Deterioration of specific aspects of gait during the instrumented 6-min walk test among people with multiple sclerosis

  • S. Shema-Shiratzky
  • E. Gazit
  • R. Sun
  • K. Regev
  • A. Karni
  • J. J. Sosnoff
  • T. Herman
  • A. Mirelman
  • Jeffrey M. HausdorffEmail author
Original Communication


Prolonged walking is typically impaired among people with multiple sclerosis (pwMS), however, it is unclear what the contributing factors are or how to evaluate this deterioration. We aimed to determine which gait features become worse during sustained walking and to examine the clinical correlates of gait fatigability in pwMS. Fifty-eight pwMS performed the 6-min walk test while wearing body-fixed sensors. Multiple gait domains (e.g., pace, rhythm, variability, asymmetry and complexity) were compared across each minute of the test and between mild- and moderate-disability patient groups. Associations between the decline in gait performance (i.e., gait fatigability) and patient-reported gait disability, fatigue and falls were also determined. Cadence, stride time variability, stride regularity, step regularity and gait complexity significantly deteriorated during the test. In contrast, somewhat surprisingly, gait speed and swing time asymmetry did not change. As expected, subjects with moderate disability (n = 24) walked more poorly in most gait domains compared to the mild-disability group (n = 34). Interestingly, a group × fatigue interaction effect was observed for cadence and gait complexity; these measures decreased over time in the moderate-disability group, but not in the mild group. Gait fatigability rate was significantly correlated with physical fatigue, gait disability, and fall history. These findings suggest that sustained walking affects specific aspects of gait, which can be used as markers for fatigability in MS. This effect on gait depends on the degree of disability, and may increase fall risk in pwMS. To more fully understand and monitor correlates that reflect everyday walking in pwMS, multiple domains of gait should be quantified.


Multiple sclerosis Gait Fatigability Fatigue Fall risk Walking disability Wearables Body-fixed-sensor Accelerometer 



We thank the study participants for their time and contribution to this research. This work was supported in part by a Grant for the National Multiple Sclerosis Society (RG-1507-05433).

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in accordance with the standards and approved by local human study committees, and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects provided informed written consent prior to their inclusion in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for the Study of Movement, Cognition and MobilityTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Motor Control Research Laboratory, Department of Kinesiology and Community HealthUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  3. 3.Neuroimmunology and Multiple Sclerosis Unit of the Department of NeurologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  4. 4.Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
  5. 5.Department of Neurology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  6. 6.Department of Physiotherapy, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  7. 7.Rush Alzheimer’s Disease Center and Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA

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