A study of the impact of yoga and physical therapy on symptoms and quality of life in patients with multiple sclerosis

INTERVENTION: A pre‐prepared list of randomization numbers is used, in which the randomization number corresponds to the observation group, using a random number generator. The observation group (1, 2 or 3) is known to both the patient and the doctor. Participants are randomised to yoga, physical therapy, or no exercise depending on the group. Yoga and exercise classes are held twice a week for 12 weeks. Each session lasts about 60‐75 minutes. In the exercise group, the class consisted of three parts: 10‐15 minutes ‐ a warm‐up, which includes exercises on stretching of the main muscle groups, flexibility, in combination with breathing training; 25‐35 minutes ‐ endurance training, muscle strength, coordination and balance exercises, aerobic exercises; 10‐15 minutes ‐ relaxing techniques in combination with breathing exercises. The yoga group use a yoga complex consisting of 13 basic and 4 alternative poses. The complex is basic, universal for patients with MS and is designed to ensure safety, but at the same time give practitioners the opportunity to progress and improve their condition. Alternative, lighter versions of those poses that may cause difficulties are also suggested, and basic postures are performed using additional materials to ensure comfortable exercise. The names of poses and the basic principles of their implementation correspond to the classification given in B.C.S. Iyengar's book "Clarification of Yoga" by Iyengar. All patients continue their MS therapy according to routine practice. Participation in the study lasts up to 14 weeks, including the preliminary examination (up to 1 week), the period of exercises (12 weeks) and the final assessment (up to 1 week after the last exercise). CONDITION: Multiple sclerosis (MS) ; Nervous System Diseases ; Multiple sclerosis PRIMARY OUTCOME: Balancing ability measured using mean Berg Balance Scale score after 14 weeks of exercises and observation SECONDARY OUTCOME: ; 1. Tolerance of physical activity measured using the 6‐minute walk test result (m) after 14 weeks of exercises and observation; 2. General well‐being measured using the SF‐36 questionnaire after 14 weeks of exercises and observation; 3. Fatigue measured using Fatigue Assessment Scale after 14 weeks of exercises and observation; 4. Proportion of patients who successfully complete the study measured using attendance records at baseline and 12 weeks; 5. Adverse events related to physical activity appeared during the study measured using interview at baseline and 12 weeks; INCLUSION CRITERIA: 1. Written informed consent form 2. Age 18 years old and above 3. A diagnosis of remitting MS or secondary progressive MS 4. Presence of the walking, balance impairment or pathological fatigue 5. A patient has no previous regular physical exercises for MS treatment 6. EDSS score from 2.0 to 6.0 7. Agreement and ability to do regular exercise during the study 8. Agreement and ability to comply with the protocol (performing tests, completing questionnaires)