Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clinical Research

Oxygen cost of walking and its relationship with body composition in multiple sclerosis



This cross-sectional study examined the relationship between the oxygen (O2) cost of walking and body composition metrics, while considering potential covariates such as disability status, step length, and cadence, in persons with multiple sclerosis (MS).


The sample included 63 persons with MS across a wide distribution of body mass index (BMI). O2 cost of walking was assessed using portable, indirect calorimetry, and percent body fat (%Fat), fat-free mass (FFM), bone mineral content, bone mineral density (BMD), and weight/FFM were determined from dual-energy x-ray absorptiometry. Other outcome measures included step length, cadence, physical activity, and disability status.


The O2 cost of walking had small-to-moderate associations with BMI (rs = –31, p = 0.015), %Fat (rs = –0.26, p = 0.041), and BMD (rs = –0.31, p = 0.013). O2 cost of walking was significantly associated with these outcomes even after controlling for age, sex, disability status, and gait outcomes. The O2 cost of walking was further significantly associated with shorter step length (rs = –0.40, p = 0.001), slower cadence (rs = –0.38, p = 0.002), and higher disability status (rs = 0.44, p < 0.001), but not physical activity. Body composition metrics were not associated with gait parameters, physical activity or disability status in our sample of persons with mild-to-moderate MS.


The results indicated that higher O2 cost of walking was associated with lower fat and worse bone health after taking factors such as disability status into consideration. Researchers may focus on interventions that change body composition, or perhaps gait profiles, as possible approaches for changing O2 cost of walking and its consequences such as disability status in persons with MS.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Oxygen consumption over a 6-min walking bout.

Data availability

The data may be made available upon request from the corresponding author. The data are not publicly available in accordance with funding requirements and participant privacy.


  1. Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Ann Rev Neurosci. 2008;31:247–69.

    Article  CAS  Google Scholar 

  2. Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler. 2020;26:1816–21.

    Article  Google Scholar 

  3. Frohman EM, Racke MK, Raine CS. Multiple sclerosis—the plaque and its pathogenesis. N Engl J Med. 2006;354:942–55.

    Article  CAS  Google Scholar 

  4. Motl RW. Ambulation and multiple sclerosis. Phys Med Rehabil Clin N Am. 2013;24:325–36.

    Article  Google Scholar 

  5. Givon U, Zeilig G, Achiron A. Gait analysis in multiple sclerosis: characterization of temporal–spatial parameters using GAITRite functional ambulation system. Gait Posture. 2009;29:138–42.

    Article  Google Scholar 

  6. Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Gait Posture. 1999;9:207–31.

    Article  CAS  Google Scholar 

  7. Motl RW, Suh Y, Dlugonski D, Weikert M, Agiovlasitis S, Fernhall B, et al. Oxygen cost of treadmill and over-ground walking in mildly disabled persons with multiple sclerosis. Neurol Sci. 2011;32:255–62.

    Article  Google Scholar 

  8. Motl RW, Sandroff BM, Suh Y, Sosnoff JJ. Energy cost of walking and its association with gait parameters, daily activity, and fatigue in persons with mild multiple sclerosis. Neurorehabil Neural Repair. 2012;26:1015–21.

    Article  Google Scholar 

  9. Sandroff BM, Klaren RE, Pilutti LA, Motl RW. Oxygen cost of walking in persons with multiple sclerosis: disability matters, but why? Mult Scler Int. 2014;2014:162765.

    Google Scholar 

  10. Jeng B, Sandroff BM, Motl RW. Energetic cost of walking and spasticity in persons with multiple sclerosis with moderate disability. NeuroRehabilitation. 2018;43:483–9.

    Article  Google Scholar 

  11. Jeng B, Sandroff BM, Motl RW. Energetic cost of walking and its physiological correlates in persons with multiple sclerosis who have moderate mobility disability. Arch Phys Med Rehabil. 2018;99:2038–44.

    Article  Google Scholar 

  12. Pilutti LA, Dlugonski D, Pula JH, Motl RW. Weight status in persons with multiple sclerosis: implications for mobility outcomes. J Obes. 2012;2012:868256.

    Article  Google Scholar 

  13. Pilutti LA, Motl RW. Body mass index underestimates adiposity in persons with multiple sclerosis. Arch Phys Med Rehabil. 2016;97:405–12.

    Article  Google Scholar 

  14. Nana A, Slater GJ, Stewart AD, Burke LM. Methodology review: using dual-energy X-ray absorptiometry (DXA) for the assessment of body composition in athletes and active people. Int J Sport Nutr Exerc Metabol. 2015;25:198–215.

    Article  Google Scholar 

  15. Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: a dual-energy x-ray absorptiometry study. Mult Scler Relat Disord. 2019;29:41–7.

    Article  Google Scholar 

  16. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–52.

    Article  CAS  Google Scholar 

  17. Motl RW, Pilutti LA, Sandroff BM, Klaren R, Balantrapu S, McAuley E, et al. Rationale and design of a randomized controlled, clinical trial investigating a comprehensive exercise stimulus for improving mobility disability outcomes in persons with multiple sclerosis. Contemp Clin Trials. 2013;35:151–8.

    Article  Google Scholar 

  18. Goldman MD, Marrie RA, Cohen JA. Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler. 2008;14:383–90.

    Article  Google Scholar 

  19. Motl RW, Dlugonski D, Suh Y, Weikert M, Agiovlasitis S, Fernhall B, et al. Multiple Sclerosis Walking Scale-12 and oxygen cost of walking. Gait Posture. 2010;31:506–10.

    Article  Google Scholar 

  20. Sandroff BM, Riskin BJ, Agiovlasitis S, Motl RW. Accelerometer cut-points derived during over-ground walking in persons with mild, moderate, and severe multiple sclerosis. J Neurol Sci. 2014;340:50–7.

    Article  Google Scholar 

  21. Cohen J. Statistical power analysis for the behavioral science. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

  22. Silveira SL, Pilutti LA, Motl RW. No evidence of associations among body composition and symptoms in persons with multiple sclerosis. Rehabil Psychol. 2020;65:80–6.

    Article  Google Scholar 

  23. Klaren RE, Motl RW, Dlugonski D, Sandroff BM, Pilutti LA. Objectively quantified physical activity in persons with multiple sclerosis. Arch Phys Med Rehabil. 2013;94:2342–8.

    Article  Google Scholar 

  24. Dlugonski D, Pilutti LA, Sandroff BM, Suh Y, Balantrapu S, Motl RW. Steps per day among persons with multiple sclerosis: variation by demographic, clinical, and device characteristics. Arch Phys Med Rehabil. 2013;94:1534–9.

    Article  Google Scholar 

  25. Browning RC, Kram R. Energetic cost and preferred speed of walking in obese vs. normal weight women. Obes Res. 2005;13:891–9.

    Article  Google Scholar 

  26. Baranowska-Bik A, Kochanowski J, Uchman D, Litwiniuk A, Kalisz M, Martynska L, et al. Association of copeptin and cortisol in newly diagnosed multiple sclerosis patients. J Neuroimmunol. 2015;282:21–4.

    Article  CAS  Google Scholar 

  27. Schreiner TG, Genes TM. Obesity and Multiple Sclerosis-a multifaceted association. J Clin Med. 2021;10:2689.

    Article  Google Scholar 

  28. Zikán V, Týblová M, Raška I Jr., Havrdová E, Luchavová M, Michalská D, et al. Bone mineral density and body composition in men with multiple sclerosis chronically treated with low-dose glucocorticoids. Physiol Res. 2012;61:405–17.

    Article  Google Scholar 

  29. Huang Z, Qi Y, Du S, Chen G, Yan W. BMI levels with MS Bone mineral density levels in adults with multiple sclerosis: a meta-analysis. Int J Neurosci. 2015;125:904–12.

    Article  CAS  Google Scholar 

  30. Jørgensen M, Dalgas U, Wens I, Hvid LG. Muscle strength and power in persons with multiple sclerosis—a systematic review and meta-analysis. J Neurol Sci. 2017;376:225–41.

    Article  Google Scholar 

Download references


Research reported in this publication was supported, in part, by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health [F31HD101281]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations



Conceptualization: BJ, RM. Project administration, supervision: BJ, RM. Methodology: BJ, RM. Data curation: BJ, TH, CF. Formal analysis: BJ, RM, TH, CF. Funding acquisition: BJ. Writing—original draft: BJ, RM. Writing—review and editing: BJ, RM, TH, CF.

Corresponding author

Correspondence to Brenda Jeng.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jeng, B., Huynh, T.L.T., Feasel, C.D. et al. Oxygen cost of walking and its relationship with body composition in multiple sclerosis. Int J Obes 47, 138–143 (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links