Free-Living Peak Cadence in Multiple Sclerosis: A New Measure of Real-World Walking?

Background: Physical function and walking performance have become important outcomes in clinical trials and rehabilitation involving persons with multiple sclerosis (MS). However, assessments conducted in controlled settings may not reflect real-world capacity and movement in a natural environment. Peak cadence via accelerometry might represent a novel measure of walking intensity and prolonged natural effort under free-living conditions.

Objective: We compared peak 30-minute cadence, peak 1-minute cadence, and time spent in incremental cadence bands between persons with MS and healthy controls, and examined the associations between peak cadence and laboratory-assessed physical function and walking performance.

Methods: Participants (147 MS and 54 healthy controls) completed questionnaires on disability status and self-reported physical activity, underwent the Short Physical Performance Battery, Timed 25-Foot Walk, Timed Up and Go, and 6-Minute Walk, and wore an accelerometer for 7 days. We performed independent samples -tests and Spearman bivariate and partial correlations adjusting for daily steps.

Results: The MS sample demonstrated lower physical function and walking performance scores, daily steps, and peak cadence ( < .001), and spent less time in purposeful steps and slow-to-brisk walking (40-119 steps/minutes), but accumulated more incidental movement (1-19 steps/minutes) than healthy controls. The associations between peak cadence and performance outcomes were strong in MS (|| = 0.59-0.68) and remained significant after controlling for daily steps (|| = 0.22-0.44), values < .01. Peak cadence was inversely correlated with age and disability, regardless of daily steps ( < .01).

Conclusions: Our findings provide preliminary evidence for the potential use of peak cadence with step-based metrics for comprehensively evaluating free-living walking performance in MS.