Healthy Lifestyle Behaviors Linked to Better MS Outcomes

Engaging with healthy lifestyle behaviors, especially eating a healthy diet and partaking in regular physical activity, was associated with better health outcomes in patients with multiple sclerosis (pwMS) in a study published in European Journal of Neurology.¹

“Although prior observational studies have identified relationships between individual lifestyle factors and better health outcomes in pwMS, few studies have investigated associations between multimodal (collective) lifestyle factors and health outcomes,” the authors explained.

Healthy behaviors, especially regular exercise and a healthy diet, were associated with better patient-reported outcomes in multiple sclerosis. | Image credit: Daniel Vincek - stock.adobe.com

Their study explored the role of healthy lifestyle behaviors with outcomes among individuals with MS using an online multimodal healthy lifestyle program they developed, the Multiple Sclerosis Online Course (MSOC), to test in a large randomized controlled trial (RCT). Baseline data from the MSOC RCT were used to analyze the relationship between individual and collective lifestyle behaviors with health outcomes such as fatigue, disability, and quality of life (QOL) in pwMS.

A total of 857 patients residing in 52 countries were enrolled over the course of 5 recruitment rounds between June 2022 and July 2023 using online platforms. The median participant age was 47 years (IQR, 38-55), and 87% of patients were female. The median MS duration was 6 years (IQR, 2-14).

The lifestyle behaviors examined in the study were based on the Overcoming MS program, which emphasizes healthy lifestyle choices for MS management.² For the new analysis,¹ these behaviors included:

• healthy diet
• vitamin D supplementation
• omega-3 supplementation
• regular physical activity
• meditation
• not smoking

The researchers developed a composite lifestyle score, the Total Healthy Lifestyle Index Score (THLIS), to measure engagement with the 6 behaviors of interest. Scores ranged from 0 to 6, with 0 indicating no engagement with any of the behaviors and 6 indicating engagement with all of the behaviors. Few patients engaged with 0 or with more than 4 of the behaviors, so THLIS categories were analyzed in 4 groups: those engaging with 0 or 1 behaviors, 2 behaviors, 3 behaviors, and 4 to 6 healthy behaviors.

The Prevalence of Healthy Lifestyle Behaviors Among Patients With MS

Overall, 4% of patients reported engaging with 0 healthy behaviors in the survey, 34% engaged with 1 behavior, 30% with 2 behaviors, 21% with 3 behaviors, 8% with 4 behaviors, 3% with 5 behaviors, and less than 1% with 6 behaviors. The most common healthy behavior was not smoking, which 91% of patients engaged with. Omega-3 supplementation (35%), vitamin D supplementation (30%), regular physical activity (29%), a healthy diet (11%), and meditation (11%) followed.

Among those with a THLIS scores above 1, the most common combinations of healthy behavior engagement for those engaging in 2 behaviors were nonsmoking with physical activity (33%), nonsmoking with omega-3 supplementation (31%), or nonsmoking with vitamin D supplementation (27%). Individuals engaging in 2 to 4 behaviors most commonly reported nonsmoking with either omega-3 supplementation, vitamin D supplementation, or physical activity. A healthy diet was only common among those engaging with at least 4 healthy behaviors, the authors noted.

Healthy Lifestyle Behaviors and Patient-Reported Outcomes in MS

Regarding patient-reported outcome measures (PROMs), healthy diet, physical activity, and nonsmoking were each independently associated with health outcomes. Healthy diet was linked with better mental QOL, physical QOL, and a lower prevalence of fatigue; physical activity was associated with better mental QOL and physical QOL, lower fatigue, and lower moderate and severe disability. Not smoking was linked with better mental QOL and physical QOL. Meditation practice, vitamin D supplementation, and omega-3 supplementation were not linked with improvement in the outcomes explored in the study.

Engaging with 3 of the examined behaviors was associated with better mental QOL and physical QOL and lower moderate disability prevalence, and engaging with 4 behaviors was linked with better mental QOL and physical QOL, as well as lower fatigue and moderate disability prevalence.

While the study was limited by reliance on self-reported measures, which introduces potential for bias, another limitation was the inability to fully assess healthy diet as recommended in guidelines because seafood consumption was not assessed. Dietary patterns also varied in the population. Because the study only included individuals who completed the survey at baseline, there may have been selection bias overrepresenting patients interested in modifying their lifestyle behaviors. The study also could not determine causal relationships.

Still, the findings support the potential of healthy lifestyle interventions, especially physical activity and a healthy diet, in better health outcomes among pwMS, with the best outcomes seen when patients engage with at least 4 of the examined healthy behaviors.

“Findings are potentially relevant to common queries in clinical practice regarding how pwMS can improve their future outcomes via facilitating self-management through lifestyle modifications,” the authors wrote. “The insights into lifestyle behavior engagement and associations with health outcomes provide a platform for future studies to further investigate the relationship between combinations of behaviors and health outcomes, ultimately improving MS care.”

References

1. Yu M, Neate S, Nag N, et al. Baseline engagement with healthy lifestyles and their associations with health outcomes in people with multiple sclerosis enrolled in an online multimodal lifestyle course. Eur J Neurol. Published online August 7, 2024. doi:10.1111/ene.16429

2. Overcoming MS program overview. Overcoming MS. Accessed August 8, 2024. https://overcomingms.org/program/