Evaluation of the Effects of Laughter Yoga

Multiple Sclerosis (MS) is a chronic, autoimmune, and demyelinating disease that generally affects the central nervous system in young adults. Multiple Sclerosis is a highly heterogeneous disease, with a wide range of clinical signs and symptoms depending on the area of the central nervous system affected, including motor, sensory, autonomic, and cognitive impairments. Multiple Sclerosis is associated with a broad spectrum of bodily dysfunctions, including motor problems such as muscle weakness, changes in muscle tone, ataxia, abnormal balance, and sensory disturbances. In addition, fatigue, pain, bladder and bowel dysfunction, cognitive and emotional problems, vision problems, speech and swallowing disorders, and sexual dysfunction also affect individuals with MS. Currently, there are 2.5 million MS patients worldwide, and the cost of treatment and care for these patients is quite high.

In addition to medical treatment, traditional and complementary medicine (TCM) methods are used in the treatment of pain and fatigue. Laughter Yoga, a type of yoga that has begun to be applied as a TCM method, was developed by Indian physician Dr. Developed by Madan Kataria in 1995, each laughter yoga session consists of breathing exercises, stretching and relaxation techniques, and laughter exercises. Physiologically, laughter yoga has been reported to increase breathing, relax muscles, stimulate circulation and the immune system, increase endorphin release, thereby increasing pain threshold and tolerance, reduce fatigue, decrease stress hormone levels, strengthen mental function, reduce depression and anxiety, improve sleep quality, and enhance interpersonal relationships and social interaction, thus improving psychological well-being. This research was planned as a randomized controlled experimental study to evaluate the effects of laughter yoga applied to Multiple Sclerosis patients on pain intensity, fatigue, and Beta Endorphin levels.

• Laughter Yoga (Behavioral): A complementary intervention including breathing exercises, stretching, relaxation techniques, and laughter exercises applied to patients with Multiple Sclerosis.

Primary outcomes

• Change in pain intensity measured by Visual Analog Scale (VAS) at [time point] [Baseline and week 4]: Pain intensity will be assessed using the Visual Analog Scale (VAS), a 10 cm scale ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will indicate their pain level by marking on the scale, and the score will be determined by measuring the distance in centimeters or millimeters.

Secondary outcomes

• Fatigue Level [1 month]: Fatigue severity will be assessed using the Fatigue Severity Scale (FSS), a 9-item questionnaire evaluating fatigue over the past month. Each item is scored on a scale of 0 to 7, with higher scores indicating greater fatigue severity. The Turkish validity and reliability study was conducted by Armutlu et al. in 2007. A change of 0.45 points is considered clinically meaningful.
• Change in plasma beta-endorphin levels measured by ELISA at baseline and week 4 [Baseline and week 4]: Plasma beta-endorphin levels will be measured using an ELISA method. Blood samples will be collected from participants in the intervention group before and after laughter yoga sessions at week 1 and week 4, and from the control group at week 1 and week 4. Samples will be centrifuged, and serum will be stored at -80°C until analysis. Beta-endorphin concentrations will be determined using a commercially available ELISA kit.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* • Being over 18 years old

  * Being able to communicate adequately
  * Volunteering to participate in the research

Exclusion Criteria:

* Unwillingness to participate in the study

Having severe cognitive impairment that prevents understanding or participation in the intervention

Having a psychiatric disorder that may affect participation in the study

Experiencing an acute MS relapse during the study period

Having another serious neurological or chronic disease that may affect the study outcomes

Regular participation in another complementary therapy program similar to laughter yoga

Communication problems that prevent participation in the intervention sessions