BackgroundThere is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS (PwMS). This investigation assessed the relation between demographic, clinical, mobility and balance metrics and falls history in persons with multiple sclerosis (MS).Methods52 ambulatory persons with MS (PwMS) participated in the investigation. All persons provided demographic information including fall history over the last 12 months. Disease status was assessed with Expanded Disability Status Scale (EDSS). Walking speed, coordination, endurance and postural control were quantified with a multidimensional mobility battery.ResultsOver 51% of the participants fell in the previous year with 79% of these people being suffering recurrent falls. Overall, fallers were older, had a greater prevalence of assistive devices use, worse disability, decreased walking endurance, and greater postural sway velocity with eyes closed compared to non-fallers. Additionally, fallers had greater impairment in cerebellar, sensory, pyramidal, and bladder/bowel subscales of the EDSS.ConclusionsThe current observations suggest that PwMS who are older, more disabled, utilize an assistive device, have decreased walking coordination and endurance and have diminished balance have fallen in the previous year. This suggests that individuals who meet these criteria need to be carefully monitored for future falls. Future research is needed to determine a prospective model of falls specific to PwMS. Additionally, the utility of interventions aimed at reducing falls and fall risk in PwMS needs to be established.

Objectives -There is increasing recognition that physical activity has beneficial consequences among persons with multiple sclerosis (MS), but there is concern regarding the current degree of physical inactivity in this population because of limitations with previous research and increased recognition of health behaviors in MS. This study compared physical activity levels between large samples of persons with mild MS and matched controls using validated measures of physical activity. Materials and methods -The sample included 77 cases of MS and 77 controls matched on age, height, weight, and gender. Physical activity was assessed using five measures, namely the Godin Leisure-Time Exercise Questionnaire (GLTEQ), International Physical Activity Questionnaire (IPAQ), and activity counts per day, step counts per day, and time spent in moderate-to-vigorous physical activity (MVPA) per day by accelerometry. Results -There were statistically significant differences between groups in accelerometer activity counts (t = À3.87, P = 0.0001), accelerometer step counts (t = À4.29, P = 0.0001), time spent in MVPA (t = À2.39, P = 0.01), GLTEQ scores (t = À3.83, P = 0.0001), and IPAQ scores (t = À3.42, P = 0.0001). The average effect size across all five measures was d = À0.59 and indicated that persons with MS overall were moderately less physically active than the matched controls. Conclusions -The primary finding was a moderate reduction in physical activity among those with MS, but the magnitude was substantially smaller than reported in a published meta-analysis. Importantly, the degree of physical inactivity can likely be overcome through the delivery of behavioral interventions for increasing physical activity and this should translate into meaningful consequences for persons with MS.

Abstract-Limited data support the strong association between rates of accelerometer activity counts and energy expenditure during dynamic activity in persons with multiple sclerosis (MS). This study examined the association between rates of activity counts and energy expenditure during walking by using two models of accelerometers and generated cut-points representing moderate-to-vigorous physical activity (MVPA) in persons with MS. Participants were 43 persons with MS and 43 controls who undertook 5 min of seated rest and up to five 6 min periods of walking at five different speeds on a treadmill. While walking, participants wore two models of accelerometers and a mouthpiece in-line with an open-circuit spirometry system for measuring energy expenditure (rate of oxygen consumption). Strong linear associations were found between accelerometer activity counts and energy expenditure, and the magnitude did not differ between MS and controls for both accelerometer models. The mean slopes of the linear relationships were steeper in persons with MS than controls and resulted in distinct cut-points for MVPA based on accelerometer counts for persons with MS and controls. The strong linear relationship between activity counts and energy expenditure and cut-points for quantifying time spent in MVPA should allow for better understanding of physical activity and examination of its predictors and consequences when using accelerometers in MS.

Walking impairment is a ubiquitous feature of multiple sclerosis (MS) and the O2 cost of walking might quantify this dysfunction in mild MS. This paper examined the difference in O2 cost of walking between persons with MS who have mild disability and healthy controls and the correlation between the O2 cost of walking and disability. Study 1 included 18 persons with mild MS and 18 controls and indicated that the O2 cost of walking was significantly higher in MS than controls and that disability was significantly associated with the O2 cost of slow, moderate, and fast treadmill walking. Study 2 included 24 persons with mild MS and indicated that disability was significantly correlated with O2 cost of comfortable, fast, and slow over-ground walking. We provide evidence that the O2 cost of walking is an indicator of walking dysfunction in mildly disabled persons with MS and should be considered in clinical research and practice.

Background. Energy cost of walking (C w) is elevated in persons with multiple sclerosis (MS), perhaps because of gait impairment, and may impact daily activity and fatigue. Objective. The authors examined for associations between C w , spatiotemporal gait parameters, daily activity, and perceived fatigue in persons with mild MS. Methods. Forty-four participants completed 4 trials of walking on a GAITRite mat and one 6-minute trial of walking on a treadmill at a constant, controlled speed of 54 m min −1 while expired gases were analyzed for oxygen consumption. Participants also completed the Fatigue Severity Scale (FSS) and wore a waist-mounted accelerometer for 7 days. Results. C w was significantly and inversely associated with gait speed (r = −.25) and stride length (r = −.32) and positively associated with double limb support (r = .27). C w was significantly and inversely associated with daily accelerometer activity counts (r = −.35) and positively associated with FSS scores (ρ = .31). Conclusion. The results support the development and application of rehabilitation strategies to address impaired gait parameters as an approach to improve C w , daily activities, and fatigue.