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

The Effects of Tai Chi and Square Stepping Exercises on Joint Position Sense and Clinical Outcomes in Women With Multiple Sclerosis

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.

Multiple Sclerosis (MS) is a chronic and demyelinating disease of the central nervous system observed in young adults. As the disease progresses, impairments occur in motor and sensory functions. Somatosensory inputs, such as knee joint position sense, which is particularly critical for balance and postural control, are frequently affected. In addition to these impairments, a decrease in lower extremity muscle strength and fatigue affecting the vast majority of patients restrict participation in activities of daily living.

Within the scope of this study, women diagnosed with MS will be randomized into one of three different intervention arms: a Tai Chi group incorporating postural stability exercises based on the Yang style; a Square Stepping Exercise (SSE) group consisting of coordinated step patterns aimed at improving sensorimotor integration; or a control group in which Frenkel exercises, representing traditional coordination approaches, are applied. Exercise interventions in all groups were planned for 8 weeks, twice a week.

The study aims to comparatively demonstrate the effects of Tai Chi and Square Stepping Exercises on knee joint position sense, lower extremity muscle strength, and fatigue levels, and to develop evidence-based strategies for these parameters in MS rehabilitation

Inclusion Criteria:

• 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).

Exclusion Criteria:

• 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