Movement for mobility: associations between physical activity, postural control, and gait in people with multiple sclerosis
Date
2021
Authors
Bandera, Victoria Maria, author
Fling, Brett, advisor
Leach, Heather, advisor
Diehl, Manfred, committee member
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Abstract
Background: Approximately 80% of people with multiple sclerosis (PwMS) experience impaired balance and mobility. The optimal duration, type and intensity of physical activity (PA) to improve balance and gait is not well understood. Purpose: Examine associations between PA duration, type and intensity with balance and gait in PwMS and neurotypical controls. Methods: Twenty-four PwMS and twenty-one neurotypical controls reported their typical PA routine, including duration [(days/week)x(minutes/bout)], type (aerobic, resistance and/or plyometric (R/P) and yoga), and intensity (rating of perceived exertion (RPE) 6-20). Balance was assessed by the mini Balance Evaluation Systems Test (Mini-BESTest). Gait speed was measured by the two-minute walk test at a normal pace and a fast pace. Pearson's and Spearman's correlations examined associations among PA variables, balance, and gait speed. Independent t-tests and Mann-Whitney U tests examined differences in gait speeds and balance, between participants who did vs. did not perform each PA type. MANOVA and Kruskal-Wallis tests compared gait and balance performance in participants who reported ≥150 PA minutes/week, and vigorous PA (RPE > 14) vs. those who did not. Results: No significant associations were found between PA duration and any outcomes in either group. Conversely, PA intensity was significantly associated with reactive postural control, rs(24) = .458, p < .05, sensory orientation, rs (24) = .487, p < .05, and dynamic gait, rs(24) = .429, p < .05, and anticipatory postural control in neurotypical controls, rs(21) = .476, p < .05. As for PA type, self-reported habitual R/P was associated with nearly significantly superior dynamic gait performance in PwMS, p = .07, but significantly lower normal gait speed in neurotypical controls, p < .05. Participants who met and/or exceeded the 150-minute per week PA guideline did not have differences in any outcomes. Habitually vigorous PA was associated with significantly improved anticipatory postural control, H(1) = 5.86, p < .05, and nearly significantly improved Mini-BEST scores in neurotypical participants H(1) = 3.273, p = 0.07. Minimally clinically important differences in fast gait speed (> 0.10 m/s) were found in neurotypical participants habitually performing vigorous PA compared to light-to-moderate PA. Conclusions: These findings suggest PA intensity and participation in R/P and yoga are associated with better balance and gait performance. Future studies should reevaluate these associations incorporating PA intensity measured by self-report perceived intensity and objectively measured, and incorporating R/P training into PA routines to improve balance and gait outcomes in PwMS.
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Subject
gait
multiple sclerosis
postural control
mobility
balance
physical activity