Effects of Blood Flow Restriction Training on Balance, Gait, Fall Risk and Fear of Falling in Middle-Aged People with Multiple Sclerosis

(I) Background: Multiple sclerosis (MS) frequently impairs balance, gait, and autonomy, increasing fall risk and fear of falling, particularly in middle-aged adults. Blood flow restriction (BFR) training has emerged as a low-load exercise strategy that may promote neuromuscular adaptations while reducing the need for high external training loads. (II) Methods: This randomized controlled trial included 65 middle-aged adults with MS (EDSS < 7), who were allocated either to a BFR exercise program performed twice weekly for 12 weeks or to a usual-care control condition. The intervention targeted upper- and lower-limb strength using individualized loads combined with BFR. Balance, gait performance, fall risk, and fear of falling were assessed at baseline and immediately post-intervention using validated clinical scales and functional tests. Intervention effects were examined using mixed-design ANOVA, with particular emphasis on group × time interactions. (III) Results: Significant group × time interactions were observed for balance, gait-related outcomes, fall risk, and fear of falling, indicating differential changes over time between the BFR and control groups. Compared with baseline, the BFR group showed improvements in balance, walking speed, walking endurance, and self-perceived walking ability, together with improvements in functional indicators of fall risk and fear of falling. The intervention was well tolerated, with no serious adverse events or injuries reported. (IV) Conclusions: A 12-week BFR exercise program was well tolerated and was associated with significant immediate post-intervention improvements in balance, gait, functional indicators of fall risk, and fear of falling in middle-aged adults with MS. These findings support BFR-based exercise as a potential low-load rehabilitation strategy in this population. However, the absence of an active exercise comparator and post-intervention follow-up precludes conclusions regarding the effects specifically attributable to BFR and the long-term maintenance of the observed improvements.