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

NCT07461987 | Recruiting

• 1 other identifier: PU-FTR-MI-03
• Study Type: interventional
• Target: 39
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Multiple Sclerosis

Keywords

Multiple sclerosis; Tai Chi; Square stepping exercise; Position sense; Fatigue; Lower extremity muscle strength

Outcome Measures

Primary Outcomes (1)

• Knee joint position sense

  Knee joint position sense will be assessed using an electrogoniometer. For standardization, participants will be evaluated in a seated position with back support, with the hip and knee at 90° flexion. A target angle of 30° knee extension (relative to the start position) will be used. When the participant reaches the target angle, she will be asked to hold the position for 5 seconds to learn the angle. The knee will then be returned to the neutral position and the participant will be asked to reproduce the target angle. Measurements will be repeated three times, the mean value will be calculated, and the absolute error (in degrees) will be recorded. Assessments will be conducted in a quiet room with eyes closed, with the joint exposed and barefoot.

  Baseline (pre-intervention) and immediately post-intervention (Week 8).

Secondary Outcomes (2)

• Five-Repetition Sit-to-Stand Test (5STS)

  Baseline (pre-intervention) and immediately post-intervention (Week 8).

• Fatigue Impact Scale (FIS)

  Baseline (pre-intervention) and immediately post-intervention (Week 8).

Study Arms (3)

Tai Chi

EXPERIMENTAL

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.

Behavioral: Tai Chi

Square Stepping Exercise (SSE)

EXPERIMENTAL

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.

Behavioral: Square Stepping Exercise (SSE)

Home Exercise Program (Frenkel)

ACTIVE COMPARATOR

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.

Behavioral: Home-based Frenkel Coordination Exercises

Interventions

Tai Chi BEHAVIORAL

Tai Chi will be delivered for 8 weeks, 2 days per week, 1 session per day (total 16 sessions). Each session will last approximately 45-60 minutes and will include warm-up stretching, main Tai Chi practice, and cool-down stretching plus controlled breathing techniques.

Tai Chi

Square Stepping Exercise (SSE) BEHAVIORAL

SSE will be delivered for 8 weeks, 2 days per week, 1 session per day (total 16 sessions). Each session will be completed in approximately 45-60 minutes, including warm-up and cool-down periods.

Square Stepping Exercise (SSE)

Home-based Frenkel Coordination Exercises BEHAVIORAL

Frenkel Coordination Exercises will be delivered as a home program for 8 weeks, 2 days per week, 1 session per day (total 16 sessions). Each session will last 15-30 minutes, excluding rest periods.

Home Exercise Program (Frenkel)

Eligibility Criteria

• Age: 20 Years - 45 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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).

You may not qualify if:

• 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

Sponsors & Collaborators

• Pamukkale University: lead

Study Sites (1)

Department of Neurology, Pamukkale University Hospital

Denizli, 20070, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Multiple Sclerosis; Fatigue

Interventions

Tai Ji

Condition Hierarchy (Ancestors)

Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Nervous System Diseases; Demyelinating Diseases; Autoimmune Diseases; Immune System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Mind-Body Therapies; Complementary Therapies; Therapeutics; Exercise Movement Techniques; Physical Therapy Modalities

Study Officials

• Müge İçelli Güneş, PhD

  Pamukkale University Denizli Health Services Vocational School of Higher Education

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Müge İçelli Güneş, PhD

CONTACT

02582964256; micelli@pau.edu.tr

Tuba Can Akman, Asst. Prof.

CONTACT

tubacan@pau.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer

Model Details: Randomized, three-arm, parallel-group trial. Participants will be randomly assigned to Tai Chi, Square Stepping Exercise and home-based Frenkel exercise (control). Interventions will be delivered for 8 weeks (2 sessions/week). Outcomes will be assessed at baseline and post-intervention

Study Record Dates

• First Submitted: March 5, 2026
• First Posted: March 10, 2026
• Study Start: February 15, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 1, 2026
• Last Updated: March 10, 2026

Record last verified: 2026-03

Locations

TU (1)