating a greater impact of fatigue on the individual.
Time frame: Baseline and immediately after the 5-week intervention
Quality of Life Assessment
The Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire, which is specifically designed for individuals with MS, will be used to assess quality of life. The questionnaire was developed based on the SF-36 Health Survey. In addition to the SF-36 items, 18 additional items assessing domains such as pain, cognitive function, and physical function were incorporated. The questionnaire consists of 54 items, and each domain is scored separately according to its specific scoring system. Scores range from 0 to 100, with higher scores indicating better quality of life.
Time frame: Baseline and immediately after the 5-week intervention
Mobility Assessment
The Multiple Sclerosis Walking Scale-12 (MSWS-12), specifically developed for individuals with multiple sclerosis (MS), will be used to assess walking ability and its limitations. The scale consists of 12 items rated on a 5-point Likert scale, ranging from 1 (not at all) to 5 (extremely). The items assess the impact of MS on walking ability, including walking distance, speed, balance, and the need for support. The raw total score ranges from 12 to 60, with higher scores indicating greater walking limitations. The raw score can be transformed to a 0-100 scale according to the instrument's scoring guidelines, with higher transformed scores also indicating greater walking impairment.
Time frame: Baseline and immediately after the 5-week intervention
Mobility Assessment
Another method that will be used to assess mobility is the Timed Up and Go (TUG) Test. Participants will be informed about the test procedure before testing. A distance of 3 meters will be marked between the chair and a designated turning point. The participant will sit in a chair with a backrest and armrests. Following the command "Go," the participant will stand up from the chair, walk 3 meters at their normal walking speed, turn around at the designated point, walk back 3 meters, and sit down in the chair again. The time required to complete the task will be recorded in seconds. A shorter completion time indicates better mobility.
Time frame: Baseline and immediately after the 5-week intervention
Cognitive Function Assessment
The Brief International Cognitive Assessment for MS (BICAMS) is a brief assessment battery specifically developed for individuals with MS to evaluate cognitive function. It consists of three subtests: the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test-Second Edition (CVLT-II), and the Brief Visuospatial Memory Test-Revised (BVMT-R). Participants will be informed about the procedures for each subtest before the assessment.
Time frame: Baseline and immediately after the 5-week intervention
Cognitive Function Assessment
The Symbol Digit Modalities Test (SDMT) is used to assess information-processing speed and consists of nine digits and nine corresponding symbols. Participants are required to write the digits corresponding to the presented symbols as quickly and accurately as possible within 90 seconds. Following one practice trial, the test will be administered. The numbers of correct and incorrect responses will be recorded.
Time frame: Baseline and immediately after the 5-week intervention
Cognitive Function Assessment
The California Verbal Learning Test-Second Edition (CVLT-II) is used to assess verbal-auditory learning and memory. The test consists of 16 words representing categories such as vegetables, household items, animals, and vehicles. The examiner will read the 16 words aloud in a clear and audible voice five consecutive times. After each presentation, participants will be asked to recall as many words as possible, and the recalled words will be recorded. A maximum of 80 words can be recalled across the five trials. The test will be administered without a time limit, and the numbers of correct and incorrect responses will be recorded.
Time frame: Baseline and immediately after the 5-week intervention
Cognitive Function Assessment
The Brief Visuospatial Memory Test-Revised (BVMT-R) requires participants to examine six geometric figures for 10 seconds and subsequently reproduce the figures from memory on a separate sheet of paper. Each figure will be scored according to both its accuracy and spatial location: 2 points will be awarded if the figure and its location are reproduced correctly, 1 point if the location is correct but the figure is only approximately reproduced, and 0 points if the figure cannot be reproduced. A maximum of 12 points can be obtained per trial. The test will be repeated three times, and the total score will be calculated.
Time frame: Baseline and immediately after the 5-week intervention
Plan to share: No — Individual patient-level data will not be publicly shared because they contain sensitive health-related information and may compromise participant privacy and confidentiality. Anonymized data may be made available upon reasonable request, subject to ethical and institutional approval.
Ran from Jan 2026 to primary completion in Jan 2026, 0 months.
Of 868 non-industry interventional studies with no phase under Multiple Sclerosis, half reached primary completion within 22 months of starting (the median), counting those still running; a quarter within 9 and three quarters within 43. This study's 0 months is below that.
Counting every sponsor, half of 889 studies reached it within 21 months; a quarter within 9 and three quarters within 43.
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From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is completed, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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