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.
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
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
Parallel
Face-to-Face Circuit Training
BehavioralParticipants 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 Training
BehavioralParticipants 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.
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.
Walking Speed: Timed 25-Foot Walk Test (T25FW)
Walking speed will be assessed using the Timed 25-Foot Walk Test. Participants will be instructed to walk a distance of 25 feet, approximately 7 meters, safely but as quickly as possible. The time required to complete the test will be recorded in seconds; a shorter completion time indicates better short-distance walking performance. This test will be used to objectively assess ambulation and lower-extremity function in individuals with MS.
Functional Mobility: Timed Up and Go Test (TUG)
Functional mobility will be assessed using the Timed Up and Go Test. The participant will begin in a seated position on a chair; upon command, the participant will stand up, walk a distance of 3 meters, turn around, return to the chair, and sit down. The time required to complete the test will be recorded in seconds. This test provides an integrated assessment of functional movements frequently used in daily life, including sit-to-stand, walking, turning, and sitting down.
Dynamic Balance: Mini-Balance Evaluation Systems Test (Mini-BESTest)
Dynamic balance will be assessed using the Mini-BESTest. The Mini-BESTest consists of tasks involving anticipatory postural control, reactive postural responses, sensory orientation, and dynamic gait. The participant's ability to use different balance strategies, generate postural responses, and maintain stability during movement will be assessed. Each item will be scored according to performance, and the total score will provide information about the level of dynamic balance.
Lower-Extremity Functional Muscle Strength: Five Times Sit-to-Stand Test (5xSTS)
Lower-extremity functional muscle strength will be assessed using the Five Times Sit-to-Stand Test. Participants will be instructed to stand up from and sit down on a standard chair five consecutive times, preferably without using their arms. The time required to complete the test will be recorded in seconds. A shorter completion time will indicate better lower-extremity functional muscle strength and functional transfer performance. Participants will be observed for safety during the test, and the use of an assistive device will be recorded if necessary.
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