title: Comparison of energy consumption in different clinical forms multiple sclerosis with normal subjects (cohort study).
abstract: BACKGROUND
  Multiple sclerosis (MS) is one of the most common joint disorders that influence walking performance.
  
  
  OBJECTIVE
  The objectives are to determine if energy consumption of three different clinical forms of MS differs from each other. Is there any difference between MS and normal subjects? Is there an association between the Physiological Cost Index (PCI) and the Expanded Disability States Scale (EDSS)?
  
  
  METHODS
  MS subjects (EDSS>4) were separated in three groups based on the Ashworth and Ataxia scales, including ataxic (n=16), spastic (n=15) and ataxic-spastic (n=14). In addition, 13 age-and-gender-matched healthy subjects were used as the control group. A Heart Rate (HR) Polar Electro Finland was used to record the heart rate during resting and walking. The energy consumption was measured based on PCI. ANOVA, MANOVA, Post-hoc Tukey analysis and Pearson correlations were used for statistical analysis (P<0.05).
  
  
  RESULTS
  There was a significant difference between the walking speeds of normal (76.05±5.70m/min) with ataxic (36.78±12.68m/min), spastic (34.45±16.32m/min) and ataxic-spastic (27.21±14.76m/min) groups (P<0.001). There were no significant differences between the resting HR and walking HR of four groups, and no significant difference between the PCI of ataxic, spastic and normal groups (P>0.1). The correlation between PCI and EDSS was 0.65 (P<0.001).
  
  
  CONCLUSIONS
  The performance of the cardiovascular system in MS subjects was the same as normal subjects. Their energy consumption increased significantly due to a decrease in their walking speed. It seems that the weakness of muscles of the lower extremity and spasticity of knee extensors play a significant role in this regard.
authors.affiliation: Department of Physical Education and Sport Science, Faculty of Humanities, Najafabad Branch, Islamic Azad University, Najafabad, Isfahan, Iran. Electronic address: mahnazmarvi3@gmail.com.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Marvi-Esfahani
authors.affiliation: Department of Orthotics and Prosthetics, Faculty of Rehabilitation, Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: karimi@rehab.mui.ac.ir.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Karimi
authors.affiliation: Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: Etemadifar@med.mui.ac.ir.
authors.forename: Masoud
authors.initials: M
authors.lastname: Etemadifar
authors.affiliation: Department of Health Professions, Manchester Metropolitan University, United Kingdom.
authors.forename: Francis
authors.initials: F
authors.lastname: Fatoye
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001259:Ataxia / Q000503:physiopathology; D015331:Cohort Studies; D004185:Disability Evaluation; D004734:Energy Metabolism / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D009128:Muscle Spasticity / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D012146:Rest; D016138:Walking / Q000502:physiology*
keywords: Energy consumption; Multiple sclerosis