Multiple sclerosis

Multiple sclerosis (MS) is a progressive autoimmune disease which interrupts the transmission of nerve impulses, impairing both body function and movement.  While this often leads to a decrease in overall physical activity, a recent study found evidence that individuals with MS and an increased risk of falling walked even less each day than did individuals with MS and a normal fall risk.


Multiple Sclerosis (MS) causes damage to the central nervous system and leads to symptoms which include muscle weakness, loss of balance, spasticity, and visual impairment.  Injuries sustained from a fall could require medical attention and may lead to increased social isolation and a premature loss of independence.  As such, it is not surprising that approximately 64% of individuals between 45 and 90 years of age with MS report being afraid of falling.

In a recent study published in the American Journal of Physical Medicine and Rehabilitation, researchers from the University of Illinois at Urbana-Champlain investigated whether fall risk was associated with physical activity in individuals with MS.  47 people with MS were recruited to participate in this cross-sectional study.  All were over 18 years of age, none had had a relapse during the month prior to the study, and none were wheelchair-bound.  To measure fall risk, each participant answered an activities-specific balance scale indicating how confident they felt engaging in 16 different activities.  Based on their responses, they were allocated into the increased fall risk group (N=21) or the normal fall risk group (N=26).  Physical activity was measured over the course of one week and was quantified by time spent doing sedentary, light-intensity activity and by the number of steps taken each day (participants wore an ActiGraph model GT3X accelerometer each day for one week).  Overall disease status was assessed during a single examination to determine their Expanded Disability Status Scale score.

All participants remained in the study and compliance with accelerometer wear time was high.  After controlling for MS disease status, the researchers found that even though individuals with an increased fall risk were equally as active when it came to light-intensity physical activity as those with a normal fall risk, they walked significantly less each day.

Since no prior falls data was gathered, we are left with the proverbial chicken and egg question.  Does a prior fall lead to an individual’s hesitation to walk?  Or does walking less lead to muscle deconditioning and result in the person’s greater fall risk?  Reproducing this study on a larger scale and gathering data over several years would help to clarify these questions.  Data such as this would also help inform the development of education programs for individuals with MS that promote walking confidence, afford opportunities to practice fall avoidance strategies, and encourage walking activity to minimize muscle deconditioning.


Written By: Debra A. Kellen, PhD

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