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References: Evidence on lifestyle and MS

[1] Barker et al (2018), Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy: cross-sectional analysis of electronic health records, http://dx.doi.org/10.1136/bmjqs-2017-007635

Preserving brain function in people with MS is essential


[2] European Committee for Treatment & Research in Multiple Sclerosis, October 13-15, 2021, p144

Outcomes for people with MS and the burden on health services are both worsened by comorbidities whilst some comorbidities [2] are associated with worsened disease progression


[3] Sorensen P and Magyari M, ‘Comorbidity in Multiple Sclerosis’, Front. Neurol., 21 August 2020 | https://doi.org/10.3389/fneur.2020.00851

Some comorbidities are associated with increased relapses 


[4] Salter A, et al Comorbidity is associated with disease activity in MS
Findings from the CombiRx trial, Neurology Aug 2020, 95 (5) e446-e456; DOI: 10.1212/WNL.0000000000010024

Metabolic syndrome has been linked with increased disability, worsened progression and reduced disease-modifying treatment efficacy


[5] MS Brain Health: Why manage comorbidities? accessed https://www.msbrainhealth.org/healthcare-professionals/why-manage-comorbidities-in-people-with-multiple-sclerosis/

By encouraging healthy lifestyle choices as part of holistic management, we can reduce the likelihood of people developing comorbidities, or minimise their impact


[6] Rodgers et al (2022), The impact of smoking cessation on multiple sclerosis progression’ ‘https://doi.org/10.1093/brain/awab385

Smoking cessation has been found to slow the rate of motor disability deterioration


[7] Proschinger, S et al. Fitness, physical activity, and exercise in multiple sclerosis: a systematic review on current evidence for interactions with disease activity and progression. J Neurol 269, 2922–2940 (2022). https://doi.org/10.1007/s00415-021-10935-6

Regular participation in exercise may impact relapse rate


[8] Tettey P, Simpson S, Taylor B, et alAn adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating eventJournal of Neurology, Neurosurgery & Psychiatry 2017;88:395-401. See also [9]

[9] Mowry EM, Azevedo CJ, McCulloch CE, Okuda DT, Lincoln RR, Waubant E, Hauser SL, Pelletier D. Body mass index, but not vitamin D status, is associated with brain volume change in MS. Neurology. 2018 Dec 11;91(24):e2256-e2264. doi: 10.1212/WNL.0000000000006644. Epub 2018 Nov 14. PMID: 30429274; PMCID: PMC6329329.

There is some evidence to suggest that people with MS who have certain comorbidities are at risk of greater disease progression and may have less positive treatment outcomes


[10] Salter A, Kowalec K, Fitzgerald KC, Cutter G, Marrie RA, ‘Comorbidity is associated with disease activity in MS: Findings from the CombiRx trial’, Neurology Aug 2020, 95 (5) e446-e456; DOI: 10.1212/WNL.0000000000010024

See also [11] and [12]

[11] Briggs FBS, Thompson NR, Conway DS. Prognostic factors of disability in relapsing remitting multiple sclerosis. Mult Scler Relat Disord. 2019 May;30:9-16. doi: 10.1016/j.msard.2019.01.045. Epub 2019 Jan 29. PMID: 30711764. See also [10] and [12]

[12] Huppke B, Ellenberger D, Hummel H, Stark W, Röbl M, Gärtner J, Huppke P. Association of Obesity With Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children. JAMA Neurol. 2019 Jul 15;76(10):1157–65. doi: 10.1001/jamaneurol.2019.1997. Epub ahead of print. PMID: 31305922; PMCID: PMC6632118.

People with MS and metabolic syndrome have been found to have an increased rate of both relapse and disease progression and reduced health-related quality of life, as well as to see the success of disease-modifying treatment impacted


[13] NICE (2022), Multiple sclerosis in adults: management, NICE guideline [NG220] https://www.nice.org.uk/guidance/ng220

See also [14]

[14] Neurology Academy (2022), Putting policy into practice; disease-modifying lifestyle https://neurologyacademy.org/articles/putting-policy-into-practice-disease-modifying-lifestyle

Symptom management can be optimised through a multi-pronged approach of lifestyle change, therapeutic interventions and medication and this is clearly established in the updates to the MS NICE guidance


[15] Peel C (2021) Evidence for non-medical management in MS: optimised management and patient participation, BJNN https://doi.org/10.12968/bjnn.2021.17.Sup1.S31

Positive changes like improving sleep or nutritional quality, better stress management or physical movement have been found to improve symptoms like fatigue, pain, mood and cognition 


[16] Asano, M. and Finlayson, M.L., 2014. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Multiple sclerosis international, 2014. See also [17]

[17] Heine, M., van de Port, I., Rietberg, M.B., van Wegen, E.E. and Kwakkel, G., 2015. Exercise therapy for fatigue in multiple sclerosis. Cochrane database of systematic reviews, (9).

Exercise has been found to be more efficacious in managing fatigue than medications


[18] Peters (2019), Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity https://doi.org/10.1186/s12955-019-1103-3

Sharing the evidence for lifestyle as a meaningful form of treatment and management when combined with therapeutic interventions and optimised medication is an incredible message of hope. This can motivate self-management and improve quality of life


[19] Barker et al (2018), Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy: cross-sectional analysis of electronic health records, http://dx.doi.org/10.1136/bmjqs-2017-007635

It can reduce the burden on healthcare services


[20] The Health Foundation (2011), Helping people help themselves. A review of the evidence considering whether it is worthwhile to support self-management https://www.health.org.uk/sites/default/files/HelpingPeopleHelpThemselv…

It can encourage people with MS to make positive lifestyle choices for the long-term.