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

BACKGROUND: Walking on different slopes is a common daily activity for many ambulatory people with multiple sclerosis (pwMS) AIM: Investigate energy expenditure measures of walking on level, uphill and downhill slopes in pwMS. DESIGN: Observational case-control study. SETTING: Sheba Multiple Sclerosis Center, Tel-Hashomer, Israel. POPULATION: Eighteen pwMS; 10 women and 8 men, aged 39.7 (SD=6.8), mean EDSS was 2.9 (SD=1.2) and 23 healthy adults; 8 women and 15 men, aged 37.1 (S.D.=5.3). METHODS: Energy expenditure values were obtained via a metabolic device during four conditions: sitting, comfortable walking, uphill and downhill walking. Each walking trial, obtained on a treadmill, lasted 6-min and were separated by10-min recovery intervals. RESULTS: For both pwMS and healthy controls, the O2 rate and O2 cost was higher during uphill walking compared to level walking and lower during downhill walking compared with level walking. O2 rate and net O2 cost during uphill walking was lower in pwMS compared with the healthy controls. The most demanding effort was during uphill walking, with pwMS rating it more demanding compared with the healthy controls. CONCLUSIONS: Perceived effort of walking on different slopes is not consistent with changes in the energy expenditure values in pwMS. CLINICAL REHABILITATION IMPACT: pwMS describe the effort of walking on different slopes higher than normal, regardless of the energy expenditure values.