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Multiple Sclerosis (MS) - Relapsing-remittingRRMS-BFRNCT07645937

Effects of Low-Load Blood Flow Restriction Exercise on Rectus Femoris Muscle Morphology in Individuals With Relapsing-Remitting Multiple Sclerosis

A study testing Blood Flow Restriction Training and Low-Load Exercise Program in people with Multiple Sclerosis (MS) - Relapsing-remitting, run by Hanifi Bal.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Multiple sclerosis (MS) is a chronic neurological disease associated with reduced muscle strength, impaired mobility, increased fatigue, and deterioration in muscle morphology. Rectus femoris muscle atrophy and reduced muscle quality have been linked to functional limitations and decreased mobility in individuals with… Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Blood Flow Restriction Training and Low-Load Exercise Program
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
30 participants
Where
No sites listed yet
Study dates
1 Jul 2026to 1 Apr 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosis of relapsing-remitting multiple sclerosis according to revised McDonald criteria
  • EDSS score between 2.5 and 3.5
  • Clinically stable disease
  • No relapse within the previous 3 months
  • No corticosteroid treatment within the previous 3 months
  • Ability to participate in exercise training
Show all 16Show fewer
  • Written informed consent
  • Exclusion Criteria: Deep vein thrombosis or pulmonary embolism history
  • Peripheral vascular disease
  • Uncontrolled hypertension
  • Severe cardiovascular disease
  • Pregnancy
  • Recent lower extremity surgery or injury
  • Musculoskeletal or neurological conditions interfering with exercise participation
  • Contraindications to blood flow restriction training
  • Participation in another structured exercise trial during the study period

Who cannot join

None listed.

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

Official title: Effects of Low-Load Blood Flow Restriction Exercise on Rectus Femoris Muscle Morphology in Individuals With Relapsing-Remitting Multiple Sclerosis: A Three-Arm Randomized Controlled Trial

Multiple sclerosis (MS) is a chronic neurological disease associated with reduced muscle strength, impaired mobility, increased fatigue, and deterioration in muscle morphology. Rectus femoris muscle atrophy and reduced muscle quality have been linked to functional limitations and decreased mobility in individuals with MS.

Blood flow restriction (BFR) training is a rehabilitation strategy that combines low-load exercise with partial vascular occlusion, enabling muscular adaptations comparable to those achieved with higher exercise loads. Although BFR has demonstrated promising results in several clinical populations, evidence regarding its effects on muscle morphology in individuals with relapsing-remitting multiple sclerosis (RRMS) remains limited.

Read more

The purpose of this randomized controlled trial is to investigate the effects of low-load BFR exercise on rectus femoris muscle morphology in individuals with RRMS. Thirty participants with RRMS (EDSS 2.5-3.5) will be randomly assigned to one of three groups: a BFR exercise group, a sham-BFR exercise group, or an exercise-only control group. All participants will complete the same supervised exercise program twice weekly for eight weeks.

The primary outcome will be rectus femoris muscle thickness assessed by ultrasonography. Secondary outcomes will include rectus femoris echo intensity, knee extensor muscle strength, Timed 25-Foot Walk performance, Nine-Hole Peg Test performance, Symbol Digit Modalities Test scores, and Modified Fatigue Impact Scale scores.

This study aims to determine whether the addition of blood flow restriction to a standardized low-load exercise program results in superior morphological and functional adaptations compared with sham-BFR and exercise-only conditions in individuals with RRMS.

Read the detailed description

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterized by demyelination, axonal degeneration, and progressive functional impairment. Individuals with relapsing-remitting multiple sclerosis (RRMS) frequently experience reductions in lower-extremity muscle strength, impaired walking performance, fatigue, and decreased physical function. Among lower-extremity muscles, the rectus femoris (RF) plays a critical role in knee extension, gait performance, and functional mobility. Previous studies have demonstrated associations between RF muscle morphology, muscle performance, and mobility outcomes in individuals with MS.

Blood flow restriction (BFR) exercise involves the application of external pressure to the proximal portion of a limb during low-load exercise. By partially restricting arterial inflow and substantially reducing venous return, BFR creates a hypoxic and metabolically stressful environment within the exercising muscle. This physiological stimulus promotes early recruitment of fast-twitch motor units and may enhance anabolic signaling pathways despite the use of relatively low exercise loads. Consequently, BFR has emerged as a promising rehabilitation strategy for populations that may not tolerate high-intensity resistance training.

Although preliminary evidence suggests that BFR is feasible and safe in people with MS, existing studies have primarily focused on functional outcomes, and the effects of BFR on muscle morphology remain unclear. Furthermore, no randomized controlled trial has investigated rectus femoris muscle morphology as a primary outcome using a three-arm design incorporating both sham-BFR and exercise-only control conditions.

This study is designed as a prospective, parallel-group, three-arm randomized controlled trial. Thirty individuals with RRMS aged 18-65 years and an Expanded Disability Status Scale (EDSS) score between 2.5 and 3.5 will be recruited. Participants will be randomly allocated in a 1:1:1 ratio to one of three groups:

  1. Low-load exercise with blood flow restriction (BFR).
  2. Low-load exercise with sham blood flow restriction.
  3. Low-load exercise without blood flow restriction (control).

All groups will participate in an identical supervised exercise program twice weekly for eight weeks (16 sessions total). Exercise sessions will include a standardized warm-up period, quadriceps-focused strengthening exercises, cycling exercise, and cool-down/stretching activities. The only systematic difference between groups will be the cuff condition applied during the strengthening component.

In the BFR group, individualized arterial occlusion pressure (AOP) will be determined using a pneumatic cuff system, and exercise will be performed at 50-60% of AOP. In the sham-BFR group, cuffs will be applied in the same location but inflated to a pressure insufficient to produce meaningful vascular occlusion. The control group will perform the same exercise program without cuff application.

Outcome assessments will be conducted at baseline and after completion of the intervention. The primary outcome will be rectus femoris muscle thickness measured by ultrasonography. Secondary outcomes will include rectus femoris echo intensity, knee extensor muscle strength, Timed 25-Foot Walk performance, Nine-Hole Peg Test performance, Symbol Digit Modalities Test scores, and Modified Fatigue Impact Scale scores.

The study is expected to provide novel evidence regarding the effectiveness of low-load BFR exercise for improving muscle morphology and related functional outcomes in individuals with RRMS. In addition, the inclusion of a sham-BFR condition will allow differentiation between the physiological effects of blood flow restriction and potential placebo or expectancy effects associated with cuff application.

Being tested
Blood Flow Restriction Training, Sham Blood Flow Restriction, Low-Load Exercise Program
Keywords
Relapsing-Remitting Multiple Sclerosis, Blood Flow Restriction, BFR Training, Rectus Femoris, Muscle Morphology
Medical subject headings
Multiple Sclerosis, Relapsing-Remitting

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Blood Flow Restriction TrainingDevice

    Low-load exercise performed with individualized blood flow restriction applied to both proximal thighs using pneumatic cuffs inflated to 50-60% of arterial occlusion pressure.

  • Sham Blood Flow RestrictionDevice

    Low-load exercise performed with pneumatic cuffs applied to both proximal thighs but inflated to a pressure insufficient to produce meaningful vascular occlusion.

  • Low-Load Exercise ProgramBehavioural

    Participants will perform a supervised low-load exercise program twice weekly for 8 weeks. The exercise program will include warm-up activities, quadriceps-focused strengthening exercises, cycling exercise, and cool-down activities. The same exercise program will be applied to all study groups.

Study groups in NCT07645937
Study groupRoleWhat they receive
BFR Exercise GroupExperimentalParticipants will perform a supervised low-load exercise program twice weekly for 8 weeks combined with blood flow restriction applied to both proximal thighs at 50-60% of individually determined arterial occlusion pressure during the strengthening component of the intervention.
Receives: Device: Blood Flow Restriction Training; Behavioral: Low-Load Exercise Program
Sham BFR GroupSham comparatorParticipants will perform the same supervised low-load exercise program twice weekly for 8 weeks. Pneumatic cuffs will be applied to both proximal thighs but inflated to a pressure insufficient to produce meaningful vascular occlusion.
Receives: Device: Sham Blood Flow Restriction; Behavioral: Low-Load Exercise Program
Exercise Control GroupActive comparatorParticipants will perform the same supervised low-load exercise program twice weekly for 8 weeks without blood flow restriction.
Receives: Behavioral: Low-Load Exercise Program

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Rectus Femoris Muscle Thickness

    Rectus femoris muscle thickness will be assessed using B-mode ultrasonography. Measurements will be obtained at baseline and after the 8-week intervention period. The primary outcome will be the change in rectus femoris muscle thickness from baseline to post-intervention.

    Measured: Baseline and Week 8

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Jun 2026
  2. Study start1 Jul 2026 (estimated)
  3. Primary completion1 Mar 2027 (estimated)
  4. Study completion1 Apr 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomly assigned in a 1:1:1 ratio to one of three parallel groups: (1) low-load exercise with blood flow restriction (BFR), (2) low-load exercise with sham blood flow restriction, or (3) low-load exercise without blood flow restriction (control). All groups will perform the same supervised exercise program twice weekly for 8 weeks. The only systematic difference between groups will be the cuff condition applied during the strengthening component of the intervention.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
30 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07645937
Sponsor's protocol ID
RRMS-BFR-RCT-2026
Acronym
RRMS-BFR
Status last verified
Jun 2026
First submitted
9 Jun 2026
Last updated
12 Jun 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be made publicly available because the informed consent obtained from participants does not include permission for public data sharing and institutional policies restrict release of participant-level data.

Publications

  • Langdon DW, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hamalainen P, Hartung HP, Krupp L, Penner IK, Reder AT, Benedict RH. Recommendations for a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Mult Scler. 2012 Jun;18(6):891-8. doi: 10.1177/1352458511431076. Epub 2011 Dec 21.

    PubMed 22190573
  • Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11):1444-52. doi: 10.1212/wnl.33.11.1444.

    PubMed 6685237
  • Benedict RH, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hamalainen P, Hartung H, Krupp L, Penner I, Reder AT, Langdon D. Brief International Cognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurol. 2012 Jul 16;12:55. doi: 10.1186/1471-2377-12-55.

    PubMed 22799620

Questions about this trial

What is this clinical trial studying?

A study testing Blood Flow Restriction Training and Low-Load Exercise Program in people with Multiple Sclerosis (MS) - Relapsing-remitting, run by Hanifi Bal.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 16 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 12 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Hanifi BAL, pt (+905532139440, fzt.hanifibal@outlook.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Rectus Femoris Muscle Thickness (time frame: Baseline and Week 8). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07645937, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jun 2026.

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