Understanding walking activity in multiple sclerosis: step count, walking intensity and uninterrupted walking activity duration related to degree of disability

Abstract

In multiple sclerosis (MS), physical activity (PA) is most commonly measured as number of steps, while also walking intensity and walking activity duration are keys for a healthy lifestyle. The aim of this study was to investigate (1) the number of steps persons with MS (PwMS) take; (2) the number of steps they take at low and moderate intensity; and (3) their walking activity duration for 2, 3, 6, 10, 12 and 14 uninterrupted minutes; all related to the degree of disability. 64 PwMS participated, distinguished in a mild (n = 31) and moderate MS subgroup (n = 34) based on their ambulatory dysfunction (Disease Steps). Standardized clinical tests were performed, and step data from the StepWatch Activity Monitor were collected for seven consecutive days. The results showed that (1) step count in PwMS was lower than PA recommendations, and is negatively influenced by a higher disability degree. (2) No walking was registered during 77 % of the day. PwMS are making steps for 22 % at low and only 1 % at moderate intensity. (3) Both MS subgroups rarely walk for more than six uninterrupted minutes, especially not at moderate intensity. PwMS need to be encouraged to make steps at moderate intensity, and to make steps for longer periods of time (minimal ten uninterrupted minutes).

Ecological validity of walking capacity tests following rehabilitation in people with multiple sclerosis

“…While significant increases in short and long clinical gait tests after MIR are important results, the primary goal of motor rehabilitation in pwMS is to increase everyday life mobility of pwMS, possibly also leading to improved participation and HRQoL. Using accelerometry as an objective and reliable outcome measure of real-life mobility in the present cohort [22–27], the number of steps performed per day as a marker of real life mobility was found to be comparable to previous studies with pwMS with “mild” walking disability averaging significantly more steps than those with “moderate and severe” walking disability [17,18]. We could demonstrate that an intervention of twenty-eight days of MIR resulted indeed not only in a significant better performance in walking capacity tests, but also in an overall increase in everyday life mobility, a finding that has not been reported so far.…”

“…However the ecological validity of these walking-specific measurements, that is the extent to which changes in these tests can be generalized to everyday life, has recently been questioned. Concerns arise from the observation that uninterrupted walking over 2 or 6 minutes is very uncommon in daily lives of pwMS thereby challenging its real life relevance [16,17]. In addition, short and long walking tests mainly sample walking capacity in an artificial setting instead of real-life walking performance of pwMS, which is further reflected by the T25FW, 2MWT and 6MWT correlating only weakly with everyday life walking reported in cross-sectional studies [18,19].…”

Influence of physical activity on serum vitamin D levels in people with multiple sclerosis

“…Past studies addressing the daily number of steps in pwMS are inconsistent with conflicting results even in patients on a similar level of disability, presumably because different tracking devices were used. This led to a wide range of documented average step counts, starting from 5,903 ± 3,185 up to 10,243 ± 3,817 steps per day among fully ambulatory pwMS [25,26]. In our study cohort we observed an average step count (6,863 ± 2,592) at the lower end of the range described above.…”

Influence of physical activity on serum vitamin D levels in people with multiple sclerosis

“…Past studies addressing the daily number of steps in pwMS are inconsistent with conflicting results even in patients on a similar level of disability, presumably because different tracking devices were used. This led to a wide range of documented average step counts, starting from 5,903 ± 3,185 up to 10,243 ± 3,817 steps per day among fully ambulatory pwMS (21,22). In our study cohort we observed an average step count (6,863 ± 2,592) at the lower end of the range described above.…”