title: Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in Persons With Multiple Sclerosis: A Randomized Crossover Trial.
abstract: OBJECTIVE
  Fatigue is a common, disabling symptom experienced by persons with multiple sclerosis (MS). Evidence shows that intermittent exercise is associated in improved performance and negligible fatigue. The purpose of this study was to examine whether subjects with MS walk greater distances with less fatigue under intermittent (INT) or continuous (CONT) walking condition.
  
  
  METHODS
  Twenty-seven subjects with MS (median Extended Disability Severity Scale 3.5, interquartile range 1.6) walked in the CONT (ie, 6 uninterrupted minutes) and INT (ie, three 2-minute walking bouts) conditions in a randomized crossover. Distance was measured for the entire 6-minute walking period and each 2-minute increment. Fatigue was measured as the difference in a visual analog scale of fatigue (ΔVAS-F) immediately preceding and following each trial.
  
  
  RESULTS
  Participants walked greater distances in the INT condition compared to the CONT condition (P = 0.005). There was a significant interaction of walking condition and time (P < 0.001), indicating that the distances walked in the INT condition changed across time. ΔVAS-F was significantly lower in the INT condition than in the CONT condition (P = 0.036).
  
  
  CONCLUSIONS
  Subjects with MS walked farther, and with less fatigue, when walking intermittently rather than continuously. Persons with MS may be able to tolerate a greater dose of walking training if the walking bouts are intermittent. Further study to determine the benefits of a walking exercise program using intermittent walking is recommended.Video Abstract available for additional insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A103).
authors.affiliation: Department of Physical Therapy, Hunter College, New York, New York (H.K.); Department of Rehabilitation and Movement Sciences-Doctor of Physical Therapy Program-South, Rutgers, The State University of New Jersey, Stratford (E.T.C.); Department of Psychology, Southern Illinois University at Carbondale (A.R.); Department of Interdisciplinary Studies, Rutgers, The State University of New Jersey, Newark (J.S.P.); Lutheran Medical Center, New York (B.B.); Texas Children's Hospital, Houston (R.H.); Union Square Rehabilitation and Sports Medicine, New York (R.L.); and Children's Rehabilitation Center, White Plains, New York (D.N.).
authors.forename: Herb
authors.initials: H
authors.lastname: Karpatkin
authors.forename: Evan T
authors.initials: ET
authors.lastname: Cohen
authors.forename: Adam
authors.initials: A
authors.lastname: Rzetelny
authors.forename: J Scott
authors.initials: JS
authors.lastname: Parrott
authors.forename: Breanne
authors.initials: B
authors.lastname: Breismeister
authors.forename: Ryan
authors.initials: R
authors.lastname: Hartman
authors.forename: Ronald
authors.initials: R
authors.lastname: Luu
authors.forename: Danielle
authors.initials: D
authors.lastname: Napolione
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005221:Fatigue / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D016138:Walking