Multiple sclerosis (MS) is a progressive, chronic disease of the central nervous system, which manifests itself in various neurological symptoms and their combinations, debuts more often at a young age, and may have different variants of the course. As a result, patients experience temporary or progressive disturbances of movement, walking function, balance, restriction of self-reliance, and a decrease in quality of life. The most common symptoms of multiple sclerosis are muscle weakness and instability in walking, spasticity, pathological fatigue, and other symptoms of CNS lesions may occur at various levels (Scierlo S. 2017). In this regard, MS is one of the frequent reasons for the increased disability length of different age groups of patients. Studies show that more than 65% of patients have trouble moving and up to 85% of patients have gait disorders (Rogers K. 2015). Thus, all MS patients need comprehensive rehabilitation and for many patients, it is required in the early stages of the disease. There is evidence that physical therapy programs (physical exercises) can improve MS patients’ functionality (mobility, walking, endurance) and quality of life (Khan T. 2007, Alphonsus K. 2019, Motl RW. 2020). There is also evidence that more than 60% of patients are willing to use additional approaches to drug treatment, which can include exercise (Miller P. 2017). Among the actively studied methods of physical therapy used in the rehabilitation of patients with MS, there is physical therapy, yoga classes, dance therapy, aerobic exercises, and a combination of these approaches.
The effectiveness of physical therapy has beenexamined in many studies. A review of 26 randomized trials found a reduction in the risk of aggravation in the group of patients with MS performing exercise compared to the patients without gymnastics (6.3% vs 4.6%), i and additionally demonstrated the safety of exercise (Pilutti LA. 2014 ). Thus, exercises can influence the course of the disease in patients with MS. There is also widely presented in the literature information about the effectiveness of exercise to reduce specific symptoms of MS (Wens I. 2015, Razazian N. 2016). Thus, 45 researches were conducted to study the effects of 69 different types of exercise in 2,250 patients with pathological fatigue in MS (Heine M. 2015). These researches demonstrate the effectiveness of exercise to control the fatigue of patients with multiple sclerosis.
any studies, as well as in the meta-analysis, have obtained data on the effectiveness of yoga in patients with MS on reducing the level of depression, pain, pathological fatigue, bladder dysfunction, postural disorders, and improvement in the quality of life and mobility (Patil N. 2012, Salgado B. 2013, Karbandi S. 2015, Rogers K. 2015, Chobe S. 2016). The safety and efficiency of yoga compared to the non-exercise group of patients are demonstrated in a variety of studies ranging in duration from eight weeks to six months (Cohen E., 2017, Kahraman T. 2018, Nejati S, 2016).
Despite a large number of positive results of using yoga and physical therapy for patients with MS, there are only a limited number of publications, where these methods of non-drug rehabilitation would be compared in a randomized controlled trial (Oken BS. 2004, Razazian N.2016, Garrett M. 2013, ).
At the same time, it is obvious that the correct comparison of these methods is of great interest for both researchers and specialists in the rehabilitation of patients with MS. This approach can expand our understanding of the mechanisms of functional disorders during MS and the ways to correct them. As a result, specialists will be able to combine the advantages of different approaches, improving the quality of rehabilitation.
It should also be noted, that contrary to the well-defined physical exercises protocols (Motl RW. 2020, Halabchi F. 2017), in most of the available at the moment studies, there is no detailed description for the performance of yoga protocols, i.e. those complexes of asanas, (special physical exercises), pranayama (breathing exercises) and techniques of mental relaxation, which were offered to patients, as well as the ways of their implementation. We can find an exception only in some articles, where the images and names of poses and the sequence of their performance are given (Guner S. 2015, Kishiyama S. 2002, de Oliveira G 2016, Najafi P. 2017). In other articles, the method of exercise and the use of yoga techniques are described only in general terms, such as hatha yoga, classical yoga, pranayama, yoga poses, breathing exercises. Typically, the frequency and duration of regular classes, the total number of classes, and the period of research are also specified.
However, our experience of teaching yoga, both in regular classes and for students with specific health problems, including patients with MS shows that for each particular disease or symptom, yoga exercises should be performed according to specially developed techniques. At the same time, each component of this technique: the choice of a set of poses, sequence, duration, and correctness of their performance, plays a crucial role in achieving the goals and is extremely important for ensuring the reproduction, verification, and further practical use of the results.
Therefore, for this study we used B.K.S. Iyengar method of yoga training, which is one of the most recognized, time-tested, and systematic methods of classical hatha yoga (Iyengar B.K.S. 1966.). At the moment, the efficiency of Iyengar yoga has been demonstrated for the treatment of different symptoms, common for patients with MS, such as chronical pain (Crow EM. 2015), depression and anxiety (Scott T. 2019) fatigue (Oken BS. 2004, Bower J. 2012). Our own experience of conducting Iyengar yoga classes for the patients with MS shows, that specially designed complexes of asanas have a beneficial effect on the condition and quality of life of the participants.
In this regard, themain aim of this study is to examine the effect of Iyengar yoga on symptoms (such as walking, balance difficulties) and quality of life in patients with MS, versus physical therapy (exercise therapy) and no exercise.