The effect of Tai Chi on executive functions in individuals with Multiple Sclerosis, a randomized controlled trial

Objective: Multiple Sclerosis (MS) is a neurodegenerative disease known to have negative effects on cognitive functions. The aim of this study was to examine the effects of Tai Chi exercises on executive functions in individuals with MS. Materials and Methods: A total of 44 individuals diagnosed with MS, with an Expanded Disability Status Scale (EDSS) score ≤ 3.5, were included in the study. Participants were randomly assigned to either the Tai Chi group (TCG n=23) or the control group (CG n=22). Exercises were performed twice a week for 8 weeks. In the TCG, 8 out of the 10 basic movements of the Yang style were practiced face-to-face, whereas the CG was given a home exercise program including Frenkel Coordination Exercises. Before and after the intervention, participants' executive functions, fatigue levels, and depression levels were assessed using the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test–Second Edition (CVLT-II), and the Brief Visuospatial Memory Test–Revised (BVMT-R) from the Brief International Cognitive Assessment for MS (BICAMS), as well as the Fatigue Impact Scale (FIS) and the Beck Depression Inventory (BDI). Results: At baseline, there were no significant differences between the groups in EDSS, SDMT, CVLT-II, BVMT-R, FIS, and BDI scores (p>0.05). After the intervention, significant differences favoring the TCG were found in CVLT-II, BVMT-R, FIS, and BDI scores (p<0.05). Although an increase was observed in SDMT scores in the TCG, it was not statistically significant (p>0.05); however, significant improvements were observed in CVLT-II and BVMT-R scores (p<0.05). In the CG, only CVLT-II scores improved, and the effect size was lower compared to the TCG (TCG ES=0.86; CG ES=0.59) (p<0.05). Additionally, no improvements were observed in FIS and BDI scores in the CG (p>0.05), whereas significant improvements were detected in the TCG (p<0.05). Conclusion: Tai Chi is more effective than a home program consisting of Frenkel Coordination Exercises in improving executive functions, fatigue, and depression in individuals with MS. These findings support the potential contributions of complementary exercise approaches to cognitive and mental health in MS. Keywords: Multiple Sclerosis; Tai Chi; Frenkel Coordination Exercises; Executive Functions; Cognitive Rehabilitation