People listening to music during an extended walk tend to sync their steps to its beat — and for those with multiple sclerosis (MS), such synchronization helps to overcome mental fatigue and improve motivation, a study found.

“Continuous 12 min walking to music, metronomes and in silence: Auditory-motor coupling and its effects on perceived fatigue, motivation and gait in persons with multiple sclerosis” was published in the journal Multiple Sclerosis and Related Disorders.

Authorities recommend that MS patients walk at moderate intensity for at least 10 uninterrupted minutes, three times a day, five days a week. But as the study noted, most don’t walk for more than five or six minutes at a time each day, possibly due to the fatigue and gait problems their disease brings.

An approach that might make more vigorous walking easier is listening to music, because music has a defined tempo, and people tend to sync their stride to the beat, a process called entrainment.

A previous study by this research team in Belgium demonstrated that people with MS show entrainment while walking for a short period of time (three minutes). Now, in the new study, the researchers wondered whether this effect would hold over a longer course of time (12 minutes), and what benefits it might have for participants.

They conducted a clinical trial (NCT03281330) that enrolled 27 MS patients and 28 healthy people as controls. The two groups were similar in terms of demographics, but MS patients had poorer motor skills and reported higher levels of fatigue that affected daily life.

After baseline (starting) tests that included measures of normal walking speed, participants were asked to walk for 12 minutes under three conditions: listening to music, listening to a metronome (clicking sounds at regular intervals), or no auditory stimuli. All were equipped with sensors to measure their strides and, when relevant, how their steps matched the beat.

To determine if audio stimulation might actually increase physical activity, the tempos chosen were slightly faster than the participants’ normal walking speeds and tailored individually. For people with MS, the tempo was, on average, 2.8% faster than their normal speed for music, and 3.4% faster for the metronome; for healthy controls, these increases were 4.6% and 4.9%, respectively.

Results showed that everyone synced to the beat of both music and metronomes, but people with MS synchronized better to the music. In the three-minute walk study, they synchronized better to metronomes, the researchers noted, suggesting the difference might be related to allowing individuals to choose their music.

Participants were also asked to rate their cognitive and physical fatigue (scale of 0-10), and their motivation (scale of 1-5) after a 12-minute walk under all three conditions.

Overall, MS patients reported greater mental and physical fatigue than did controls across all conditions.

Physical fatigue was not affected by what the participants were listening to, with scores similar for metronomes, music, and silence. Cognitive fatigue, in contrast, was significantly lower after listening to music than a metronome among MS patients, although notably, not significantly different from silence— according to the team, these results might be due to the study’s small size.

All participants rated their motivation as higher after listening to music than either metronomes or no stimuli.

The team concluded that MS patients “perceived less cognitive fatigue, no difference in perceived physical fatigue, and a higher motivation walking to music compared to metronomes and silence.”

According to the them, music seems to require “less unconscious attention compared to sustained coupling to metronomes, yet similar physical effort.”

Researchers also noted that music may “appeal to the biosocial nature of human corporeal expression” more than the tick of metronomes. In other words, music is more entertaining to listen to, which may explain the increased motivation and decreased mental fatigue observed.

Given the study’s small size, these findings need to be confirmed in larger groups. Nonetheless, the team advises the “use of music as an auditory stimulus,” as MS patients were able to sustain “synchronization for 12 min, with low cognitive fatigue and high motivation.”