Abstract
INTRODUCTION: Individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) often experience chronic pain, leg fatigue and/or pain, which may contribute to a higher metabolic cost of walking. How these subjective measures may manifest in an elevated metabolic cost of transport and perceived pain at varying walking speeds remains to be evaluated. METHODS: We recruited 11 HSD/hEDS participants (33 ± 14 yrs, 170 ± 6. cm, weight 71 ± 11 kg) and 11 age- and sex-matched controls. Self-reported subjective outcome measures of health-related quality of life, fatigue severity, and foot function were evaluated prior to treadmill walking using the 36-Item Short Form Health Survey (SF-36) and the Fatigue Severity Scale (FSS). Participants also rated their self-perceived leg pain/fatigue following 3 x 6 min of treadmill walking at 80%, 100% and 120% of preferred walking speed (PWS). Cost of transport (CoT) was calculated from indirect calorimetry. RESULTS: CoT was significantly higher in HSD/hEDS compared to CON at all speeds (p = 0.034). CoT was significantly higher at 80% PWS compared to both 100% and 120% PWS in HSD/hEDS. HSD/hEDS reported significantly poorer health outcomes across all SF-36 domains (p < 0.05), significantly poorer foot function (p < 0.001) and significantly higher fatigue severity (p < 0.001) prior to walking. Despite similar PWS (1.1 ± 0.3 m⸱s(-1)), Leg pain/fatigue immediately following walking was significantly higher in HSD/hEDS compared to CON (group main effect p < 0.001) and increased with speed in HSD/hEDS (p = 0.011). The physical function domain was significantly related post-walking leg pain/fatigue, and perceived energy prior to walking (all r > 0.69, p < 0.001). DISCUSSION: These results have important implications for exercise prescription in individuals with HSD/hEDS whose CoT is higher during walking, which may exacerbate already elevated symptoms of pain and fatigue.