Abstract
Background/objectives
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).
Subjects/methods
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.
Results
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.
Conclusions
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.
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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.
References
Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Ann Rev Neurosci. 2008;31:247–69.
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.
Frohman EM, Racke MK, Raine CS. Multiple sclerosis—the plaque and its pathogenesis. N Engl J Med. 2006;354:942–55.
Motl RW. Ambulation and multiple sclerosis. Phys Med Rehabil Clin N Am. 2013;24:325–36.
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.
Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Gait Posture. 1999;9:207–31.
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.
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.
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.
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.
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.
Pilutti LA, Dlugonski D, Pula JH, Motl RW. Weight status in persons with multiple sclerosis: implications for mobility outcomes. J Obes. 2012;2012:868256.
Pilutti LA, Motl RW. Body mass index underestimates adiposity in persons with multiple sclerosis. Arch Phys Med Rehabil. 2016;97:405–12.
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.
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.
Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444–52.
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.
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.
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.
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.
Cohen J. Statistical power analysis for the behavioral science. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
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.
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.
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.
Browning RC, Kram R. Energetic cost and preferred speed of walking in obese vs. normal weight women. Obes Res. 2005;13:891–9.
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.
Schreiner TG, Genes TM. Obesity and Multiple Sclerosis-a multifaceted association. J Clin Med. 2021;10:2689.
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.
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.
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.
Acknowledgements
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.
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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.
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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). https://doi.org/10.1038/s41366-022-01244-7
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DOI: https://doi.org/10.1038/s41366-022-01244-7