scholarly journals Accelerated Trajectories of Walking Capacity Across the Adult Life Span in Persons With Multiple Sclerosis: An Underrecognized Challenge

2020 ◽  
Vol 34 (4) ◽  
pp. 360-369
Author(s):  
Lars G. Hvid ◽  
Peter Feys ◽  
Ilse Baert ◽  
Alon Kalron ◽  
Ulrik Dalgas
Keyword(s):  
Multiple Sclerosis ◽  
Life Span ◽  
Gait Speed ◽  
Age Groups ◽  
Adult Life ◽  
Advanced Age ◽  
Walk Test ◽  
Adult Life Span ◽  
Walking Capacity ◽  
Minute Walk

Background. In the general population, trajectories of walking capacity is accelerated and nonlinear with advanced age. Whether this is more pronounced in persons with multiple sclerosis (pwMS), along with the prevalence of dismobility (ie, slow gait speed), are currently unknown. Our objective was to investigate trajectories of walking capacity and prevalence of dismobility across the adult life span in pwMS versus healthy controls (HC). Methods. Data on maximal timed 25-foot walk test (T25FWT), 2-minute walk test (2MWT), and 6-minute walk test (6MWT) along with prevalence of dismobility were assembled from 2 RIMS multicenter studies (n = 502 pwMS; age range 21-77 years, 6 age groups: 20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years). HC data were extracted from studies containing normative reference values (n = 1070-3780 HC). Results. Age trajectories of walking capacity was nonlinear and accelerated in pwMS versus HC. While measures of walking capacity in pwMS were suppressed already early in life, the gap between pwMS and HC significantly widened across the 6 age groups (pwMS performed 64%, 70%, 57%, 59%, 51%, and 37% of HC, respectively). This coincided with high prevalences of dismobility in pwMS across the 6 age groups when using usual gait speed cut-point values <1.0 m/s (corresponding to 33%, 32%, 51%, 59%, 75%, and 100%) and <0.6 m/s (corresponding to 19%, 12%, 26%, 23%, 33%, and 43%), markedly exceeding that observed in HC. Conclusion. The present data on walking capacity provide evidence for an accelerated deterioration in pwMS with advanced age, coinciding with high prevalences of dismobility (ie, slow gait speed).

Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span

2000 ◽  
Vol 30 (1) ◽  
pp. 11-22 ◽  
Author(s):  
A. F. JORM
Keyword(s):  
Risk Factors ◽  
Life Span ◽  
Population Sample ◽  
Age Groups ◽  
Adult Life ◽  
Consistent Pattern ◽  
Anxiety And Depression ◽  
Adult Life Span ◽  
Epidemiological Surveys ◽  
Anxiety Depression

Background. There is considerable disagreement about what happens to the risk of anxiety and depression disorders and symptoms as people get older.Methods. A search was made for studies that examine the occurrence of anxiety, depression or general distress across the adult life span. To be included, a study had to involve a general population sample ranging in age from at least the 30s to 65 and over and use the same assessment method at each age.Results. There was no consistent pattern across studies for age differences in the occurrence of anxiety, depression or distress. The most common trend found was for an initial rise across age groups, followed by a drop. Two major factors producing this variability in results were age biases in assessment of anxiety and depression and the masking effect of other risk factors that vary with age. When other risk factors were statistically controlled, a more consistent pattern emerged, with most studies finding a decrease in anxiety, depression and distress across age groups. This decrease cannot be accounted for by exclusion of elderly people in institutional care from epidemiological surveys or by selective mortality of people with anxiety or depression.Conclusion. There is some evidence that ageing is associated with an intrinsic reduction in susceptibility to anxiety and depression. However, longitudinal studies covering the adult life span are needed to distinguish ageing from cohort effects. More attention needs to be given to understanding the mechanism behind any ageing-related reduction in risk for anxiety and depression with age. Possible factors are decreased emotional responsiveness with age, increased emotional control and psychological immunization to stressful experiences.

scholarly journals Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis

2018 ◽  
Vol 20 (4) ◽  
pp. 158-163 ◽  
Author(s):  
David A. Scalzitti ◽  
Kenneth J. Harwood ◽  
Joyce R. Maring ◽  
Susan J. Leach ◽  
Elizabeth A. Ruckert ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Gait Speed ◽  
Discriminant Validity ◽  
Alternative Measure ◽  
Walk Test ◽  
Timed Up And Go ◽  
Cross Sectional ◽  
Functional Measures ◽  
6 Minute Walk Test ◽  
Minute Walk

Abstract Background: Persons with multiple sclerosis (MS) commonly have difficulty walking. The 6-Minute Walk Test (6MWT) assesses functional capacity but may be considered burdensome for persons with MS, especially those with higher disability levels. The 2-Minute Walk Test (2MWT) may be an alternative measure to the 6MWT. The purpose of this study was to investigate the validity of the 2MWT in persons with MS. Methods: Twenty-eight ambulatory persons with MS aged 18 to 64 years participated in this cross-sectional study. Participants completed five measures of walking performance (2MWT, 6MWT, usual and fast gait speed, and Timed Up and Go test) and two functional measures (Berg Balance Scale and five-times sit-to-stand test) during a testing session. Participants were classified into two subgroups based on Disease Steps scale classification. Results: The 2MWT was significantly correlated with the 6MWT (r = 0.947), usual gait speed (r = 0.920), fast gait speed (r = 0.942), the Timed Up and Go test (r = −0.911), and other functional measures. The 2MWT explained 89% of the variance seen during the 6MWT. The distances completed on the 2MWT and 6MWT accurately distinguished the subgroups. Conclusions: This study demonstrated good construct and discriminant validity of the 2MWT in persons with MS, providing an efficient and practical alternative to the 6MWT. Validation of the 2MWT with other functional measures further supports these findings.

Studying Post-Traumatic Growth Across the Adult Life Span

2021 ◽  
pp. 186-211
Author(s):  
Omar E. Staben ◽  
Molly J. Gardner ◽  
Frank J. Infurna ◽  
Suniya S. Luthar ◽  
Kevin J. Grimm
Keyword(s):  
Life Span ◽  
Healthy Aging ◽  
Character Strengths ◽  
Age Groups ◽  
Adult Life ◽  
Adult Life Span ◽  
Post Traumatic Growth ◽  
Post Traumatic ◽  
The Stability ◽  
Methodological Considerations

This chapter discusses conceptual and methodological considerations for studying post-traumatic growth across adulthood and into old age. Conceptual considerations that the authors focus on include examining character strengths and virtues longitudinally across multiple age groups and also the stability of these strengths and virtues across the life span. Methodological considerations elaborated are the use of convenience sampling in scale development and the importance of measurement invariance when examining character strengths in the context of post-traumatic growth. The authors provide examples from previous research on post-traumatic growth and discuss methods of measurement that could be utilized to enhance the validity of current measures. The chapter highlights the importance of character strengths and virtues and aims to solidify their role in the scientific community. Additionally, it highlights the need for more rigorous lines of scientific inquiry in this area due to its potential to impact healthy aging outcomes for persons across the adult life span.

scholarly journals Effects of Rehabilitation on Gait Pattern at Usual and Fast Speeds Depend on Walking Impairment Level in Multiple Sclerosis

2018 ◽  
Vol 20 (5) ◽  
pp. 199-209 ◽  
Author(s):  
Carmela Leone ◽  
Alon Kalron ◽  
Tori Smedal ◽  
Britt Normann ◽  
Inez Wens ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Walking Speed ◽  
Step Length ◽  
Physical Rehabilitation ◽  
Walk Test ◽  
Rehabilitation Treatment ◽  
Gait Parameters ◽  
Patient Reported ◽  
Walking Capacity ◽  
Minute Walk

Abstract Background: Physical rehabilitation can improve walking capacity in persons with multiple sclerosis (MS). However, changes in spatiotemporal gait parameters after rehabilitation are not frequently evaluated, and it is unknown to what extent potential effects depend on baseline disability level. The objective was to investigate the effectiveness of rehabilitation programs on gait parameters at usual and fastest speeds in persons with MS categorized according to walking speed. Methods: This nonrandomized multinational study in “real-world” settings evaluated participants before and after conventional rehabilitation. Outcome measurements included spatiotemporal gait parameters assessed by an electronic walkway (at usual and fastest speeds), walking capacity tests (Timed 25-Foot Walk test, 2-Minute Walk Test, 6-Minute Walk Test), and the patient-reported 12-item Multiple Sclerosis Walking Scale. Patients were allocated into three subgroups based on walking speed (&lt;0.82 m/s and &gt;1.14 m/s) and MS center. Results were calculated for the total group and subgroups. Results: Forty-two persons with MS (26 women; mean ± SD age, 44.6 ± 11.0 years; mean ± SD Expanded Disability Status Scale score, 3.5 ± 1.5) receiving rehabilitation treatment were enrolled. After rehabilitation treatment, the group demonstrated a significant decrease in double support time and an increase in stride length and step length (left leg) at usual and fastest speeds. Velocity and step length (right leg) increased only at usual speed. Subgroup analysis revealed greatest and clinically meaningful improvements in more disabled persons with MS. Conclusions: Physical rehabilitation induced changes in spatiotemporal gait parameters in persons with MS. The magnitude of improvement was greater in participants with more walking impairment.

Effect of time of day on walking capacity and self-reported fatigue in persons with multiple sclerosis: a multi-center trial

2011 ◽  
Vol 18 (3) ◽  
pp. 351-357 ◽  
Author(s):  
P Feys ◽  
D Gijbels ◽  
A Romberg ◽  
C Santoyo ◽  
B Gebara ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Time Of Day ◽  
Diurnal Change ◽  
Walk Test ◽  
Expanded Disability Status Scale ◽  
Time Points ◽  
Walking Capacity ◽  
Disability Status ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: Many persons with multiple sclerosis (PwMS) report increased fatigue in the afternoon and evening compared with the morning. It is commonly accepted that physical capacity also decreases as time of day progresses, potentially influencing the outcomes of testing. Objective: The objective of this article was to determine whether self-reported fatigue level and walking capacity are influenced by time of day in PwMS. Methods: A total of 102 PwMS from 8 centers in 5 countries, with a diverse level of ambulatory dysfunction (Expanded Disability Status Scale [EDSS] <6.5), participated. Patients performed walking capacity tests and reported fatigue level at three different time points (morning, noon, afternoon) during 1 day. Walking capacity was measured with the 6-Minute Walk Test (6MWT) and the 10-m walk test performed at usual and fastest speed. Self-reported fatigue was measured by the Rochester Fatigue Diary (RFD). Subgroups with mild (EDSS 1.5–4.0, n = 53) and moderate (EDSS 4.5–6.5, n = 49) ambulatory dysfunction were formed, as changes during the day were hypothesized to depend on disability status. Results: Subgroups had different degree of ambulatory dysfunction ( p < 0.001) but reported similar fatigue levels. Although RFD scores were affected by time of day with significant differences between morning and noon/afternoon ( p < 0.0001), no changes in walking capacity were found in any subgroup. Additional analyses on subgroups distinguished by diurnal change in self-reported fatigue failed to reveal analogous changes in walking capacity. Conclusions: Testing of walking capacity is unaffected by time of day, despite changes in subjective fatigue.

scholarly journals The Role of Wearable Devices in Multiple Sclerosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maddalena Sparaco ◽  
Luigi Lavorgna ◽  
Renata Conforti ◽  
Gioacchino Tedeschi ◽  
Simona Bonavita
Keyword(s):  
Multiple Sclerosis ◽  
Step Test ◽  
Motion Sensors ◽  
Walk Test ◽  
Timed Up And Go ◽  
Walking Behavior ◽  
Patient Reports ◽  
Patient Reported ◽  
Walking Capacity ◽  
Minute Walk

Multiple sclerosis (MS) is the most common neurological disorder in young adults. The prevalence of walking impairment in people with MS (pwMS) is estimated between 41% and 75%. To evaluate the walking capacity in pwMS, the patient reported outcomes (PROs) and performance-based tests (i.e., the 2-minute walk test, the 6-minute walk test, the Timed 25-Foot Walk Test, the Timed Up and Go Test, and the Six Spot Step Test) could be used. However, some studies point out that the results of both performance-based tests and objective measures (i.e., by accelerometer) could not reflect patient reports of walking performance and impact of MS on daily life. This review analyses different motion sensors embedded in smartphones and motion wearable device (MWD) that can be useful to measure free-living walking behavior, to evaluate falls, fatigue, sedentary lifestyle, exercise, and quality of sleep in everyday life of pwMS. Caveats and limitations of MWD such as variable accuracy, user adherence, power consumption and recharging, noise susceptibility, and data management are discussed as well.

A Head-to-Head Comparison of an Isometric and a Concentric Fatigability Protocol and the Association With Fatigue and Walking in Persons With Multiple Sclerosis

2020 ◽  
Vol 34 (6) ◽  
pp. 523-532 ◽  
Author(s):  
Laurits Taul-Madsen ◽  
Ulrik Dalgas ◽  
Tue Kjølhede ◽  
Lars G. Hvid ◽  
Thor Petersen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Knee Extension ◽  
Walk Test ◽  
Future Studies ◽  
Subjective Perceptions ◽  
Impact Scale ◽  
Walking Capacity ◽  
Fatigue Impact Scale ◽  
6 Minute Walk Test ◽  
Minute Walk

Background. Fatigue is one of the most frequent symptoms in persons with multiple sclerosis (MS). Distinction is made between subjective perceptions of fatigue and objective measures of fatigability. Fatigability can be measured by different protocols. Yet no studies have compared isometric and concentric contraction protocols of the lower extremities head-to-head. Therefore, the purpose of the present study was to (1) compare 2 such protocols head-to-head and (2) to investigate the association between fatigability evoked by the 2 protocols and measures of fatigue and walking. Methods. A total of 45 patients with MS had their walking capacity measured objectively by the 6-minute walk test (6MWT) and subjectively by the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Fatigue was measured by the Modified Fatigue Impact Scale (MFIS) and fatigability by 2 knee extension protocols: sustained isometric and concentric. Results. The sustained isometric protocol induced a higher degree of fatigability than the concentric protocol ( P < .01). Regression analyses revealed that sustained isometric fatigability was not associated with either measures of fatigue or walking (all r2 = 0.00; P = .85-.99), whereas the concentric protocol was significantly associated with fatigue ( r2 = 0.20; P < .01), 6MWT ( r2 = 0.09; P < .05), and MSWS-12 ( r2 = 0.16; P < .01). Furthermore, after adjusting for maximal strength and sex, concentric fatigability remained a strong and significant predictor of fatigue (β = 0.49) and walking (6MWT: β = −0.26; MSWS: β = 0.37). Conclusion. This study provides the first evidence that a lower-extremity concentric fatigability protocol provides superior reflection of both fatigue and walking when compared with a sustained isometric protocol. We suggest that concentric protocols should be the focus of future studies investigating fatigability.

Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set

2011 ◽  
Vol 18 (3) ◽  
pp. 364-371 ◽  
Author(s):  
Domien Gijbels ◽  
Ulrik Dalgas ◽  
Anders Romberg ◽  
Vincent de Groot ◽  
Francois Bethoux ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Multicentre Study ◽  
Walking Speed ◽  
Walking Distance ◽  
Gait Velocity ◽  
Walk Test ◽  
Estimation Errors ◽  
Test Formats ◽  
Walking Capacity ◽  
Minute Walk

Background: Many different walking capacity test formats are being used. It is unclear whether walking speed, obtained from short tests, and walking distance, obtained from long tests, provide different clinical information. Objectives: To determine the differential effect of various short and long walk test formats on gait velocity, and the actual relationship between walking speed and walking distance in multiple sclerosis (MS) patients with diverse ambulation status. Methods: A cross-sectional multicentre study design was applied. Ambulatory MS patients (Expanded Disability Status Scale (EDSS) 0–6.5; n = 189) were tested at 11 sites. Short tests consisted of the Timed 25-Foot Walk (static start, fastest speed) and 10-Metre Walk Test (dynamic start, usual and fastest speed). Long tests consisted of the 2- and 6-Minute Walk Tests (fastest speed). Subjects were divided into mild (EDSS 0–4; n = 99) or moderate (EDSS 4.5–6.5; n = 79) disability subgroups. Results: In both subgroups, the start protocol, instructed pace and length of test led to significantly different gait velocities. Fastest walking speed and 6-Minute walking distance showed the strongest correlation ( R2 = 0.78 in mild and R2 = 0.81 in moderate MS; p < 0.01). Short tests’ relative estimation errors for 6-Minute walking distance were 8–12% in mildly and 15–16% in moderately affected subjects. Based on the 2-Minute Walk Test, estimation errors significantly reduced to approximately 5% in both subgroups. Conclusions: A single short test format at fastest speed accurately describes an MS patient’s general walking capacity. For intervention studies, a long test is to be considered. We propose the Timed 25-Foot Walk and 2-Minute Walk Test as standards. Further research on responsiveness is needed.

scholarly journals The Two-Minute Walk Test in Persons with Multiple Sclerosis: Correlations of Cadence with Free-Living Walking Do Not Support Ecological Validity

2020 ◽  
Vol 17 (23) ◽  
pp. 9044
Author(s):  
Viktoria Karle ◽  
Verena Hartung ◽  
Keti Ivanovska ◽  
Mathias Mäurer ◽  
Peter Flachenecker ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Ecological Validity ◽  
Walk Test ◽  
Free Living ◽  
Walking Capacity ◽  
Disability Status ◽  
Intensity Category ◽  
Walking Performance ◽  
The Relationship ◽  
Minute Walk

The two-minute walk test (2MWT) is a frequently used walking capacity test in persons with multiple sclerosis (pwMS). However, less is known about its relevance with regards to walking capacity during free-living walking performance. Therefore, the ecological validity of the 2MWT was tested by 1. computing free-living minutes with the same intensity (cadence) as during the 2MWT and 2. investigating the relationship between 2MWT cadence and minutes with the same cadence during free-living walking. 20 pwMS aged 44.2 ± 12.2 (Expanded Disability Status Scale (EDSS) score of 3.1 ± 1.4) performed a 2MWT and wore an accelerometer for seven days. The number of pwMS reaching 100%, 90%, 80% or 70% of 2MWT cadence for at least one minute a day and minutes/day with at least 100%, 90%, 80% and 70% of 2MWT cadence during free-living walking was calculated. Six participants reached 100% of the 2MWT cadence for at least one minute/day during free-living walking. A total of 80% 2MWT cadence was the first intensity category that was reached by all participants during free-living walking. No significant correlation was found between cadence in the 2MWT and minutes in which this cadence was reached during free-living walking. Ecological validity with regard to walking intensity could not be confirmed in our study sample.

Interdisciplinary Adult Life Span Learning (Really!)

1996 ◽  
Vol 41 (6) ◽  
pp. 590-591
Author(s):  
Barbara R. Bjorklund
Keyword(s):  
Life Span ◽  
Adult Life ◽  
Adult Life Span
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