Effects of lower extremity proprioceptive neuromuscular facilitation exercises versus resistance training on gait, balance, and fatigue in patients with multiple sclerosis: A randomized controlled study

Abstract

Objective

This study aimed to investigate the effects of lower extremity Proprioceptive Neuromuscular Facilitation (PNF) exercises on balance, gait, and fatigue in patients with Multiple Sclerosis (pwMS).

Method

Twenty-six pwMS (18 females, 8 males), aged 18-65 years, and an EDSS score of ≤5.5 were included in the study. Patients were randomly allocated to the PNF group (PNFG) or the resistance training group (RTG) (n = 13/group) and performed lower extremity PNF exercises or resistance training, respectively, three times per week for six weeks. Static and dynamic balance were assessed using the Tandem Stance Test (TST) and the Four-Square Step Test (FSST), respectively. Gait was evaluated using the Timed 25-Foot Walk (T25-FW) test, and fatigue using the Fatigue Severity Scale (FSS). Assessments were performed at baseline and after six weeks.

Results

Both groups showed significant within-group improvements across balance, gait, and fatigue measures (all within-group p < 0.001). Between-group comparisons of change scores demonstrated significantly larger improvements for PNFG versus RTG on: TST—right (Δ = 7.55 vs 4.11 s; p < 0.001; Cohen’s d = 0.76), TST—left (Δ = 6.96 vs 2.60 s; p < 0.001; d = 1.22), FSST (Δ = −3.24 vs −1.07 s; p < 0.001; d = −1.47), and T25-FW (Δ = −4.25 vs −1.29 s; p < 0.001; d = −1.50). There was no significant between-group difference for fatigue (FSS Δ = −0.35 vs −0.34; p = 0.884; d = −0.03). However, ANCOVA analyses adjusting for baseline values, and sensitivity analyses including age, BMI, and baseline EDSS, revealed no statistically significant between-group differences for any outcome, with small-to-medium effect sizes.

Conclusion

Both lower extremity PNF exercises and resistance training effectively improve balance, gait, and fatigue in pwMS. After accounting for baseline performance and relevant covariates, PNF did not confer additional statistically significant benefits over resistance training. Nevertheless, incorporating PNF into rehabilitation programs remains a practical approach to enhance neuromuscular coordination and functional mobility, and it may be combined with conventional strengthening exercises and targeted fatigue-management strategies for more comprehensive outcomes.