Frenkel Coordination Exercises Demonstrate Reliability, Fatigue Benefits in Multiple Sclerosis

February 25, 2021
Marco Meglio
Marco Meglio

Marco Meglio, Associate Editor for NeurologyLive, has been with the team since October 2019. Follow him on Twitter @marcomeglio1 or email him at

The authors concluded that this approach may be applied in fatigue management treatment protocols, without increasing symptoms, in patients with multiple sclerosis.

Data presented from a study that included 17 persons with multiple sclerosis (PwMS) revealed that Frenkel Coordination Exercises (FCE) reduce social, physical, and general fatigue complaints, making it a reliable and effective exercise protocol for this patient population.1

The study was presented virtually at the ACTRIMS Forum 2021, February 25-27, by Furkan Bilek, MSc, faculty of health sciences, department of physiotherapy and rehabilitation, Firat University, Turkey. At the conclusion of the 6-week study, Bilek and colleagues found no significant difference in cognitive fatigue in Fatigue Impact Scale (FIS) sub-parameters (P >.05), while there was a significant decrease in total fatigue scores (P <.05), as well as social fatigue and physical fatigue sub-parameters (P ≤.001).

Patients included in the study received a total of 18 sessions of FCE, with each session lasting 30 minutes and including 4 different exercises with 4-5 repetitions, depending on the functional and motor state of the individual. The average age of the participants was 30.4 (±5.69) years, with fatigue status measured using FIS.

The inclusion criteria allowed individuals with Expanded Disability Status Scale (EDSS) scores between 2 and 3.5, as well as those with a diagnosis of relapsing-remitting MS. Those with visual involvement or diplopia, spasticity level greater than 3 according to the Modified Ashworth Scale, and relapse within the last 3 months were not included.

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Bilek and colleagues determined that this approach can be applied in the fatigue management treatment protocols, without increasing symptoms, in PwMS; however, “further research focusing on the different MS subtypes, longer duration of administration, and more sensitive outcome measures are needed to specify the other potential benefits of FCE in PwMS,” they wrote.

FCE are a series of motions of increasing difficulty to facilitate the restoration of coordination. These exercises are used to bring back rhythmic, smooth, and coordinated movements. Originally developed in 1889 to treat patients of tabes dorsalis and problems of sensory ataxia, this approach has been applied in the treatment of individuals with ataxia, particularly cerebellar ataxia.2

The exercises are performed in supine, sitting, standing, and walking. Each activity is performed slowly with the patient using vision to carefully guide correct movement. The main principles of FCE are concentration or attention, precision, and repetition. Similar exercises can be devised for the upper limb wherein the patient may be directed to place the hand on the various points marked on the table or wall board to improve coordination of all the movements in the upper limb.

Fatigue among PwMS has been a known and prevalent issue with no treatments currently available. Findings from another study presented at MS Virtual, the 8th Joint ECTRIMS-ACTRIMS meeting, September 11–13, 2020, suggested that fatigue occurs in most patients with relapsing MS and influences daily functioning.3

Using a survey that included relapsing MS-specific Fatigue Symptoms and Impacts Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS), higher scores indicated greater severity on a score range from 0 to 100. Findings from the cohort of 142 patients with relapsing MS revealed that fatigue levels are severe, with a mean FSIQ-RMS symptom domain score of 59.5 during a 7-day period.

Demographic and clinical questionnaires that included disease history and status, sleep, and social and emotional function were completed by the participants along with the FSIQ-RMS, which was administered daily for 7 days. Physical, cognitive/emotional, and coping subdomain scores were 45.1, 44.9, and 50.6, respectively, following the 7-day period.

1. Bilek F, Cetisli-Korkmaz N, Demir CF. The effects of Frenkel Coordination Exercises on fatigue in patients with multiple sclerosis. Presented at ACTRIMS 2021 Forum; February 25–27, 2021. Abstract P217.
2. Das P. Frenkel exercises for ataxic conditions. Physiotherapy treatment. Accessed February 24, 2021.
3. Azoulai M, Levy-Heidmann T, Morisseau V, et al. A real-world study characterizing symptoms and impacts of fatigue in US adults with relapsing multiple sclerosis using a novel disease specific scale. Presented at: MS Virtual 2020 Joint ECTRIMS-ACTRIMS meeting; September 11–13, 2020. Abstract P1004.