Objective

To compare oxygen consumption and energy expenditure (EE) of the activities of daily living (ADL) in people with multiple sclerosis (PwMS) and healthy subjects.

Design

Cross-sectional observational study.

Setting

Outpatient care facilities.

Participants

Twenty-four moderately impaired PwMS and 21 healthy controls (N=45).

Intervention

Not applicable.

Main Outcome Measures

Oxygen consumption, EE rate, and total EE assessed by portable open-circuit spirometry during the accomplishment of a comprehensive set of 14 ADL. Body composition was also assessed with bioelectrical impedance analysis. Body cell mass was used to normalize metabolic rates between groups.

Results

PwMS exhibited significantly higher oxygen consumption than controls in transfer and mobility tasks (walking with stairs: +10.4%, P=.04; without stairs: +15.2%, P=.002; driving: +10.4%, P=.04) and higher EE rates for walking (+13.6%, P=.01). ADL completion took significantly longer in PwMS. Consequently, when total EE to complete each ADL was considered, PwMS used significantly more energy in 10 of the 14 ADL. Of these, “climb stairs” and walking with or without stairs showed the largest differences (+100%, +99.5%, +79.3%, respectively; all P values<.0005), followed by “dressing” (+48.8%; P=.002), “laundry” (+41.7%; P=.007), and “shopping” (+40.1%; P=.003).

Conclusions

Moderately disabled PwMS display oxygen consumption and EE rates during ADL that are comparable to those of matched healthy subjects, except for the activities that involve walking. Although metabolic rates were not different for the majority of ADL, PwMS showed higher total EE to complete the same activities at a comparable work intensity, which may contribute to the burden of “real-life” tiredness and fatigue typically described in this population. Importantly, the subjective Modified Fatigue Impact Scale score significantly correlated to EE and oxygen consumption of selected ADL, such as “make a bed,” “driving,” “clean surfaces,” and “climb stairs.” The joint employment of open-circuit spirometry during ADL and body composition analysis allows an accurate metabolic characterization of PwMS, who frequently complain of fatigue.

中文翻译：

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多发性硬化症患者和健康受试者日常生活活动中的能量消耗和耗氧量：估算现实生活疲劳和易疲劳的生态方法

客观的

比较多发性硬化症 (PwMS) 和健康受试者的日常生活活动 (ADL) 的耗氧量和能量消耗 (EE)。

设计

横断面观察研究。

环境

门诊护理设施。

参与者

24 名中度受损的 PwMS 和 21 名健康对照（N=45）。

干涉

不适用。

主要观察指标

在完成一组 14 项 ADL 的综合过程中，通过便携式开路肺量计评估的耗氧量、EE 率和总 EE。还通过生物电阻抗分析评估了身体成分。体细胞质量用于使各组之间的代谢率正常化。

结果

PwMS 在转移和移动任务中的耗氧量明显高于对照组（走楼梯：+10.4%，P =.04；不走楼梯：+15.2%，P =.002；开车：+10.4%，P =.04）和更高的步行 EE 率（+13.6%，P = .01）。在 PwMS 中完成 ADL 的时间要长得多。因此，当考虑完成每个 ADL 的总 EE 时，PwMS 在 14 个 ADL 中的 10 个中使用了明显更多的能量。其中，“爬楼梯”和走楼梯与不走楼梯的差异最大（分别为+100 %、+99.5%、+79.3%；所有P值<.0005），其次是“穿衣”（+48.8%；P =.002）、“洗衣”（+41.7%；P =.007）和“购物”（+40.1%；P = .003）。

结论

中度残疾的 PwMS 在 ADL 期间显示的耗氧量和 EE 率与匹配的健康受试者相当，但涉及步行的活动除外。尽管大多数 ADL 的代谢率没有不同，但 PwMS 显示出更高的总 EE，以在可比的工作强度下完成相同的活动，这可能会导致“现实生活”疲劳和疲劳的负担，通常在该人群中描述。重要的是，主观修正疲劳影响量表评分与所选 ADL 的 EE 和耗氧量显着相关，例如“铺床”、“驾驶”、“清洁表面”和“爬楼梯”。在 ADL 和身体成分分析期间联合使用开路肺活量测定法可以准确地表征经常抱怨疲劳的 PwMS。