A multi-domain lifestyle intervention in multiple sclerosis: a longitudinal observational study.

OBJECTIVE

To examine the effects of a multi-domain lifestyle intervention that advocated a Mediterranean style diet, and concurrently targeted physical activity, stress and sleep, on multiple sclerosis.

METHODS

A longitudinal observational study investigating the effect of a multi-domain lifestyle intervention (i.e., diet, exercise, stress, and sleep management) at four timepoints: start run-in, start and stop 3-month intensive interval, and 3-month follow-up. The primary outcome (i.e., impact of multiple sclerosis on daily functioning) and secondary outcomes (i.e., quality of life, general health, multiple sclerosis-specific symptoms, and lifestyle factors) were analyzed using mixed models. Analyses were repeated among subgroups based on program compliance, body mass index, education level, and multiple sclerosis-subtype.

RESULTS

Out of 668 participants, 579 were included (age 46.2 ± 10.5 years, 84.5% women, and 71% relapsing-remitting multiple sclerosis). The impact of multiple sclerosis on physical functioning remained stable during the run-in period, but reduced significantly from baseline to both post-intervention (β = -2.50 [-3.40, -1.60]) and to 3-month follow-up (β = -2.00 [-2.93, -1.07]). The impact of multiple sclerosis on mental functioning decreased significantly across all time periods (run-in β = 1.86 [0.78, 2.94], post-intervention β = -3.48 [-4.58, -2.39], and 3-month follow-up β = -2.44 [-3.56, 1.31]). Effect size was greatest among participants with higher compliance, lower education, and obesity.

INTERPRETATION

The lifestyle program was associated with reduced impact of multiple sclerosis on daily functioning, multiple sclerosis-related symptoms, mental quality of life, and general health determinants. Future randomized trials are needed to establish causal effects of lifestyle adjustments on multiple sclerosis.