ORIGINAL RESEARCH article
Front. Rehabil. Sci.
Sec. Rehabilitation for Musculoskeletal Conditions
Perceived Quality of Life, fatigue and the metabolic cost of walking in Generalized Hypermobility Spectrum Disorder and Hypermobile Ehlers-Danlos Syndrome
Provisionally accepted
Aera J.M. Ladell1,2
Donald W. Golden3,4Jason P. Oliemans3Kalindra D Walls3
Ranita Manocha4
Jared R Fletcher3*- 1Department of Biology, Mount Royal University, Calgary, Canada
- 2University of Calgary Faculty of Kinesiology, Calgary, Canada
- 3Mount Royal University Department of Health and Physical Education, Calgary, Canada
- 4University of Calgary Cumming School of Medicine, Calgary, Canada
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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. 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 3x6 min of treadmill walking at 80%,100% and 120% of preferred walking speed (PWS). Cost of transport (CoT) was calculated from indirect calorimetry. 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). 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.
Keywords: SF-36, Foot function, Fatigue, Hypermobility, Ehlers-Danlos Syndrome
Received: 16 Sep 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 Ladell, Golden, Oliemans, Walls, Manocha and Fletcher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jared R Fletcher, jfletcher@mtroyal.ca
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