The Effect of a Cognitive-motor program on balance and gait, quality of life, and stress management in patients with multiple sclerosis

INTERVENTION: Intervention 1: The participation group: The testing group will do the balancing exercises for 6 week and 45 minutes a session. The training plan includes the following: 5 warmup sessions(5 minutes), initial stretch(5 minutes), strength exercises for lower body(15 minutes), balancing exercises(15minutes) and cooling down(5 minutes), all of these will be done under the close supervition of a coach in a standard gym. The 5 minute‐warmup includes walking, The 5 minute‐initial stretch, flat arms stretch, upper head stretch, triceps stretch, shoulder stretch, quadriceps femoris stretch, Hamestring stretch while grounded(sitting down), strength training for lower body for 15 minutes, Hamstring flexion, crus extension, knee lifting, thighbone abduction and adoction, leaning and opening the ankle, ankle whirl, (Bottom squeeze) scot with a chair, scot with the wall, pulling up the legs from the sides, balancing exercises for 15 minutes, balancing with one leg, up‐right sitting on a ball, dynamic sitting on a ball, turning to the sides, leaning the hands to the sides from up the head, The last stretch(cool down) 5 minutes. These exercises all exist in the initial stretches. To control the stress in this experiment, stress management will be done cognitive‐behavioral style, during 10 sessions of 60 minutes and in groups. Sessions will start with relaxation trainings which include practicing relaxation techniques, in the second port of every session cognitive‐behavioral techniques are taught combined with issues related to patients health. Every session includes the following details: First session: in troduction, introducing the plans, getting to know the stress‐makers, and stress reactions, muscular relaxation training for 16 muscle groups. Second session: gradual muscle relaxation training for 8 muscle groups and knowing how stress affects thoughts, feelings and behavior. Third session: breathing exercise, visualization, and mutual analysis of thoughts and feelings and in a CONDITION: Multiple sclerosis. ; Multiple sclerosis INCLUSION CRITERIA: Selection of persons with a score of 2 to 4 scale, as the physical disability scale of the subjects group The age range of subjects was 20‐60 years Patients except multiple sclerosis were not affected by another diseas Patients had the ability to participate in all training sessions Patients were good sampling of society with multiple sclerosis PRIMARY OUTCOME: Dynamic balance. Timepoint: One day before the start of the Dynamic balance training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐Dynamic balance will be assessed. Method of measurement: Timed Up and Go Test. Fear of falling. Timepoint: One day before the start of the Fear of falling training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐Fear of falling will be assessed. Method of measurement: Short scale "Falling efficiency" international form in multiple sclerosis patients. Quality of life. Timepoint: One day before the start of the quality of life training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐quality of life will be assessed. Method of measurement: Multiple Sclerosis Impact Scale (MSIS‐29). Speed walking. Timepoint: One day before the start of the Speed walking training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐Speed walking will be assessed. Method of measurement: Timed 25‐Foot Walk. Static balance. Timepoint: One day before the start of the Static balance training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐Static balance will be assessed. Method of measurement: One‐leg balance. Stress. Timepoint: One day before the start of the stress training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐stress will be assessed. Method of measurement: Stress Scale‐DASS‐21. Trust balance. Timepoint: One day before the start of the Trust balance training protocol is assessed and participants are performed for 6 weeks, three sessions a week, and 48 hours after the last day of training, re‐Trust balance will be assessed. Method of measurement: Scale of trust in the special balance of activities.