Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.
Disability and Health, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia.
PLoS One. 2018 May 23;13(5):e0197759. doi: 10.1371/journal.pone.0197759. eCollection 2018.
Modifiable risk factors such as smoking and sedentary lifestyle adversely affect multiple sclerosis (MS) progression. Few multimodal behavioural interventions have been conducted for people with MS, and follow-up beyond 1 year is rare for lifestyle interventions. This study assessed adoption and adherence to healthy lifestyle behaviours and health outcomes 3 years after a lifestyle modification intervention, using generalized estimating equation models to account for within-participant correlation over time.
95 people with MS completed baseline surveys before participating in 5-day MS lifestyle risk-factor modification workshops. 76 and 78 participants completed the 1-year and 3-year follow-up surveys respectively. Mean age at 3-year follow-up was 47 years, 72% were female, most (62.8%) had MS for 5 years or less, and 73% had relapsing remitting MS (RRMS).
Compared to baseline, participants reported clinically meaningful increases in physical (mean difference (MD): 8.0, 95% Confidence Interval (CI): 5.2-10.8) and mental health (MD: 9.2, CI: 5.8-12.6) quality of life (QOL) at 1-year, and physical (MD: 8.7, CI: 5.3-12.2) and mental health (MD: 8.0, CI: 4.2-11.8) QOL at 3-year follow-up. There was a small decrease in disability from baseline to 1-year follow-up (MD: 0.9, CI: 0.9,1.0) and to 3-year follow-up (MD: 1.0, CI: 0.9,1.0), which was not clinically meaningful. Of those with RRMS, compared to baseline, fewer had a relapse during the year before 1-year follow-up (OR: 0.1, CI 0.0-0.2) and 3-year follow-up (OR: 0.15, CI 0.06-0.33). Participants' healthy diet score, the proportion meditating ≥1 hours a week, supplementing with ≥ 5000IU vitamin D daily, and supplementing with omega-3 flaxseed oil increased at 1-year follow-up and was sustained, although slightly lower at 3-year follow-up. However, there was no evidence for a change in physical activity and not enough smokers to make meaningful comparisons. Medication use increased at 1-year follow-up and at 3-year follow-up.
The results provide evidence that lifestyle risk factor modification is feasible and sustainable over time, in a small self-selected and motivated sample of people with MS. Furthermore, participation in a lifestyle intervention is not associated with a decrease in MS medication use.
可改变的风险因素，如吸烟和久坐的生活方式，会对多发性硬化症（MS）的进展产生不利影响。针对 MS 患者开展了为数不多的多模式行为干预措施，且生活方式干预的随访时间超过 1 年的情况很少见。本研究使用广义估计方程模型来评估生活方式改变干预 3 年后的健康生活方式行为的采用和坚持情况，并考虑到参与者随时间的内在相关性。
95 名 MS 患者在参加为期 5 天的 MS 生活方式危险因素修正研讨会之前完成了基线调查。76 名和 78 名参与者分别完成了 1 年和 3 年的随访调查。3 年随访时的平均年龄为 47 岁，72%为女性，大多数（62.8%）的 MS 病程为 5 年或更短，73%为复发缓解型 MS（RRMS）。
与基线相比，参与者在 1 年时报告了身体（平均差异（MD）：8.0，95%置信区间（CI）：5.2-10.8）和心理健康（MD：9.2，CI：5.8-12.6）质量生活（QOL）有显著的临床改善，在 3 年时报告了身体（MD：8.7，CI：5.3-12.2）和心理健康（MD：8.0，CI：4.2-11.8）QOL 的改善。残疾情况从基线到 1 年随访（MD：0.9，CI：0.9，1.0）和 3 年随访（MD：1.0，CI：0.9，1.0）均有轻微下降，但无临床意义。在 RRMS 患者中，与基线相比，在 1 年随访前（OR：0.1，CI 0.0-0.2）和 3 年随访前（OR：0.15，CI 0.06-0.33）复发的人数较少。参与者的健康饮食评分、每周冥想≥1 小时的比例、每日补充≥5000IU 维生素 D 和补充欧米伽-3 亚麻籽油的比例在 1 年时增加，并持续增加，尽管在 3 年时略有下降。然而，没有证据表明体力活动有变化，且吸烟人数不足，无法进行有意义的比较。药物使用在 1 年随访和 3 年随访时均有所增加。
结果表明，在一个自我选择和有动力的 MS 小样本中，生活方式危险因素修正具有可行性和可持续性。此外，参加生活方式干预并不会导致 MS 药物使用减少。
