From the Division of Pediatric Neurology (J.N.B., S.M., E.W., R.C.), Department of Neurology, and School of Medicine (B.F., H.K.), University of Virginia, Charlottesville; and Departments of Biostatistics (S.C.) and Neurology (M.G.), Virginia Commonwealth University, Richmond.
Neurology. 2022 Nov 7;99(19):e2161-e2170. doi: 10.1212/WNL.0000000000201098.
Despite low levels of disability, youth with pediatric-onset multiple sclerosis (POMS) engage in less physical activity compared with peers. The contribution of walking capacity, endurance, behavior, and MS comorbidities remains relatively undefined and may provide valuable insights into the limitations toward physical activity in youth with MS. The primary objective of this study was to investigate differences in walking capacity, endurance, and real-world behaviors of daily activity between youth with POMS and controls.
Youth diagnosed with MS prior to 18 years and aged 21 years or younger were recruited in addition to healthy controls. Participants completed questionnaires to quantify fatigue, depression, and physical activity levels and the timed 2- and 6-minute walk (6MW) as an assessment of walking capacity and endurance. Participants completed questionnaires to quantify fatigue, depression, and physical activity levels. Participants also completed the timed 2- and 6-minute walk (6MW) as an assessment of walking capacity and endurance and were sent home with a waist-worn accelerometer to assess real-world walking behavior.
Forty-five patients with POMS and 85 control participants were enrolled. The POMS cohort had a mean age of 16.9 ± 2.7 years, with a mean disease duration of 2.8 ± 2.6 years. A greater proportion of the POMS cohort was overweight/obese compared with controls (75% vs 33%). Participants with MS walked a significantly shorter distance in 6 minutes compared with controls (1,848 feet vs 2,134 feet, < 0.0001) and, unlike controls, were unable to accelerate to their peak speed at the end of the 6MW. Body mass index category and MS disease significantly affected 6MW performance. Using continuous accelerometry, participants with MS spent less time in moderate-to-vigorous physical activity compared with controls (20.4 vs 35.4 min/d, = 0.0003). The POMS cohort reported significantly higher levels of depression and fatigue but self-reported similar levels of daily physical activity as controls.
Youth with POMS exhibit slower 6MW performance and less daily engagement in moderate-to-vigorous physical activity, suggesting limitations in functional walking capacity, endurance, and daily activity behavior. Limitations in walking endurance and capacity are most prominent in those youth who are overweight/obese and living with MS.
This study provides Class III evidence that, compared with healthy controls, patients with POMS walk shorter distances on the 6MW test, are less able to accelerate to peak speed at the end of the test, and are less physically active.
尽管残疾程度较低，但与同龄人相比，患有儿科发病型多发性硬化症（POMS）的年轻人参与的身体活动较少。行走能力、耐力、行为和多发性硬化症合并症的贡献仍然相对不明确，这可能为理解多发性硬化症青少年身体活动的局限性提供有价值的见解。本研究的主要目的是调查 POMS 青少年与对照组之间行走能力、耐力和日常活动实际行为的差异。
除了健康对照组外，还招募了在 18 岁之前被诊断为 MS 且年龄在 21 岁或以下的 POMS 青少年患者。参与者完成了问卷调查以量化疲劳、抑郁和身体活动水平，以及定时的 2 分钟和 6 分钟步行（6MW）以评估行走能力和耐力。参与者完成了问卷调查以量化疲劳、抑郁和身体活动水平。参与者还完成了定时的 2 分钟和 6 分钟步行（6MW），以评估行走能力和耐力，并被送回家中佩戴腰部佩戴的加速度计以评估实际行走行为。
共纳入 45 例 POMS 患者和 85 例对照组参与者。POMS 队列的平均年龄为 16.9 ± 2.7 岁，平均病程为 2.8 ± 2.6 年。与对照组相比，POMS 队列中超重/肥胖的比例更高（75%比 33%）。与对照组相比，MS 患者在 6 分钟内行走的距离明显较短（1848 英尺比 2134 英尺，<0.0001），并且与对照组不同的是，他们无法在 6MW 结束时加速到最高速度。体重指数类别和 MS 疾病显著影响 6MW 表现。使用连续加速度计，MS 患者的中到剧烈身体活动时间明显少于对照组（20.4 分钟/天比 35.4 分钟/天，= 0.0003）。POMS 队列报告的抑郁和疲劳水平明显较高，但自我报告的日常身体活动水平与对照组相似。
与健康对照组相比，POMS 青少年的 6MW 表现较慢，日常参与中到剧烈身体活动的时间较少，这表明他们的功能性行走能力、耐力和日常活动行为存在限制。在超重/肥胖和患有 MS 的青少年中，行走耐力和能力的限制最为明显。
本研究提供了 III 级证据，表明与健康对照组相比，POMS 患者在 6MW 测试中行走的距离更短，在测试结束时无法加速到最高速度，并且身体活动较少。
