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Steps to Health: Backward Walking Predicts Physical Activity Levels in Multiple Sclerosis.
Michael VanNostrand1,2, Patrick G Monaghan1,2, Taylor N Takla1,3
1Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA.
Neurorehabilitation and Neural Repair
|January 23, 2026
Summary
Backward walking speed accurately predicts daily step goals in people with multiple sclerosis (PwMS). Faster backward walking indicates higher physical activity levels, aiding clinical interventions for mobility and health.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Physical Therapy
Background:
- Physical activity (PA) is crucial for physical, cognitive, and mental health.
- Persons with multiple sclerosis (PwMS) often face limitations in PA due to mobility, cognitive, and psychological factors.
- Clinically practical methods are needed to assess PA in PwMS.
Purpose of the Study:
- To develop a clinical approach combining patient-reported outcomes and objective measures to determine if PwMS meet daily step count goals.
- To identify predictors of meeting PA recommendations in PwMS.
Main Methods:
- 45 PwMS completed mobility assessments (balance, forward walking [FW], backward walking [BW]), cognitive tests, and self-report measures.
- Fitbit devices tracked PA for 3 months, assessing adherence to a 7500-step daily goal.
- Logistic regression analyzed predictors of meeting the step goal.
Main Results:
- 15 participants met the daily step goal.
- Those meeting the goal reported fewer mobility limitations and less concern about falling.
- Backward walking (BW) at comfortable (0.89 m/s) and fast (1.25 m/s) speeds were the strongest predictors of achieving the daily step goal (80-82.2% accuracy).
- Cognitive function did not differ between groups.
Conclusions:
- Backward walking (BW) speed is a clinically relevant predictor for achieving daily step goals in PwMS.
- Established BW speed cut-offs can accurately predict PA adherence.
- BW assessment can inform interventions to promote PA in PwMS.
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