Effectiveness of Home-Based Exercise and Brain Stimulation for Reducing Fatigue in Patients 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.