Ai-Chi in Individuals With Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic neurological disease affecting the central nervous system and has a multidimensional negative impact on individuals' physical, cognitive, and psychosocial functioning due to its progressive and heterogeneous clinical course. The exact cause of MS remains unknown. Genetic factors, environmental factors, and the interaction between these factors are generally thought to play a role in the development of MS. Race, sex, low vitamin D levels, limited exposure to sunlight, Epstein-Barr virus infection, and smoking have been identified as major risk factors for the development of MS. Clinical signs and symptoms of MS vary depending on the regions of the brain and spinal cord affected by the disease. Although MS is associated with a wide range of clinical signs and symptoms, motor, sensory, and autonomic dysfunctions are among the most common manifestations. The most common motor impairments observed in MS include muscle weakness, spasticity, tremor, ataxia, and visuomotor deficits. These impairments negatively affect balance and walking function and may lead to falls. Individuals with MS also demonstrate reduced muscle contraction strength, decreased endurance, reduced total muscle mass, and increased muscle atrophy. Balance impairments are among the most common symptoms experienced by individuals with MS. Postural instability occurs as a result of impaired neural connections within the somatosensory, visual, and vestibular systems, which play important roles in maintaining balance in individuals with MS. Walking problems are another common symptom in individuals with MS. Reduced walking speed, step length, and cadence, as well as increased step width and double-support phase duration, have been reported. These walking impairments have been particularly associated with muscle weakness, spasticity, and reduced postural stability and balance. Sensory disturbances are also common in individuals with MS. Hypoesthesia, hyperesthesia, and loss of proprioception may negatively affect postural control and walking, thereby limiting individuals' activities of daily living. Fatigue is experienced by approximately 90% of individuals with MS and has a substantial negative impact on their quality of life. Cognitive dysfunction is observed in approximately 20% of individuals with MS within the first five years following disease onset, and this proportion increases as the disease progresses. Depression and anxiety are also common in MS and occur at higher rates than in the general population. Muscle weakness, balance and mobility impairments, fatigue, cognitive problems, and depression experienced by individuals with MS restrict independence in activities of daily living and lead to a substantial reduction in quality of life. Therefore, in addition to pharmacological treatments, the development of effective, safe, and sustainable rehabilitation approaches is of great importance. Physical activity decreases as the disease progresses in individuals with MS. Appropriate exercise programs for individuals with MS can lead to significant improvements in aerobic capacity, muscle strength and endurance, flexibility, balance, mobility, fatigue, and quality of life. In addition, systematic analyses investigating the effects of exercise have demonstrated that exercise may promote the production of neurotrophic factors, neuronal growth and proliferation, and improvements in cognitive functions such as learning and memory. Exercise has also been shown to increase the production of Brain-Derived Neurotrophic Factor (BDNF). Treatment approaches for MS are generally classified into pharmacological and non-pharmacological interventions. Although there is currently no definitive cure for MS, pharmacological agents used in its management modify or suppress the immune system and thereby alter the course of the disease. These agents are generally used to reduce the frequency of relapses, slow physical deterioration, and alleviate MS-related symptoms. In addition to pharmacological treatment, physiotherapy and rehabilitation are among the most important approaches for improving quality of life and maintaining independent mobility in individuals with MS. Exercise-based rehabilitation approaches are known to have positive effects on functional capacity, balance, walking, and quality of life in individuals with MS. However, land-based exercises may be limiting for some individuals due to MS-specific factors such as heat sensitivity, rapid fatigue, and changes in muscle tone. In this context, the buoyancy of water reduces body weight and increases the range of motion, while the greater density of water compared with air provides natural resistance. Hydrostatic pressure contributes to reducing edema and provides proprioceptive feedback, while the thermal properties of water may reduce muscle spasms at an appropriate temperature and promote circulation. Aquatic exercises offer several advantages for individuals with MS, including facilitating thermoregulation, providing a pain-free and supported movement environment, improving balance and coordination, increasing muscle strength and endurance, reducing spasticity and muscle tension, promoting psychological well-being, and improving functional ability and quality of life. Aquatic exercises have been used for many years in the treatment of various diseases. The aquatic environment possesses several properties, including buoyancy, turbulence, hydrostatic pressure, and resistance, which facilitate various therapeutic exercise benefits. Buoyancy reduces body weight and helps individuals who have difficulty moving on land to move more easily. Turbulent water provides a suitable environment for static and dynamic balance training with minimal risk of injury. Resistance is also important for strength training in water. Aquatic exercises are widely used in various therapeutic settings. Individuals with MS are frequently referred to physical therapy to benefit from aquatic exercises. However, the literature indicates that research in this field remains limited. Studies in the literature suggest that aquatic exercise approaches are effective, safe, and feasible methods for improving balance, fatigue, pain, functional mobility, and quality of life in individuals with MS. In particular, mind-body-based aquatic approaches such as Ai-Chi and WATSU appear to be effective in improving fatigue and psychosocial symptoms. Ai-Chi is a holistic exercise approach performed in water that combines Tai Chi- and Qigong-based slow and controlled movements with breathing awareness. Ai-Chi focuses on balance, strength, relaxation, flexibility, and breathing. Through these characteristics, Ai-Chi has the potential to simultaneously target physical, cognitive, and emotional components in individuals with MS. However, studies systematically and multidimensionally investigating the effects of Ai-Chi exercises in individuals with MS remain limited. This highlights the need to scientifically clarify the role of Ai-Chi in MS rehabilitation. Research Question In individuals diagnosed with Multiple Sclerosis, are Ai-Chi exercises, as an aquatic exercise method, more effective than land-based exercises in improving balance, mobility, muscle strength, quality of life, depression, fatigue, and cognitive functions? Research Hypotheses H1: Individuals with MS who participate in Ai-Chi exercises demonstrate significantly greater improvements in balance and mobility compared with individuals who participate in land-based exercise programs. H2: Ai-Chi exercises are more effective than land-based exercises in reducing fatigue and improving quality of life in individuals with MS. H3: Ai-Chi exercises have more positive effects on depression levels and cognitive functions in individuals with MS compared with land-based exercises. H4: Ai-Chi exercises result in a significant increase in muscle strength in individuals with MS.