Long-term effects of various exercise training modalities on balance, gait and fatigue in patients with multiple sclerosis: a randomized controlled study

Abstract

Objective: To investigate the long-term effects of vestibular exercises (VE), cervical stabilization exercises (CSE) and standard balance exercises (SBE) on balance, gait and fatigue in patients with multiple sclerosis. Methods: Thirty-five patients were randomly allocated to three groups, performing different exercises three days a week for 12 weeks. Assessments were conducted at baseline, at Week 12 and at a 6-month follow-up using the Functional Reach Test (FRT), Four-Square Step Test (FSST), 2-Minute Walk Test (2MWT), Timed Up and Go (TUG) test, and Fatigue Impact Scale (FIS). Results: At 12 weeks, both CSE and VE groups improved on FRT and 2MWT, with the CSE group also experiencing improvements on FSST, TUG, and FIS (p < 0.05). The SBE group showed no significant changes. At 6 months, FRT, FSST, and 2MWT improvements persisted in the VE group, while the CSE group-maintained TUG and FIS gains. The VE group had superior FRT at 6 months, while the CSE group showed greater FSST improvements at 12 weeks. The VE group exhibited greater 2MWT improvements than the CSE group at 6 months, while the CSE group had better TUG results at both timepoints. Both CSE and VE groups showed greater reductions in fatigue (FIS) than the SBE group at 6 months. Discussion; VE provide long-term benefits for balance and gait speed, while CSE enhance gait endurance and postural control during training. Both modalities contribute to long-term fatigue reduction. SBE are less effective, highlighting the need for targeted interventions such as VE and CSE for sustained improvements.