Effectiveness of Home-Based Exercise and Brain Stimulation for Reducing Fatigue in Patients With Multiple Sclerosis

Effectiveness of a Home-Based Therapeutic Exercise Program and Transcranial Direct Current Stimulation (tDCS) as a Treatment for Fatigue in Patients With Multiple Sclerosis

This randomized, double-blind, parallel-group clinical trial aims to assess the effectiveness of a combined intervention consisting of a home-based therapeutic exercise program and transcranial direct current stimulation (tDCS) for the management of fatigue in patients with multiple sclerosis (MS). Fatigue is one of the most disabling and prevalent symptoms in MS, significantly impacting patients' quality of life and functional independence.

Participants diagnosed with MS who meet inclusion criteria will be randomized into two groups:

Group 1: Home-based therapeutic exercise plus sham (placebo) tDCS

Group 2: Home-based therapeutic exercise plus active tDCS

The intervention will span a defined period, with tDCS sessions applied over the dorsolateral prefrontal cortex (DLPFC) using a standard montage and parameters validated in previous studies. The sham stimulation group will follow identical procedures without active current delivery, preserving blinding for participants and evaluators.

The therapeutic exercise program is designed to be feasible for home implementation, targeting key domains affected in MS such as strength, endurance, balance, and mobility. Exercises will be prescribed based on individual patient assessments and progressively adjusted throughout the intervention period.

Primary outcome measures will include functional capacity, evaluated through the Six-Minute Walk Test (6MWT), and fatigue levels, assessed via the Fatigue Severity Scale (FSS) and a Visual Analogue Scale (VAS) for fatigue. Secondary observations may include adherence rates to the exercise program and subjective reports of tolerability and perceived benefits.

This trial seeks to explore whether combining a physical intervention (exercise) with a neuromodulation technique (tDCS) can offer additive benefits in managing fatigue, beyond what exercise alone provides. The ultimate goal is to develop accessible, non-pharmacological treatment strategies to improve daily functioning and quality of life for individuals living with multiple sclerosis.

This study is a randomized, double-blind, controlled clinical trial designed to investigate the efficacy of a combined intervention consisting of a structured home-based therapeutic exercise program and transcranial direct current stimulation (tDCS) for the treatment of fatigue in patients with multiple sclerosis (MS).

Eligible participants will be randomly assigned to one of two parallel groups:

An intervention group receiving a prescribed home-based exercise program in combination with active tDCS.

A control group receiving the same exercise program combined with sham (placebo) tDCS.

The tDCS intervention will target the dorsolateral prefrontal cortex (DLPFC) using a standardized electrode placement, with stimulation parameters based on protocols previously demonstrated to be safe and potentially effective in neurological populations. The sham condition will simulate the sensation of stimulation without delivering an active current, ensuring the integrity of the blinding process for both participants and evaluators.

The therapeutic exercise program will focus on improving muscular strength, cardiovascular endurance, balance, and functional mobility, components known to be affected in individuals with MS. The program will be tailored to individual baseline capabilities and progressively adapted throughout the intervention period to optimize participant engagement and safety.

Primary outcome measures include changes in functional exercise capacity, as assessed by the Six-Minute Walk Test (6MWT), and fatigue severity, evaluated using the Fatigue Severity Scale (FSS) and a Visual Analogue Scale (VAS) for fatigue. Adherence to the intervention and tolerability will also be monitored.

The proposed study addresses a critical need for accessible, non-pharmacological interventions to manage fatigue, one of the most common and disabling symptoms in MS. By combining physical rehabilitation strategies with neuromodulation techniques, the trial aims to determine whether synergistic effects can be achieved, potentially informing future clinical practices aimed at enhancing the quality of life of individuals with multiple sclerosis.

Inclusion Criteria:

• Signed written informed consent
• Confirmed diagnosis of multiple sclerosis
• Presence of fatigue associated with multiple sclerosis, defined as a fatigue Visual Analogue Scale (VAS) score equal to or greater than 4
• Functional capacity sufficient to perform the Six-Minute Walk Test (6MWT), assessed by a Functional Ambulation Category (FAC) score of 3 or higher

Exclusion Criteria:

• Presence of any neurological, rheumatological, or other medical condition prior to the diagnosis of multiple sclerosis that could interfere with the study outcomes
• Presence of contraindications for transcranial direct current stimulation (tDCS), such as having a pacemaker, a history of epillepsy, pregnancy, implanted intracranial electrodes, defibrillator, or similar electronic devices.
• Cognitive impairment that limits the participant's ability to collaborate with study procedures.
• Any changes in physical therapy or pharmacological treatments for multiple sclerosis and/or fatigue that are not specified by the study protocol.
• Occurrence of a multiple sclerosis relapse or disease progression with functional repercussions during the study period.