Effect of a Single Bout of Intermittent versus Continuous Walking on Perceptions of Fatigue in People with Multiple Sclerosis

Abstract

Fatigue may limit the ability of people with multiple sclerosis (MS) to participate in walking exercises, which could ultimately reduce their benefit from physical therapy. An exercise program that minimizes the fatigue experienced by people with MS during exercise may lead to an increase in the amount of exercise being performed. The purpose of this study was to determine whether subjective feelings of fatigue differ in people with MS depending on whether they exercised intermittently or continuously. Using a within-subjects, counterbalanced crossover design, a sample of 30 individuals with MS performed 6 minutes of continuous and 6 minutes of intermittent walking 1 week apart. Fatigue was measured on the Visual Analogue Scale of Fatigue (VASF) and recorded before and after the walking conditions. A 2 × 2 repeated-measures analysis of variance was used to assess the potential effects of intermittent versus continuous walking on self-reported fatigue. A significant interaction revealed that pre-post mean self-ratings of fatigue on the VASF increased less in the intermittent condition (from 37.93 mm to 44.83 mm; difference = 6.90 mm) compared with the continuous condition (from 34.33 mm to 54.43 mm: difference = 20.10 mm) (P < .001), suggesting that patients experienced less fatigue in the intermittent condition despite walking an equivalent total duration. The interaction effect was not influenced by age, gender, disease severity or duration, use of antispasticity medication, use of assistive devices, or mood. The results suggest that people with MS may be more tolerant of, and able to perform, greater amounts of exercise if they exercise intermittently. Int J MS Care. 2012;14:124-131.

Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in Persons With Multiple Sclerosis

“…This study is an extension of previously reported work where subjects with MS reported intermittent walking to be less fatiguing than continuous walking, although distance walked was not measured. 14 In the INT condition in this study, participants walked longer distances and, therefore, achieved a larger dose of training while avoiding some of the limiting effects of fatigue. It has been suggested that people with MS should limit exercise intensity to a low to moderate level to minimize detrimental effects to those with thermosensitivity.…”

Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis

“…The 6MWT involved walking back and forth along a 10m walkway with 180° turns at each end and was used as a means of inducing activity related fatigue [15,21]. Gait analysis was conducted under four conditions at each session in the following order:…”

“…A consequence of these abnormalities in the neuromuscular control of gait is an increased metabolic cost of walking [14] which in turn can worsen activity related fatigue [15], another major problem experienced by people with MS [16]. Fatigue in people with MS typically exacerbates pre-existing deficits in gait, with fatigued individuals demonstrating slower walking speeds with associated shorter step lengths and prolonged periods of double support compared to non-fatigued individuals [17].…”

Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis

“…Fatigue, another common symptom reported by people with MS [9], may also contribute to reduced walking capacity [10]. Muscle fatigue is known to worsen with physical activity [11] and is related to perceived fatigue levels in people with MS [12] .…”

“…The six-minute walk test (6MWT) is recognised as a measure of functional mobility in people with MS [21] and leads to increased levels of perceived fatigue [10,22], reduced cadence in slower walkers [23] and poorer balance after walking [24]. In addition, we have recently reported that a modified 6MWT (m6MWT) using a 10-metre walkway can cause a deterioration in lower limb muscle strength and standing balance in people with MS, however the effects on gait mechanics are unknown [22].…”