Abstract
Objective
To compare oxygen consumption and energy expenditure (EE) of the activities of daily
living (ADL) in people with multiple sclerosis (PwMS) and healthy subjects.
Design
Cross-sectional observational study.
Setting
Outpatient care facilities.
Participants
Twenty-four moderately impaired PwMS and 21 healthy controls (N=45).
Intervention
Not applicable.
Main Outcome Measures
Oxygen consumption, EE rate, and total EE assessed by portable open-circuit spirometry
during the accomplishment of a comprehensive set of 14 ADL. Body composition was also
assessed with bioelectrical impedance analysis. Body cell mass was used to normalize
metabolic rates between groups.
Results
PwMS exhibited significantly higher oxygen consumption than controls in transfer and
mobility tasks (walking with stairs: +10.4%, P=.04; without stairs: +15.2%, P=.002; driving: +10.4%, P=.04) and higher EE rates for walking (+13.6%, P=.01). ADL completion took significantly longer in PwMS. Consequently, when total
EE to complete each ADL was considered, PwMS used significantly more energy in 10
of the 14 ADL. Of these, “climb stairs” and walking with or without stairs showed
the largest differences (+100%, +99.5%, +79.3%, respectively; all P values<.0005), followed by “dressing” (+48.8%; P=.002), “laundry” (+41.7%; P=.007), and “shopping” (+40.1%; P=.003).
Conclusions
Moderately disabled PwMS display oxygen consumption and EE rates during ADL that are
comparable to those of matched healthy subjects, except for the activities that involve
walking. Although metabolic rates were not different for the majority of ADL, PwMS
showed higher total EE to complete the same activities at a comparable work intensity,
which may contribute to the burden of “real-life” tiredness and fatigue typically
described in this population. Importantly, the subjective Modified Fatigue Impact
Scale score significantly correlated to EE and oxygen consumption of selected ADL,
such as “make a bed,” “driving,” “clean surfaces,” and “climb stairs.” The joint employment
of open-circuit spirometry during ADL and body composition analysis allows an accurate
metabolic characterization of PwMS, who frequently complain of fatigue.
Keywords
List of abbreviations:
ADL (activities of daily living), ANOVA (analysis of variance), BCM (body cell mass), BW (body weight), EDSS (Expanded Disability Status Scale), EE (energy expenditure), MFIS (Modified Fatigue Impact Scale), MS (multiple sclerosis), O2 (oxygen), PwMS (people with multiple sclerosis), V̇o2 (oxygen consumption)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 01, 2021
Footnotes
Ortopedia Pinna - Obiettivo Salute for providing wheelchairs.
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
