High-Intensity Interval Training for Walking and Function Across Different Multiple Sclerosis Disability Levels

The Effect of High-Intensity Interval Training on Maximum Walking Distance and Functional Parameters in Patients With Multiple Sclerosis at Different Disability Levels

Multiple Sclerosis (MS) is a chronic neurological disease that can affect daily functioning, mobility, and overall quality of life. High-Intensity Interval Training (HIIT) is known to be a time-efficient exercise approach that improves exercise capacity and reduces fatigue in MS. However, current research lacks sufficient data on how HIIT affects individuals with different levels of disability.

The main purpose of this study is to evaluate the effects of a stationary bicycle-based HIIT protocol on maximum walking distance, fatigue, balance, muscle strength, endurance, gait speed, and quality of life in MS patients across three different disability levels: mild, moderate, and severe (classified according to Expanded Disability Status Scale - EDSS scores).

Participants will complete a cycle ergometer-based HIIT program. Assessments will be conducted at three time points:

Before starting the exercise program (baseline)

Immediately after completing the program (post-treatment)

4 weeks after the completion of the program (follow-up)

To ensure unbiased results, a triple-blind design will be used, meaning the outcome assessor, the treating physiotherapist, and the data analyst will be blinded to group assignments. The findings aim to help clinicians tailor personalized, effective HIIT protocols based on a patient's specific disability level rather than using a standardized, one-size-fits-all approach in MS rehabilitation.

Inclusion Criteria:

• Be between the ages of 18 and 65,
• Have been diagnosed with MS by a treating physician,
• Have an EDSS score between 0 and 6.5,
• Not having experienced a relapse within the last 3 months,
• Not having severe lower extremity contractures, severe spasticity (≥3 on the Modified Ashworth Scale), or an acute orthopedic problem that would prevent the participant from pedaling on a bicycle ergometer,
• Having a Mini Mental State Examination score of ≥24.

Exclusion Criteria:

• Having a severe cardiovascular, orthopedic, respiratory, or metabolic disease,
• Having an additional neurological condition,
• Being pregnant or suspecting pregnancy,
• Having received a botulinum toxin injection within the last 3 months,
• Having a COMPASS-31 total score greater than 13.6