Acute Effects of Intermittent Walking on Gait Parameters and Fatigability in People with Mild Multiple Sclerosis
1
Faculty of Physical Education, University of Brasília, Brasília 70910-900, Brazil
2
REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium
3
Faculty of Ceilândia, University of Brasília, Brasília 72220-275, Brazil
4
Faculty of Medicine, University of Brasília, Brasília 70910-900, Brazil
*
Author to whom correspondence should be addressed.
Sclerosis 2025, 3(3), 21; https://doi.org/10.3390/sclerosis3030021
Submission received: 18 February 2025
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Revised: 7 June 2025
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Accepted: 11 June 2025
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Published: 20 June 2025
(This article belongs to the Special Issue Neuropsychiatric and Quality of Life (QoL) Aspects of Multiple Sclerosis, 2nd Edition)
Abstract
:Introduction: Walking is perceived as the most important bodily function for persons with multiple sclerosis (pwMS) and is impaired in more than 70% of pwMS. In addition, the effect of multiple sclerosis (MS) on gait pattern increases in fast walking and during fatiguing exercises, altering the spatiotemporal gait parameters and walking reserve. Objectives: The objective of this study is to investigate the impact of a 12 min intermittent-walking protocol on spatiotemporal gait parameters and on the fatigability of pwMS, as well as the association with perceived exertion and reported symptoms of fatigue. Methods: Twenty-six persons with relapse-remitting MS and twenty-eight healthy controls (HCs) were included in this cross-sectional study. The Modified Fatigue Impact Scale and the Symbol Digit Modality Test were used to evaluate fatigue symptoms and cognitive function, respectively. Participants walked six times during an uninterrupted 2-min period. Before, during the rest periods and after the last 2 min walk, the rate of perceived exertion (RPE) was measured using the Borg Scale, and the spatiotemporal gait parameters were assessed with GaitRite. The cut-off value of 10% deceleration of the distance walked index classified pwMS into two groups: MS Fatigable (MS-F) and MS Non-Fatigable (MS-NF). One-way and two-way Analyses of variance (ANOVAs) were used to verify the effect of time and groups, respectively. Results: PwMS walked slower, travelled shorter distances, and presented shorter step lengths compared to HCs. No effects of the intermittent-walking protocol were found for all pwMS, but the MS-F group had deteriorated walking speed, step length, and cadence. Walking dysfunction was associated with perceived fatigability, reported symptoms of fatigue, cognitive function, and disability. Reported symptoms of fatigue was associated with perceived exertion but not with performance fatigability. Conclusions: Changes in gait parameters were weak to moderately associated with performance fatigability and the perception of effort and disability but not with reported fatigue symptoms, highlighting distinct constructs. The walking speed reserve and step length reserve also emerged as potential early markers of performance decline.
1. Introduction
Multiple sclerosis (MS) is an autoimmune inflammatory disorder of the central nervous system (CNS) and a leading cause of disability in adults worldwide [1]. Clinically, persons with MS (pwMS) demonstrate a variety of neurological symptoms associated with neuroinflammation and the degeneration of the CNS, with a large impact on physical and mental functioning [2]. Concerning physical function, walking is perceived as the most important bodily function for pwMS [3] and is impaired in more than 70% of the patients [2]. PwMS perform considerably worse on short- and long-distance walking tests such as the timed 25-foot walk (T25FW) and the six-minute walk test (6MWT) vs. healthy controls (HCs) [4,5]. In addition to factors such as impaired lower extremity muscle strength and balance that affect walking performance in pwMS [6,7], alterations in spatiotemporal gait parameters have been reported in this population [5]. Compared to HCs, pwMS usually walk with slower velocity, lower cadence, shorter step length, longer stride time, and higher step width and spend more time in double support [5,8]. Furthermore, the effect of MS on gait patterns increases in fast walking conditions [5]. The walking speed reserve has also been investigated in pwMS and reflects the ability of increasing speed in response to different environmental demands [9,10]. However, the walking reserve (WR) of spatiotemporal parameters have not yet been proposed for pwMS. A low walking speed reserve represents the incapacity of increasing the walking speed, which could be due to the inability of increasing cadence and/or step length, suggesting that a person typically walks at, or close to, their maximal speed, especially when it is necessary (e.g., in adverse circumstances such as crossing the street).
Another symptom that affects walking in pwMS is fatigue. Fatigue symptoms are highly reported and present in about 70% of pwMS [11]. The reported symptom of fatigue comprehends the pathological fatigue referring to a frequent, prolonged, or constant sensation over longer time frames, which represents the fatigue construct assessed by self-report questionnaires. Studies have shown that the general subjective perception of the impact of fatigue is not significantly associated with walking, but the motor/physical subdomain of self-report questionnaires is associated with walking endurance [12]. On the other hand, fatigability has been defined as the transient sensations of weariness or a lack of energy during or right after a given task, often described as activity-based fatigue [13]. Fatigability therefore has perceived (subjective, i.e., perceived exertion) and performance (objective) components [13,14,15]. The prevalence of walking-related motor fatigability is up to almost half in the more disabled pwMS [16,17,18]. During the 6MWT, changes in spatiotemporal parameters have been found, defining the gait quality fatigability by the decrement in gait quality [19]. PwMS presented worsening gait characteristics (cadence, step duration, step duration variability, or toe-off angle) from minute 2 onwards of the 6MWT, while controls without MS and pwMS without abnormal changes stabilized their gait from minute 2 towards the end of the 6MWT [19]. A review [20] on gait characteristics during and immediately after the 6MWT revealed that following the 6MWT, deterioration occurs in the spatiotemporal, variability, asymmetry, regularity, stability, kinetics, and kinematics metrics of gait. In addition, deterioration in most gait parameters is more pronounced in moderately to severely disabled pwMS compared to mildly disabled individuals.
Although changes in gait characteristics (i.e., due to disease progression and/or during and after a walking task) can impair the walking capacity, pwMS have learned to maintain mobility by taking regular rest breaks [21]. However, during uninterrupted prolonged walking (e.g., 6MWT), mild pwMS usually start walking with a moderate pace and keep the pacing strategy in order to not decelerate until the end of the test, and moderate and severe pwMS significantly decelerate over time [16,18,19]. In addition, pwMS walk longer distances and present diminished perceived exertion when performing intermittent 6 min walking (i.e., three bouts of 2 min walking) [21], and in daily living, pwMS perform 8 times more uninterrupted 2 min walking with moderate speeds compared to uninterrupted 6 min walking [22].
Currently, the literature does not provide enough data concerning the impact of intermittent walking on gait characteristics and its correlation in pwMS. Although, it has previously been suggested that 12 min of intermittent walking impacts the maximal walking speed, muscle strength, and power from the lower limbs [23], data regarding spatiotemporal gait parameters has not been discussed. In addition, the association between performance fatigability and reported symptoms of fatigue has barely been discussed. The present exploratory study aims to investigate (1) the effects of 12 min of intermittent walking on spatiotemporal gait parameters, walking-related motor fatigability, and the perceived exertion of pwMS and HCs and (2) the association of changes in spatiotemporal gait parameters with performed fatigability, perceived exertion, and reported symptoms of fatigue.
2. Methods
Thirty-four eligible persons diagnosed with relapse-remitting MS [24] were recruited from neurological clinics and MS community organizations in the city of Brasília, Brazil. Exclusion criteria included confirmed MS relapse in the month prior to testing, significant cardiac or respiratory disease, and not being able to walk for 2 min without stopping. Twenty-eight HCs matched for age, sex, and weight were recruited. All participants provided informed written consent prior to their involvement in the study, which was approved by the Research Ethics Committee of the Faculty of Health Sciences (CEP/FS), University of Brasília, Brazil (CAAE: 05142918.7.0000.0030).
Participants determined their disability level with the patient-determined disease steps scale (PDDS-BR) [25]. The modified fatigue impact scale (MFIS) was used to evaluate the reported symptom of fatigue. The oral version of the symbol digit modalities test (SDMT) was administered as a measure of cognitive function.
The spatiotemporal gait parameters with the participants’ preferred walking speed (PWS) were measured prior to the 12 min intermittent-walking protocol using a 4.88 m electronic walkway—GaitRite (CIR Systems Inc., Haverton, PA, USA). The complete intermittent-walking protocol was composed of six 2 min walks with a rest period of 30 s between bouts, adding up to a total of 12 min of walking. Participants were instructed to walk along a 10 m corridor, turning 180 degrees, during the uninterrupted 2 min period. Participants were instructed to “walk as fast as possible, but safely”. If necessary, the use of a walking aid was allowed. Before, during the rest periods and after the last 2 min walk, the rate of perceived exertion (RPE) was reported by the patient using the 15-point Borg Scale, and the spatiotemporal gait parameters were assessed with the participants walking with their maximal/fast walking speed (FWS) on GaitRite. The walking reserve (WR) for the spatiotemporal parameters speed, cadence, and step length was calculated as the difference between each trial of the FWS (before, during, and after the intermittent-walking protocol) and the PWS.
WR = FWS (pre to n − 2MW) − PWS
In order to investigate walking-related motor fatigability, the distance walked index (DWI) from the second to the sixth 2 min walks was calculated [16].
Refer to Ramari et al. [23] for a detailed description of the methodology applied in this study.
Statistical Analysis
Adopting a cut-off value of 10% deceleration (i.e., DWI ≤ −10) [26] in the sixth 2 min walk (DWI6-1), pwMS were allocated into two groups: MS Fatigable (MS-F) and MS Non-Fatigable (MS-NF).
Statistical analyses were performed using GraphPad Prism version 7.03. The distribution of data was visually checked by box plots, q-q plots, histograms, dot plots, and the Shapiro–Wilk normality test. All baseline data were analyzed using the unpaired t-test to compare HCs vs. MSAll (i.e., all pwMS). One-way ANOVA followed by Tukey’s multiple comparison test was used for comparisons among the HC, MS-F, and MS-NF groups. In addition, one-way ANOVA verified the effect of time for each group. Two-way ANOVA was used to analyze the effects of time and groups. Changes in percentage of the spatiotemporal parameters were calculated [Change (%) = ((FWS pre − FWS post, 6th—2MW)/FWS pre) × 100]. Pearson’s and Spearman’s coefficients were used to verify associations between changes in spatiotemporal gait parameters and fatigability (i.e., walking-related fatigability and perceived exertion), trait fatigue, cognition, and disease step. Spearman’s coefficient was used to verify associations between trait fatigue and fatigability. The level of statistical significance was set at p < 0.05.
3. Results
Of the 34 patients recruited, 8 either could not complete the protocol or were unable to perform the 6MW test during the pre-selection process; therefore, the final sample of MS was 26. Results from the PDDS suggest that our sample was mainly composed of pwMS with lower to mild disability. As shown in Table 1, no differences were found between groups regarding the participant’s demographic characteristics. Clinical results revealed that cognitive function was significantly reduced in pwMS vs. HCs, with no difference between MS-F and MS-NF. Concerning reported symptoms of fatigue, MFIS total and MFIS physical were significantly higher for pwMS vs. HCs, and no differences have been found between MS fatigability subgroups. PwMS walked significantly slower vs. HCs, and a shorter distance was reached by MS-F compared to MS-NF.
Figure 1 shows that pwMS walked less than HCs in all 2 min walks, with the MS-F group walking significantly less than the MS-NF group from the 3rd to the 6th 2MW. Absolute RPE values were significantly higher for MS-F from the 3rd to the 6th 2MW compared to HCs and at the 6th 2MW for MS-NF vs. HCs. One-way ANOVA revealed a significant RPE increase at the fifth and sixth 2MW in MS-F and at the sixth 2MW in MS-NF compared to the first 2MW.
Table 2 presents the absolute values of spatiotemporal parameters and group comparisons at baseline (pre) and throughout the intermittent-walking protocol. Overall, pwMS walked significantly slower than HCs. A significant difference in walking speed between MS-F and MS-NF emerged only after the fifth 2MW. While cadence showed no significant differences between groups, the step length was significantly shorter in pwMS vs. HCs, with differences between MS-F and MS-NF appearing after the fourth and fifth 2MW. Significant differences between pwMS and HCs were observed for swing (%GC), stance (%GC), and double support (%GC) but not for step time or the base of support. Over time, only the MS-F group exhibited a significant reduction in walking speed and step length from the fourth to the sixth 2MW and in cadence after the fifth and sixth 2MW compared to baseline FWS values.
For pwMS, changes in the percentage (i.e., after the intermittent-walking protocol) in spatiotemporal gait parameters were as follow [mean (95% CI)]: walking speed [−1.2 (−16:13) %], cadence [1.6 (−14:17) %], step length [−0.59 (−4:3) %], WR speed [−23 (−57:10) %], WR cadence [−53 (−143:36) %], and WR step length [−0.56 (−29:28) %].
As shown in Figure 2, the MS-F group showed significant differences in WR speed and WR step length compared to both HCs and MS-NF. Additionally, in the MS-F group, the WR speed decreased significantly from the 2nd to the 6th 2MW, while the WR cadence and the WR step length declined significantly from the 3rd 2MW onward compared to baseline WR values.
Table 3 shows that the baseline values of spatiotemporal gait parameters measured during the FWS were mostly associated with the total distance travelled, perceived fatigability (i.e., RPE), reported symptoms of fatigue, cognitive function, and PDDS but not with performance fatigability (DWI 6-1). On the other hand, the effects of the intermittent-walking protocol revealed that changes in walking, WR speed, and cadence were significantly associated with the total distance, performance and perceived fatigability, cognitive function, and PDDS but not with reported symptoms of fatigue.
Table 4 presents the associations among reported symptoms of fatigue, perceived exertion, and performance fatigability over the intermittent-walking protocol. The results showed no association between reported fatigue and performance fatigability but revealed significant associations between reported fatigue symptoms and perceived exertion throughout the walking protocol.
4. Discussion
The main findings of the present study were that changes in spatiotemporal gait parameters and the manifestation of perceived and performance fatigability were found in pwMS over the intermittent-walking protocol. However, a significant reduction in walking speed and reductions in the absolute values of step length, as well as the increment in perceived exertion, were present in pwMS with walking-related motor fatigability (i.e., the MS-F group).
In general, pwMS travelled shorter distances, walked slower, and presented shorter step lengths compared to HCs, but no differences could be found among HC, MS-NF, and MS-F for the absolute values of cadence. Comparisons of baseline values have shown that no differences in spatiotemporal gait parameters, except for step length, were found between pwMS vs. HCs for the PWS, but walking speed and step length were significantly impaired in pwMS compared to HCs during FWS pre. The results are in line with findings from the literature, where differences between HCs and pwMS seem to appear as the walking speed for short walk tests increases [5]. Interestingly, the baseline values of WR speed, WR cadence, and WR step length were not significantly different between groups, revealing that pwMS and HCs presented a similar ability of altering speed, cadence, and step length in response to a different environmental demand (i.e., from preferred to maximal walk speed). To the best of our knowledge, there is no studies comparing the WR of spatiotemporal parameters between pwMS and HCs. However, with the mean value of about 0.42 m/s in WR speed from our MS sample, our result corroborates with findings by Kalron et al. [9] for low disabled pwMS, who found a mean value of 0.47 m/s in WR speed.
Regarding the effects of the intermittent-walking protocol, we suggest that changes in spatiotemporal gait parameters were only found in those pwMS who had decreased walking performance over time. When analyzing the results from all pwMS in the same group, no effects of the intermittent-walking protocol could be found, which agrees with previous studies for low to moderate disabled pwMS during and after the 6MWT [20]. However, the analysis of subgroups revealed that the MS-F group started to deteriorate its absolute value of walking speed and step length after the fourth 2MW and cadence after the fifth 2MW, even when the walking protocol allowed short rest breaks. These results highlight the importance of identifying a specific subgroup of pwMS that shows a decline in walking performance that alters the walking speed, cadence, and step length in order to manage the symptoms of fatigue [8,18,19], presenting a more conservative strategy, which has been found in young adults after fatiguing tasks [27]. In addition, WR speed and WR step length were revealed as a potential marker of decrement in performance. From the beginning of the protocol, the MS-F group reduced their WR, presenting significant differences from HCs and from the MS-NF group, and the declines in WR over the walking protocol were significantly different from FWS pre. The results suggest that the ability to speed up and/or maintain gait parameters declines as fatigue sets in, potentially reducing walking speed during daily activities. This reduction in walking speed is associated with decreased community ambulation and an increased energetic cost of walking [28]. Regarding perceived exertion, RPE values were significantly higher in the MS-F group compared to HCs. Although the MS-NF group also showed an increase in RPE after the final 2MW bout, this was not accompanied by changes in spatiotemporal gait parameters. These findings suggest that perceived exertion may play a role in modulating gait patterns during prolonged walking.
There are few studies investigating factors associated with walking-related fatigability [17,23,29] but not with changes in spatiotemporal parameters during prolonged walking. Associations of gait parameters from the baseline values (FWS pre) were found with the total distance travelled, perceived exertion, reported symptoms of fatigue, cognitive function, and disability in pwMS. However, there were no associations with performance fatigability (i.e., DWI). Although walking fatigability was found in our sample composed of mild MS patients, it is important to highlight that the higher prevalence of walking-related motor fatigability is present in more disabled pwMS [16,17,18]. Given that the characteristics of our sample indicate being mild impaired, alterations in spatiotemporal parameters were primarily observed over the course of the 12 min intermittent-walking protocol. Similarly, a recent study reported that walking fatigability during the 6 min walk test manifests as reduced walking performance and gait quality (i.e., changes in spatiotemporal parameters). PwMS may exhibit distinct fatigability profiles, either showing reduced walking distances (i.e., distance walking fatigability) or altered gait quality (i.e., gait quality fatigability), in isolation or combination. However, some pwMS may not exhibit any significant changes during prolonged walking [19]. Concerning changes in the spatiotemporal gait parameters, significant associations were found with the total distance travelled, performance fatigability, perceived exertion, and PDDS. In addition, changes in gait characteristics were not associated with the reported symptoms of fatigue, suggesting that a decline in performance may not be related to the frequent sensation of fatigue. Some studies [14,30] suggest that self-reported measures of fatigue derived from questionnaires and objective fatigability assess different constructs, highlighting the need to clarify their underlying factors to improve future research on this symptom.
The reported symptoms of fatigue and perceived exertion have been significantly associated in our sample of pwMS. This finding suggest that the reported symptoms of fatigue could impact perceived exertion during exercise; however a decline in performance might be more impacted by other symptoms such as muscle strength, spasticity, balance impairment, the energy cost of walking [29,31,32], and disability [16,17,18]. Furthermore, a possible physiological mechanism underlying the phenomenon of fatigability could add to the interpretation of the results. Central nervous system disfunction in MS, which is already present at the early stage, is thought to lead to a reduced walking speed, impacting the self-paced strategies during prolonged walking. The reduced activation capacity of the brain over time may impair the efficiency of motor commands to the muscles. Damage in the neural cognitive processes may influence the attentional focus on the task, slowing down the walking speed. In addition, higher fatigue perception may be related to abnormal connectivity between the prefrontal cortex, basal ganglia, and emotional areas, impacting both cognition and motor control [33].
Although this study examines the effects of an intermittent-walking protocol on spatiotemporal gait parameters and their association with performance fatigability, perceived exertion, and self-reported fatigue symptoms, it presents several limitations. Notably, the MS-F group had a small sample size, likely due to the overall low to mild disability level within the MS cohort. Nevertheless, the findings underscore the importance of identifying the determinants of performance fatigability, particularly as it was not associated with baseline walking dysfunction or reported fatigue symptoms.
We acknowledge that using the expanded disability status scale (EDSS) would have allowed for more standardized comparisons of disability across studies. However, the PDDS-BR remains a valid tool for characterizing patients based on self-reported disability, especially regarding ambulation, which is the primary focus of this study. Additionally, we recognize the absence of spasticity measurements as a limitation; this symptom should be included in future studies aiming to identify predictors of gait impairment and walking fatigability.
From a practical standpoint, future rehabilitation programmes should consider incorporating intermittent walking training with short bouts and longer rest periods—particularly for individuals with moderate to severe disability—as a means to help people with multiple sclerosis walk closer to their fast walking speed, mitigate the fall risk, and address reductions in step length that may reflect worsening balance over time. Emphasizing task-specific walking exercises focused on step length and balance control may be key to slowing gait deterioration.
5. Conclusions
PwMS presenting walking fatigability showed significant declines in walking speed, step length, and cadence during the 12 min intermittent walking test, while the MS-NF group maintained stable performance despite increased perceived exertion. Changes in gait parameters were weak to moderately associated with performance fatigability and the perception of effort and disability but not with reported symptoms of fatigue, highlighting distinct constructs. The walking speed reserve and the step length reserve also emerged as potential early markers of performance decline.
Author Contributions
Conceptualization, C.R. and A.C.d.D.; methodology, C.R. and A.C.d.D.; software, C.R.; formal analysis, C.R.; investigation, C.R., A.R.D. and F.v.G.; resources, C.R. and A.C.d.D.; data curation, C.R., A.R.D., A.C.d.D. and F.v.G.; writing—original draft preparation, C.R.; writ-ing—review and editing, C.R., A.R.D., A.C.d.D. and F.v.G.; visualization, C.R.; supervision, A.C.d.D. and F.v.G.; project administration, C.R.; funding acquisition, C.R. and A.C.d.D. All authors have read and agreed to the published version of the manuscript.
Funding
This work was partially funded by the Coordination for the Improvement of Higher Education (CAPES, Brazil—Finance Code 001).
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Research Ethics Committee of the—Faculty of Health Sciences (CEP/FS), University of Brasília, Brazil (CAAE: 05142918.7.0000.0030, approved on 28 January 2019).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Data from the current study can be assessed by reaching the correspondent author. The data are not publicly available due to privacy.
Acknowledgments
We thank the neurologists Carlos Bernardo Tauil and Eber Castro Correa and the Apemigos (Association of People with Multiple Sclerosis from the Federal District) for encouraging the participants to contribute to the multiple sclerosis research projects. At last, we thank all the participants.
Conflicts of Interest
The authors declare no conflicts of interest.
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Figure 1.
(A) Distance travelled in each 2 min walk. (B) Rate of perceived exertion (RPE) in arbitrary units after each 2 min walk. MS-NF, non-fatigable persons with MS. MS-F, fatigable persons with MS. Statistical significance (p ≤ 0.05) is denoted by *, indicating a significant difference from healthy controls (HCs); +, indicating a significant difference from MS-NF; and c, indicating a difference from the 1st 2MW.
Figure 1.
(A) Distance travelled in each 2 min walk. (B) Rate of perceived exertion (RPE) in arbitrary units after each 2 min walk. MS-NF, non-fatigable persons with MS. MS-F, fatigable persons with MS. Statistical significance (p ≤ 0.05) is denoted by *, indicating a significant difference from healthy controls (HCs); +, indicating a significant difference from MS-NF; and c, indicating a difference from the 1st 2MW.
Figure 2.
Walking reserve (WR) speed, cadence, and step length over the intermittent-walking protocol. FWS, fast walk speed. 2MW, 2 min walk. HCs, healthy controls. MS-NF, non-fatigable persons with MS. MS-F, fatigable persons with MS. Results are presented as the mean and the standard error of the mean. * denotes statistical significance (p < 0.05) compared to HCs. + denotes statistical significance compared to MS-NF. b denotes statistical significance compared to FWS pre.
Figure 2.
Walking reserve (WR) speed, cadence, and step length over the intermittent-walking protocol. FWS, fast walk speed. 2MW, 2 min walk. HCs, healthy controls. MS-NF, non-fatigable persons with MS. MS-F, fatigable persons with MS. Results are presented as the mean and the standard error of the mean. * denotes statistical significance (p < 0.05) compared to HCs. + denotes statistical significance compared to MS-NF. b denotes statistical significance compared to FWS pre.
Table 1.
Participant characteristics of the total sample and clinical results.
| HC | MS All | MS-F | MS-NF | |
|---|---|---|---|---|
| N (females) | 28 (22) | 26 (23) | 8 (6) | 18 (17) |
| Age, y | 40.3 (37:45) | 43.5 (39:48) | 47 (36:57) | 42 (37:47) |
| Height, m | 1.66 (1.62:1.70) | 1.64 (1.61:1.68) | 1.69 (1.59:1.78) | 1.62 (1.58:1.66) |
| Weight, kg | 67.7 (62:73.3) | 67.9 (61.6:74.2) | 77 (61:92.9) | 63.8 (57.7:70) |
| PDDS | --- | 1.38 (0.73:2.03) | 2 (0.26:3.73) | 1.1 (0.45:1.76) |
| Time since diagnosis, yrs | --- | 8.1 (5.4:10.9) | 11.3 (3.9:18.8) | 6.7 (4.1:9.4) |
| SDMT, score | 63.3 (58.1:68.5) | 47.1 (42.9:51.3) * | 44 (34.1:53.8) * | 48.6 (43.7:53.4) * |
| MFIS total | 24.6 (19.3:29.8) | 40 (32.2:47.8) * | 40 (26.1:53.8) * | 40 (29.6:50.5) * |
| MFIS cognitive | 12.3 (9.3:15.2) | 17.5 (13.5:21.4) | 16.1 (9.4:22.7) | 18.1 (12.8:23.3) |
| MFIS physical | 10.5 (7.9:13.1) | 18.6 (15.1:22.1) * | 20.1 (13:27.2) * | 18 (13.6:22.4) * |
| MFIS psychosocial | 2 (1.3:2.7) | 3.8 (2.8:4.8) * | 3.7 (1.9:5.5) * | 3.8 (2.5:5.1) |
| Distance Total—12 min, m | 1156 (1102:1210) | 864 (768:960) * | 722 (484:959) *+ | 927 (833:1022) * |
| DWI, % | −0.99 (−3.3:1.3) | −6.1 (−10.5:−1.7) | −19.1 (−25.9:−12.4) *+ | −0.37 (−3.3:2.5) |
Legend: Results are presented as the mean and the 95% confidence interval (CI). MS All, all persons with MS. MS-F, fatigable persons with MS. MS-NF, non- fatigable persons with MS. PDDS, patient-determined disease steps. MFIS, modified fatigue impact scale. DWI, distance walked index. Statistical significance (p ≤ 0.05) is denoted by *, indicating a significant difference from healthy controls (HCs), and +, indicating a significant difference from MS-NF.
Table 2.
Spatiotemporal gait parameters presented as the mean (95% CI): comparisons between groups and the time effect.
Table 2.
Spatiotemporal gait parameters presented as the mean (95% CI): comparisons between groups and the time effect.
| PWS | FWS | 1st 2MW | 2nd 2MW | 3rd 2MW | 4th 2MW | 5th 2MW | 6th 2MW | ||
|---|---|---|---|---|---|---|---|---|---|
| Walking speed (m/s) | HC | 1.24 (1.15:1.33) | 1.90 a (1.80:2.0) | 1.81 a (1.66:1.95) | 1.78 a (1.64:1.91) | 1.81 a (1.68:1.93) | 1.86 a (1.77:1.95) | 1.81 a (1.69:1.93) | 1.83 a (1.71:1.94) |
| MSAll | 1.05 (0.96:1.14) | 1.45 * a (1.30:1.61) | 1.44 * a (1.30:1.58) | 1.41 * a (1.24:1.59) | 1.44 * a (1.28:1.60) | 1.41 * a (1.25:1.57) | 1.36 * a (1.20:1.51) | 1.38 * a (1.22:1.53) | |
| MS-NF | 1.06 (0.98:1.13) | 1.45 * a (1.28:1.62) | 1.52 a (1.37:1.66) | 1.48 * a (1.30:1.66) | 1.54 a (1.39:1.69) | 1.51 * a (1.35:1.66) | 1.46 a (1.30:1.61) | 1.48 a (1.32:1.64) | |
| MS-F | 1.04 (0.76:1.33) | 1.45 * a (1.05:1.86) | 1.29 * a (0.94:1.63) | 1.27 * (0.79:1.75) | 1.24 * (0.81:1.66) | 1.21 * b (0.79:1.63) | 1.14 * + b (0.75:1.52) | 1.17 * b (0.80:1.53) | |
| Cadence (steps/min) | HC | 108.4 (103:113) | 136.9 a (131:143) | 130.4 a (121:139) | 128.4 a (121:136) | 131.7 a (123:140) | 134 a (129:139) | 129.9 a (123:137) | 130.6 a (125:137) |
| MSAll | 105.7 (100:111) | 126.3 a (116:136) | 126.9 a (120:134) | 124 a (115:132) | 125.4 a (117:134) | 123.8 a (116:131) | 121.2 a (113:129) | 122.2 a (114:130) | |
| MS-NF | 105 (99:111) | 123 a (110:135) | 129.2 a (121:137) | 123.9 a (115:133) | 127.5 a (120:135) | 125.6 a (117:134) | 123.6 a (116:131) | 124.7 a (116:133) | |
| MS-F | 105.6 (93:118) | 130.1 a (112:149) | 119.8 (104:136) | 118 (92:144) | 116.7 (93:141) | 115.3 (95:136) | 111.7 b (91:133) | 112.9 b (93:132) | |
| Step Length (cm) | HC | 69.1 (66.4:71.9) | 83.5 a (79.8:87.2) | 82.9 a (79.4:86.5) | 83.4 a (79.8:87.1) | 82.8 a (78.9:86.6) | 83.5 a (79.8:87.3) | 83.2 a (79.3:87.1) | 84 a (80:88) |
| MSAll | 59.9 * (56.3:63.4) | 70.4 * a (66.3:74.5) | 68.7 * a (64.7:72.8) | 69.1 * a (64.6:73.6) | 69.1 * a (65:73.3) | 68.1 * a (63.4:72.8) | 67.1 * a (62.4:71.8) | 67.5 * a (63:71.9) | |
| MS-NF | 60.9 (57.7:64.1) | 71.9 * a (67.8:76) | 71.1 * a (67.2:75) | 71.5 * a (67.3:75.6) | 72.4 * a (68.9:75.9) | 71.7 * a (67.7:75.7) | 70.5 * a (65.9:75.2) | 70.6 * a (66.1:75.1) | |
| MS-F | 57.7 * (47.1:68.3) | 67.3 * a (56.3:78.3) | 63.6 * a (53.2:74.1) | 64.1 * a (51.9:76.3) | 62.1 * (51.6:72.6) | 60.5 * + b (48.3:72.6) | 59.9 * + b (48.9:70.9) | 60.8 * b (50.5:71.1) | |
| Step Time (sec) | HC | 0.54 (0.50:0.57) | 0.49 a (0.37:0.61) | 0.61 (0.35:0.86) | 0.64 a (0.34:0.94) | 0.68 a (0.30:1.07) | 0.63 a (0.39:0.87) | 0.57 a (0.37:0.76) | 0.45 a (0.42:0.48) |
| MSAll | 0.55 (0.50:0.60) | 0.68 (0.46:0.91) | 0.73 (0.31:1.16) | 0.52 (0.44:0.59) | 0.47 (0.44:0.51) | 0.50 (0.46:0.53) | 0.49 (0.45:0.52) | 0.52 (0.43:0.61) | |
| MS-NF | 0.57 (0.50:0.63) | 0.79 (0.46:1.11) | 0.77 (0.13:1.40) | 0.48 (0.44:0.52) | 0.48 (0.44:0.52) | 0.48 (0.45:0.50) | 0.48 (0.44:0.52) | 0.51 (0.37:0.65) | |
| MS-F | 0.52 (0.43:0.61) | 0.46 (0.40:0.52) | 0.67 (0.29:1.04) | 0.59 (0.34:0.84) | 0.45 (0.37:0.53) | 0.54 (0.44:0.63) | 0.50 (0.43:0.58) | 0.54 (0.44:0.63) | |
| Base of Supp. (cm) | HC | 9.59 (8.3:10.8) | 8.9 (7.8:9.9) | 8.91 (7.7:10) | 9.24 (7.7:10.6) | 8.86 (7.5:10.1) | 8.96 (7.8:10) | 8.50 (7.2:9.7) | 9.31 (7.8:10.8) |
| MSAll | 10.26 (8.3:12.2) | 8.98 (7.3:10.6) | 10.33 (8.7:11.9) | 11.16 (9.3:12.9) | 10.07 (8.4:11.7) | 10.31 (8.4:12.1) | 10.41 (8.6:12.2) | 9.41 (7.7:11) | |
| MS-NF | 9.33 (7.3:11.2) | 8.28 (6.3:10.2) | 9.87 (8:11.7) | 10.6 (8.4:12.8) | 9.28 (7.2:11.2) | 9.71 (7.4:11.9) | 9.81 (7.5:12) | 8.96 (7:10.8) | |
| MS-F | 12.22 (7.1:17.3) | 10.45 (7:13.8) | 11.29 (7.4:15) | 12.24 (8.5:15.9) | 11.73 (8.3:15) | 11.58 (7.3:15.7) | 11.69 (8.1:15.2) | 10.37 (6.3:14.3) | |
| Swing (%GC) | HC | 34.9 (32.2:37.5) | 39 a (36.4:41.5) | 38.6 a (36.8:40.5) | 36.7 a (32.7:40.6) | 35.1 a (30.9:39.4) | 36.7 a (32.8:40.6) | 36.2 (32.6:39.8) | 37.1 (34.8:39.4) |
| MSAll | 31.8 (29.3:34.2) | 36.1 a (33.7:38.5) | 30.8 * (25.6:35.9) | 34.2 a (30.8:37.5) | 35 a (32.2:37.8) | 36.1 a (34.2:37.9) | 32.1 (28.1:36.2) | 30 * (24.6:35.4) | |
| MS-NF | 33 (30.8:35.2) | 36 a (32.5:39.4) | 33.7 (28.5:39) | 35.8 a (32.9:38.8) | 37.7 a (36.2:39.3) | 36.6 a (34.1:39.1) | 32 (26.3:37.8) | 28.9 * (21.1:36.6) | |
| MS-F | 29.2 (22.3:36.1) | 36.4 a (33.4:39.5) | 24.4 * b (11.7:37.1) | 30.6 (21.2:40) | 29.2 (21.6:36.8) | 35 (31.6:38.3) | 32.4 (26.8:38) | 32.4 (25.6:39.1) | |
| Stance (%GC) | HC | 65 (62.4:67.7) | 61 a (58.4:63.5) | 61.3 a (59.5:63.1) | 63.3 a (59.3:67.2) | 64.8 a (60.6:69) | 63.2 a (59.3:67.1) | 63.7 (60.1:67.3) | 62.8 (60.5:65.1) |
| MSAll | 68.1 (65.7:70.6) | 63.8 a (61.4:66.2) | 69.2 * (64:74.3) | 65.8 a (62.4:69.1) | 64.9 a (62.1:67.8) | 63.8 a (62:65.7) | 67.8 (63.7:71.8) | 69.9 * (64.5:75.3) | |
| MS-NF | 66.9 (64.7:69.1) | 64 a (60.5:67.4) | 66.2 (60.9:71.5) | 64.1 a (61.1:67) | 62.2 a (60.7:63.7) | 63.3 a (60.8:65.8) | 67.9 (62.1:73.7) | 71.1 * (63.4:78.8) | |
| MS-F | 70.7 (63.7:77.6) | 63.5 a (60.4:66.6) | 75.5 * b (62.9:88.2) | 69.3 (60:78.7) | 70.8 (63.2:78.3) | 65 (61.6:68.3) | 67.6 (62:73.2) | 67.6 (60.8:74.3) | |
| Double Supp. (%GC) | HC | 32.5 (25.1:39.9) | 19.2 a (16.3:22.1) | 24 a (18.3:29.6) | 21.3 a (16.8:25.9) | 24.6 (17.4:31.7) | 24 a (19.6:28.3) | 21.1 a (16.7:25.4) | 23 a (17.6:28.3) |
| MSAll | 37.5 (31.6:43.4) | 27.7 a (24.1:31.3) | 37 * (28.1:45.8) | 26.4 a (23.2:29.6) | 32 (26.6:37.5) | 27.6 a (23.4:31.8) | 30.8 a (24.6:37) | 39.5 * (30.1:48.9) | |
| MS-NF | 36.5 (29:44) | 28.5 (24:33) | 35.7 * (25.1:46.2) | 24.6 a (22:27.1) | 30.4 (24.1:36.7) | 26.8 (21.6:32.1) | 29.1 (21.3:36.9) | 42.2 * (29.6:54.8) | |
| MS-F | 39.2 (29.9:48.4) | 25.3 a (20.1:30.4) | 49.5 * b (28.9:70.1) | 35.2 (21:49.3) | 37.8 (25.4:50.3) | 29.9 (23.4:36.4) | 34.5 (25.3:43.8) | 34.1 (23:45.2) |
Legend: PWS, preferred walk speed. FWS, fast walk speed. 2MW, 2 min walk. HCs, healthy controls. MSAll, all persons with MS. MS-NF, non-fatigable persons with MS. MS-F, fatigable persons with MS. * denotes statistical significance (p < 0.05) compared to HCs. + denotes statistical significance compared to MS-NF. a denotes statistical significance compared to PWS. b denotes statistical significance compared to FWS.
Table 3.
Coefficients of correlation R (p-value) between the spatiotemporal gait parameters and total distance, performance and perceived fatigability, trait fatigue, cognitive function, and disability in persons with multiple sclerosis.
Table 3.
Coefficients of correlation R (p-value) between the spatiotemporal gait parameters and total distance, performance and perceived fatigability, trait fatigue, cognitive function, and disability in persons with multiple sclerosis.
| Spatiotemporal Parameters | Distance Total | DWI 6-1 | RPE 6th 2MW | MFIS Total | MFIS Physical | SDMT | PDDS |
|---|---|---|---|---|---|---|---|
| Baseline FWS | |||||||
| Speed | 0.77 (0.000) | 0.07 (0.7) | −0.64 (0.000) | −0.54 (0.005) | −0.56 (0.003) | 0.51 (0.009) | −0.67 (0.000) |
| Cadence | 0.55 (0.004) | −0.01 (0.9) | −0.34 (0.08) | −0.41 (0.03) | −0.39 (0.05) | 0.22 (0.2) | −0.56 (0.003) |
| Step Length | 0.77 (0.000) | −0.001 (0.9) | −0.57 (0.002) | −0.62 (0.000) | −0.59 (0.001) | 0.50 (0.009) | −0.53 (0.006) |
| WR Speed | 0.63 (0.000) | 0.11 (0.5) | −0.54 (0.004) | −0.65 (0.000) | −0.69 (0.000) | 0.45 (0.02) | −0.56 (0.003) |
| WR Cadence | 0.27 (0.1) | −0.009 (0.9) | −0.20 (0.3) | −0.46 (0.02) | −0.49 (0.01) | 0.11 (0.5) | −0.32 (0.1) |
| WR Step Length | 0.56 (0.00) | 0.31 (0.1) | −0.49 (0.01) | −0.46 (0.01) | −0.45 (0.02) | 0.26 (0.19) | −0.37 (0.06) |
| Change (%) | |||||||
| Speed | 0.53 (0.00) | 0.65 (0.00) | −0.40 (0.04) | −0.03 (0.8) | −0.12 (0.5) | 0.35 (0.08) | −0.45 (0.02) |
| Cadence | 0.54 (0.00) | 0.57 (0.00) | −0.50 (0.009) | −0.10 (0.6) | −0.18 (0.3) | 0.42 (0.03) | −0.38 (0.05) |
| Step Length | −0.006 (0.9) | 0.33 (0.09) | 0.18 (0.38) | 0.27 (0.1) | 0.16 (0.4) | 0.08 (0.6) | −0.09 (0.6) |
| WR Speed | 0.64 (0.000) | 0.65 (0.000) | −0.48 (0.01) | −0.02 (0.9) | −0.18 (0.2) | 0.24 (0.2) | −0.68 (0.000) |
| WR Cadence | 0.67 (0.000) | 0.50 (0.01) | −0.55 (0.003) | −0.14 (0.5) | −0.23 (0.2) | −0.07 (0.7) | −0.66 (0.000) |
| WR Step Length | −0.18 (0.3) | 0.01 (0.9) | 0.22 (0.2) | 0.22 (0.2) | 0.13 (0.5) | 0.23 (0.05) | 0.25 (0.2) |
Legend: DWI, distance walked index; RPE, rate of perceived exertion; MFIS, modified fatigue impact scale; SDMT, symbol digit modality test (oral version); PDDS, patient-determined disease steps. Statistical significances (p ≤ 0.05) are highlighted with bold letters. Italic letters denote the trend to statistical significance (p ≤ 0.10).
Table 4.
Spearman’s coefficient of correlation R (p-value) between the reported symptoms of fatigue and fatigability in persons with multiple sclerosis.
Table 4.
Spearman’s coefficient of correlation R (p-value) between the reported symptoms of fatigue and fatigability in persons with multiple sclerosis.
| State Fatigue | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Trait Fatigue | DWI2-1 | DWI3-1 | DWI4-1 | DWI5-1 | DWI6-1 | RPE 1st 2MW | RPE 2nd 2MW | RPE 3rd 2MW | RPE 4th 2MW | RPE 5th 2MW | RPE 6th 2MW |
| MFIS total | −0.05 (0.7) | 0.08 (0.7) | 0.01 (0.9) | 0.05 (0.8) | 0.08 (0.6) | 0.55 (0.003) | 0.33 (0.1) | 0.49 (0.01) | 0.40 (0.04) | 0.54 (0.005) | 0.54 (0.004) |
| MFIS physical | −0.11 (0.5) | −0.01 (0.9) | −0.07 (0.7) | −0.05 (0.7) | −0.02 (0.9) | 0.66 (0.000) | 0.44 (0.02) | 0.53 (0.006) | 0.46 (0.01) | 0.56 (0.003) | 0.55 (0.003) |
Legend: DWI, distance walked index; RPE, rate of perceived exertion; MFIS, modified fatigue impact scale; Statistical significances (p ≤ 0.05) are highlighted with bold letters. Italic letters denote the trend to statistical significance (p ≤ 0.10).
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MDPI and ACS Style
Ramari, C.; Diniz, A.R.; von Glehn, F.; de David, A.C. Acute Effects of Intermittent Walking on Gait Parameters and Fatigability in People with Mild Multiple Sclerosis. Sclerosis 2025, 3, 21. https://doi.org/10.3390/sclerosis3030021
AMA Style
Ramari C, Diniz AR, von Glehn F, de David AC. Acute Effects of Intermittent Walking on Gait Parameters and Fatigability in People with Mild Multiple Sclerosis. Sclerosis. 2025; 3(3):21. https://doi.org/10.3390/sclerosis3030021
Chicago/Turabian StyleRamari, Cintia, Ana R. Diniz, Felipe von Glehn, and Ana C. de David. 2025. "Acute Effects of Intermittent Walking on Gait Parameters and Fatigability in People with Mild Multiple Sclerosis" Sclerosis 3, no. 3: 21. https://doi.org/10.3390/sclerosis3030021
APA StyleRamari, C., Diniz, A. R., von Glehn, F., & de David, A. C. (2025). Acute Effects of Intermittent Walking on Gait Parameters and Fatigability in People with Mild Multiple Sclerosis. Sclerosis, 3(3), 21. https://doi.org/10.3390/sclerosis3030021
