Pilates exercise with a relaxation technique improved walking abilities and self-awareness among people with multiple sclerosis (MS), according to a small study. The study, "Impact of Pilates suspension with self-awareness on gait and metacognition in multiple sclerosis: Randomized, single-blinded and parallel-group trial," was published in EXPLORE. Walking difficulties are often the first symptom of MS, an autoimmune disorder caused by immune-mediated damage to the brain and spinal cord. Physical training can improve fitness and ease the symptoms of MS. Pilates is a form of low-impact, mind-body exercise that involves precise movement and breathing techniques to strengthen muscles and improve balance. Studies suggest it can improve gait impairment in MS. Relaxation techniques can aid metacognition, an awareness of one's own thought processes, leading to better physical performance. Researchers in Iran designed a small study to evaluate the impact of relaxation techniques combined with Pilates suspension training (PST), a type of resistance training that uses a set of ropes to work against body weight. Benefits of Pilates, relaxation techniques in MS. The researchers enrolled 22 women with MS (mean age, 44.3) and divided them into three groups — two intervention groups, each receiving PST plus a different relaxation technique, and an untreated control group. Led by certified Pilates suspension instructors, the researchers used the CoreAlign apparatus, first on a floor mat, then sitting and standing. Three exercises were applied — Good Morning, Turtle, and Hoof, all designed to improve core stability with lower body muscle stretching and mobility. Benson's relaxation is a mental self-awareness technique whereby participants sit comfortably, close their eyes, relax all their muscles, inhale through the nose, and exhale through the mouth. The patients in this group were asked to repeat "I am" while ignoring disturbing thoughts and staying in the moment. The second method was Jacobson's progressive muscle relaxation for physical self-awareness. As part of it, participants lay in a quiet room and are asked to contract and release their muscles. They also control their breathing while focusing on muscle tension and release. The sessions were held in patients' homes, with PST plus self-awareness exercises consisting of three 60-minute weekly sessions for seven weeks. Dynamic gait index (DGI) was used to assess gait, while self-awareness was measured with the metacognition questionnaire-30 (MCQ-30). The women who underwent PST plus Benson's relaxation showed significant improvement in DGI scores for gait compared with before treatment (14.57 vs. 9.42). MCQ-30 scores in this group were also significantly higher after the intervention (80.28 vs. 71.42), indicating improved metacognition. Similar findings were observed for PST plus Jacobson's progressive muscle relaxation in DGI scores (15.12 vs. 10.37) and MCQ-30 scores (81.25 vs. 76.75). Both relaxation techniques plus PST scores were significantly better than no treatment, with patients in the control group showing no change before and after treatment in both DGI (10.14 vs. 10.42) and MCQ-30 (73.14 vs. 73.71) assessments. "This treatment can top the list of treatment protocols for [people with MS] to prevent relapse and improve characteristics and treatments," the researchers said. "It is hoped that this study can be expanded in future research, by including male participants and also by using alternative approaches to measure the effect of Pilates intervention such as objective measures for evaluation of balance performance."