Steps to Health: Backward Walking Predicts Physical Activity Levels in Multiple Sclerosis

Abstract

Background

Physical activity (PA) supports physical, cognitive, and mental health, yet is often limited in persons with multiple sclerosis (PwMS) due to mobility, cognitive, and psychological factors. Practical methods to identify those meeting PA recommendations are needed. This study aimed to develop a clinically useful approach combining patient-reported outcomes and objective measures to determine whether PwMS meet step count goals.

Methods

Participants completed mobility assessments (static balance, reactive balance, forward walking [FW], and backward walking [BW]), cognitive testing, and self-report measures. Fitbit tracked PA for 3 months, categorizing participants based on whether they met the MS daily step goal (7500 steps).

Results

Forty-five PwMS (age: 51.16 ± 11.12 years; median Patient Determined Disease Steps: 1; 84% female) participated, with 15 meeting the daily step goal. Participants who met the step count goal reported significantly lower mobility limitations (MS Walking Scale-12, P = .01) and concern about falling (Falls Efficacy Scale—International, P < .01) compared to those who did not. Significant differences were also observed for BW at both comfortable and fast speeds (P < .01), FW at both speeds (P = .01), and reactive balance (P = .04). No differences were observed for cognition. Logistic regression identified BW at both comfortable (0.89 m/s) and fast speeds (1.25 m/s) as the strongest predictors of achieving the daily step goal, with predictive accuracies of 80% and 82.2%, respectively.

Conclusion

BW is a clinically relevant predictor of achieving daily step goals in PwMS. Established cut-off values—0.89 m/s for comfortable and 1.25 m/s for fast BW—demonstrated strong predictive accuracy. These findings highlight the utility of BW as a mobility measure to inform interventions and promote PA in clinical practice.