Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials.

Balance problems are common in multiple sclerosis, and physiotherapists use many different kinds of balance training, from simple standing exercises to complex dual-task drills. This review asked what actually works and whether particular training ingredients make a difference, pooling results from 18 randomized controlled trials involving over 900 people with MS across a wide range of disability levels. Across these trials, balance training showed a moderate improvement when measured with composite balance scores, and a smaller improvement on general mobility tests. When balance was measured through stepping ability or walking speed specifically, no effect was found.

One notable exception was cognitive dual-task training, which showed a stronger effect on mobility outcomes than other approaches. The authors also noted that studies with more total training volume tended to show better results. Overall study quality and reporting were only moderate, and the researchers say a clearer, standardized way of describing training intensity is still needed before firmer conclusions can be drawn about what works best.

If you have multiple sclerosis and struggle with balance, you may wonder whether balance exercises actually help, and if so, what kind. This research pooled results from 18 studies involving over 900 people with MS to look at this question across many different balance training programs. The combined evidence suggests that balance training can lead to improvements when balance is measured using composite scoring tools or general mobility tests, though the size of that improvement was modest to moderate.

However, when researchers specifically looked at stepping ability or walking speed, no improvement was detected. One interesting exception was training that combined balance work with mental tasks, like counting or problem-solving while moving, which showed a stronger benefit for mobility than other approaches. It is worth understanding that the studies included varied quite a bit in quality and reporting, and the researchers themselves note that more research is needed to pin down exactly how much and what kind of training intensity produces these benefits.

This is encouraging but not conclusive evidence.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis pooled 18 randomized controlled trials (902 participants, EDSS 0 to 7.5) evaluating balance-focused interventions in MS, where at least half of intervention content targeted balance control. Effect sizes varied meaningfully by outcome measure: composite balance scores showed a moderate pooled effect (ES 0.46, 95% CI 0.18-0.74), while general mobility tests showed a small pooled effect (ES 0.19, 95% CI 0.01-0.36).

Stepping and gait speed outcomes showed no statistically significant effect across training types, highlighting that outcome measure choice substantially influences apparent efficacy. A subgroup analysis found cognitive dual-task training produced a larger effect on mobility outcomes (ES 0.81, 95% CI 0.24-1.37) than other training categories, though this reflects a subgroup comparison rather than a primary finding and should be interpreted with corresponding caution regarding sample size and heterogeneity across training types. Median study quality (TESTEX) was 11 out of 15, indicating moderate but not high methodological rigor across the included trials. Larger training volume was positively associated with balance effect, but the authors emphasize that intensity in balance training remains inconsistently defined and reported, limiting firm dose-response conclusions.