Comfortable walking speed and energy cost of locomotion in patients with multiple sclerosis

  • Alex Buoite StellaEmail author
  • Maria Elisa Morelli
  • Fabiola Giudici
  • Arianna Sartori
  • Paolo Manganotti
  • Pietro Enrico di Prampero
Invited Review
Part of the following topical collections:
  1. Energetics of Human Locomotion


Comfortable walking speed and energy cost of walking are physiological markers of metabolic activity during gait. People with multiple sclerosis are characterized by altered gait biomechanics and energetics, related to the degree of disability and spasticity, which lead to an increased energy cost of walking. Several studies concerning the energy cost of walking in multiple sclerosis have been published. Nevertheless, differences in protocols and characteristics of the sample have led to different outcomes. The aim of the present meta-analysis is to summarize results from studies with specific inclusion characteristics, and to present data about the comfortable walking speed and the energy cost of walking at that speed. Moreover, a detailed discussion of the potential mechanisms involved in the altered metabolic activity during exercise was included. A total of 19 studies were considered, 12 of which were also part of the quantitative analysis. Despite the strict selection process, high between-group heterogeneity was found for both outcomes. Nevertheless, the overall results suggest a pooled mean comfortable walking speed of 1.12 m/s (95% CI 1.05–1.18) and energy cost of 0.19 mLO2/kg/m (95% CI 0.17–0.21). These findings support the results of previous studies suggesting that energy cost of walking may be increased by 2–3 times compared to healthy controls (HC), and encourage the use of this marker in association with other parameters of the disease.


Energy cost Walking 6MWT Multiple sclerosis Gait 



Ankle–foot orthoses


Adenosine triphosphate


Body mass index


Central nervous system


Energy cost of walking


Comfortable walking speed


Expanded disability status scale


Functional electrical stimulation


Fatigue severity scale


Modified Ashworth scale


Multiple sclerosis


Multiple sclerosis walking scale


Moderate-to-vigorous physical activity


Near-infrared spectroscopy


Nitric oxide


Patient determined disability scale


People with multiple sclerosis


Self-selected speed


Oxygen uptake


Walking handicap scale



PEdP is professor emeritus of human physiology at the Department of Medicine, University of Udine (Italy). No funding was allocated for this study. We thank the certified translator Ms Paola Gentile for editorial assistance and English proof-reading.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Clinical Unit of Neurology, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly
  2. 2.Unit of Statistics, Department of Medicine, Surgery and Health SciencesUniversity Hospital and Health Services of Trieste, University of TriesteTriesteItaly

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