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Comfortable walking speed and energy cost of locomotion in patients with multiple sclerosis

  • Alex Buoite StellaEmail author
  • Maria Elisa Morelli
  • Fabiola Giudici
  • Arianna Sartori
  • Paolo Manganotti
  • Pietro Enrico di Prampero
Invited Review
Part of the following topical collections:
  1. Energetics of Human Locomotion

Abstract

Comfortable walking speed and energy cost of walking are physiological markers of metabolic activity during gait. People with multiple sclerosis are characterized by altered gait biomechanics and energetics, related to the degree of disability and spasticity, which lead to an increased energy cost of walking. Several studies concerning the energy cost of walking in multiple sclerosis have been published. Nevertheless, differences in protocols and characteristics of the sample have led to different outcomes. The aim of the present meta-analysis is to summarize results from studies with specific inclusion characteristics, and to present data about the comfortable walking speed and the energy cost of walking at that speed. Moreover, a detailed discussion of the potential mechanisms involved in the altered metabolic activity during exercise was included. A total of 19 studies were considered, 12 of which were also part of the quantitative analysis. Despite the strict selection process, high between-group heterogeneity was found for both outcomes. Nevertheless, the overall results suggest a pooled mean comfortable walking speed of 1.12 m/s (95% CI 1.05–1.18) and energy cost of 0.19 mLO2/kg/m (95% CI 0.17–0.21). These findings support the results of previous studies suggesting that energy cost of walking may be increased by 2–3 times compared to healthy controls (HC), and encourage the use of this marker in association with other parameters of the disease.

Keywords

Energy cost Walking 6MWT Multiple sclerosis Gait 

Abbreviations

AFOs

Ankle–foot orthoses

ATP

Adenosine triphosphate

BMI

Body mass index

CNS

Central nervous system

Cw

Energy cost of walking

CWS

Comfortable walking speed

EDSS

Expanded disability status scale

FES

Functional electrical stimulation

FSS

Fatigue severity scale

MAS

Modified Ashworth scale

MS

Multiple sclerosis

MSWS-12

Multiple sclerosis walking scale

MVPA

Moderate-to-vigorous physical activity

NIRS

Near-infrared spectroscopy

NO

Nitric oxide

PDDS

Patient determined disability scale

pwMS

People with multiple sclerosis

SSS

Self-selected speed

VO2

Oxygen uptake

WHS

Walking handicap scale

Notes

Acknowledgements

PEdP is professor emeritus of human physiology at the Department of Medicine, University of Udine (Italy). No funding was allocated for this study. We thank the certified translator Ms Paola Gentile for editorial assistance and English proof-reading.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 1.Clinical Unit of Neurology, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly
  2. 2.Unit of Statistics, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly

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