Poorer dynamic balance was associated with higher energy cost of walking in people with multiple sclerosis, predominantly at lower walking speeds, suggesting that jointly improving walking speed and dynamic balance may reduce the energetic burden of walking in this population.
The mean energy cost of walking in people with multiple sclerosis was 4.99 J/kg/m at comfortable speed and 4.84 J/kg/m at fast walking speed.
The medio-lateral margin of stability was significantly associated with energy cost of walking, with walking speed acting as a significant effect modifier.
The association between dynamic balance and energy cost of walking was stronger at lower walking speeds and attenuated at higher walking speeds.
Dynamic balance was approximated using both the medio-lateral margin of stability during treadmill walking and balance board testing.
The authors concluded that jointly improving walking speed and dynamic balance may reduce the energetic burden of walking in people with multiple sclerosis.
This research suggests that people with multiple sclerosis (MS) who have poorer balance tend to expend more energy when walking, and that this relationship is especially pronounced when walking slowly. The study had 20 participants with MS walk on an instrumented treadmill at two speeds — their comfortable pace and a faster pace — while researchers measured their oxygen consumption (to calculate energy cost) and assessed their balance using measures of sideways stability and balance board testing. On average, participants used about 4.99 joules of energy per kilogram of body weight per meter walked at their comfortable speed, and 4.84 J/kg/m at the faster speed. The key finding was that worse sideways (medio-lateral) balance was linked to higher energy cost of walking, but this connection was strongest at slower walking speeds and became weaker as speed increased. In other words, people who struggled more with balance paid a greater energetic 'penalty' particularly when walking slowly. This interaction between balance and walking speed helps explain why some MS patients find walking so exhausting — their balance difficulties may force them to work harder with every step, especially at the slower speeds many MS patients commonly use. This research suggests that rehabilitation approaches for MS that target both improving walking speed and improving balance at the same time — rather than focusing on just one — could be especially effective at reducing the fatigue and physical burden that walking places on people with MS. Because this was a relatively small cross-sectional study, the findings should be considered preliminary and would need to be confirmed in larger studies before drawing firm conclusions about treatment strategies.
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Upload Your LabsTimmermans S, Gravesteijn A, Wishaupt K, Beckerman H, Van der Krogt M, De Groot V. (2026). The cost of imbalance: how balance problems drive energy cost of walking in persons with multiple sclerosis.. Journal of rehabilitation medicine. https://doi.org/10.2340/jrm.v58.45814