PTOTCohortEuropean journal of physical and rehabilitation medicine2023

Energy expenditure and perceived effort during uphill and downhill walking in people with multiple sclerosis.

Itai Har-Nir, Lior Frid, Alon Kalron

PMID 36458477

WHAT IT FOUND

People with mild multiple sclerosis felt uphill and downhill walking was much harder than healthy controls did, even though their actual energy use was lower.

They may be working differently to manage slopes. Ask about effort, not just speed.

Key findings

01Participants with MS reported significantly higher perceived exertion during uphill walking compared to healthy controls, despite having lower oxygen consumption rates.

02The increase in energy cost from level to uphill walking was smaller in participants with MS than in healthy controls, suggesting different walking strategies.

03Perceived effort did not always align with measured energy expenditure, indicating that patients may feel more strain than their metabolic cost suggests.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

Small sample size (18 participants with MS). Participants had mild disability (EDSS < 4.5), so results may not apply to those with more severe mobility issues. Treadmill walking does not perfectly replicate over-ground walking, especially on slopes. Fear of falling or balance anxiety may have inflated perceived exertion scores, as participants were on a moving belt. No data was collected on specific gait mechanics or strategies used.

Declared interests

No specific funding sources or conflicts of interest were declared in the provided text.

The easy way to misread this

Do not conclude that patients with MS have a lower capacity for physical activity based on their high perceived exertion scores. Their actual energy consumption was lower than controls, suggesting the high effort rating may reflect anxiety, balance concerns, or compensatory movement strategies rather than physiological inability.

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