Effect of Tai Chi on Balance, Mood, Cognition, and Quality of Life in Patients With Multiple Sclerosis
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central
      nervous system (CNS). The clinical picture is very variable, ultimately resulting in
      disability. Disease attacks manifest themselves depending on the location of the CNS damaged
      by inflammation, demyelination, axonal loss and gliosis. The most common manifestations
      include motor disorders with the development of stiffness, balance and coordination,
      cognition, fatigue and depression. In the long term, most patients with MS will achieve
      significant and irreversible incapacitation. Immunomodulatory therapy is designed to reduce
      disease activity, slowing progression, but only to a certain extent. A significant benefit,
      but little researched, is physical exercise. Tai Chi has a positive effect on various
      neurological diseases. In recent studies, Tai Chi has shown improvements in coordination and
      balance, depression, anxiety, cognition and overall quality of life in patients with MS. The
      aim of the project is to assess the therapeutic value of structured Tai Chi exercise based on
      published clinical work.
    

Detailed description: 
      Multiple sclerosis (MS) is a chronic disease that mainly affects young people with a maximum
      incidence in working age. Demyelination, axial damage, inflammation and gliosis affect the
      brain, spinal cord and optic nerves. The resulting symptoms are both physical and mental, and
      are closely related. The degree of disability in MS can range from relatively benign to
      malignant forms leading to severe disability in patients over several years. The most common
      symptoms of MS are impaired motor and sensitive functions, imbalances and coordination. Loss
      of balance leads to falls, in patients with MS they occur with a prevalence of 34-64%. The
      result is injuries, fractures, soft tissue damage, restricted activities and reduced
      mobility. The psychological aspect is loss of independence, social isolation, reduced quality
      of life. The clinical picture of MS also includes cognitive dysfunction (more than half of
      patients with MS) and a number of neurobehavioral disorders, especially fatigue (53-90%),
      depression (with a prevalence of 40-60%), anxiety disorders (35%). They are conditioned not
      only by reactivity, but indeed by the pathophysiology of the disease itself. Cognitive and
      affective symptoms associated with MS are a serious psychosocial factor limiting the course
      of the disease. MS is an incurable disease. Immunomodulatory therapy, which is continuously
      modified according to the patient's condition, is essentially a variety of effective
      prevention of progression of disability. At present, there is not enough knowledge about the
      right combination and structure of programmed physical exercise, which would significantly
      alleviate the symptoms of MS. While in the past it has not been recommended to patients in
      the traditional sense of MS, recent findings integrate physical exercise into the treatment
      of MS as an essential component. Current research points to significant benefits of physical
      activity in patients with MS: improved aerobic capacity and muscle strength, mobility,
      fatigue, and quality of life. Even the potential of physical exercise for the pathology of SM
      itself is expected, namely anti-inflammatory - by modulating the cytokine profile of T-cells
      and neuroprotective - by increasing the level of serum BDNF (brain-derived neurotrophic
      factor). Tai Chi Chuan - The inner art of Taoist Tai Chi is not practiced as a martial art
      technique or in a competitive spirit. A characteristic feature of Tai Chi is stretching and
      rotation in every movement. Another aspect is the emphasis on sitting and getting up, which
      helps to improve balance, strengthen legs, tendons and ligaments. Tai Chi also has a
      spiritual dimension associated with physical exercise. The primary goal is relaxation of body
      and soul, for Tai Chi are characterized by slow and controlled movements, deep relaxed
      breathing and correct posture through a state of awareness and concentration. Tai Chi
      improves flexibility, range of motion, muscle strength and balance and therefore could be
      beneficial for MS patients. As many of the basic principles of Tai Chi are directly related
      to postural control, initial smaller studies have begun to show that improvements in
      depression, quality of life and balance have improved.
    

Intervention name(s): "Tai-chi" - a special program for patients with multiple sclerosis - once a week training with a Tai Chi instructor lasting 90 minutes
Intervention type(s): Other
Intervention description(s): "Tai-chi" - a special program for patients with multiple sclerosis - once a week training with a Tai Chi instructor lasting 90 minutes for 12 months
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The intervention study will include treated patients with relapsing-remitting MS who meet the 2010 MR McDonald criteria for dissemination in time and space, last month before enrollment without relapse, no severe cognitive impairment, and according to the Kurtz Disability Scale (EDSS). 4.5 for 12 months and exercise intensity three times a week.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Multiple sclerosis; Tai Chi Chuan; balance; non-pharmacological interventions; physical therapy; posturography