Long-term Supplement Use May Improve Gait, Strength in RRMS
Long-term use of a high-dose nutritional supplement containing specific antioxidant vitamins and omega-3 and omega-6 fatty acids may boost walking performance and other measures of functional capacity in people with relapsing-remitting multiple sclerosis (RRMS), a new study found.
The study, “The Effects of Specific Omega-3 and Omega-6 Polyunsaturated Fatty Acids and Antioxidant Vitamins on Gait and Functional Capacity Parameters in Patients with Relapsing-Remitting Multiple Sclerosis,” was published in Nutrients.
Multiple sclerosis (MS) is a progressive disease that causes muscle weakness and fatigue, as well as balance and walking abnormalities such as slower walking speed and reduced stride length.
Earlier studies have shown that long-term use of a nutritional supplement — Neuroaspis PLP10, containing high-dose omega-3 and omega-6 fatty acids and antioxidant vitamins A and E — reduces annual relapse rates and disability progression in people with MS, without significant side effects.
The same supplement also improves functional capacity and cognitive function in older people with mild cognitive dysfunction.
Now, a team of researchers in Greece investigated whether Neuroaspis PLP10 could improve gait, functional capacity, and muscle function in people with RRMS, which would translate to better overall well-being.
The study included 51 RRMS patients — mean age 38 years, 59% female — who were assigned randomly to receive the dietary supplement (the Omega group) or pure virgin olive oil (the placebo group) once daily for two years. Patients were asked to maintain their usual dietary habits for that period.
At baseline (study start), the mean expanded disability status scale (EDSS) score was 2.22 for the Omega group and 2.36 for the placebo group, indicating minimal disability.
After one and two years on the trial, patients were examined for changes in gait parameters (such as step time, walking speed, stride time, and cadence), overall gait quality (using GDI, the gait deviation index), knee extension strength, and handgrip strength.
Other measures of functional capacity included the six-minute walk test (6MWT) and two sit-to-stand tests (STS-5 and STS-60), in which patients are asked to perform six cycles of sit-to-stand movement, or as many of those movements as possible in 60 seconds. Also included was the timed up and go test (TUG), which measures the time patients take to rise from a chair, walk 3 meters (almost 10 feet), turn around, and sit back on the chair.
While patients in the placebo group showed increases in step and stride times, those in the Omega group experienced a decrease in those times, indicating improved gait after two years.
There were no improvements in walking speed and cadence in the Omega group, but these patients had better overall gait quality on the GDI scores after two years. In contrast, people in the placebo group experienced a worsening in gait quality.
“While GDI of the control group between the baseline and the 24 months follow up decreased across legs by about 10% on average, the opposite was found for the OMEGA group, where GDI increased by about 4% on average across both legs,” the researchers wrote.
“These results suggest that the dietary supplement might have a significant protective effect against overall deterioration of gait,” they added.
The supplement also improved functional capacity after 24 months, with patients covering on average a 9.1% greater distance on the 6MWT than at study start. They also took less time to perform the sit-to-stand movement and were faster in the TUG test.
Patients on placebo also improved their times on the sit-to-stand and TUG tests after two years, but the improvements were greater in the Omega group at all times.
“Considering the fact that STS tests are considered mechanically demanding movements in relation to the daily living activities, specifically due to the high level of muscle activation requirements (since an individual needs to coordinate a transfer from a horizontal to a vertical position in a single movement), the positive effects [of the omega supplement] on this parameter can be considered clinically and practically important,” the researchers wrote.
Assessments of muscle function also showed greater improvements in the Omega group. In particular, handgrip strength of the right hand improved by 12.7% in the placebo group and by 14.1% in the Omega group. Similar findings were observed for the left hand, with improvements of 5.4% in the placebo group, compared with 14.3% in the Omega group.
Right knee extension strength also increased for the Omega group while patients on a placebo experienced reductions in this score. However, left knee extension strength improved by 10.7% in the placebo group and 7% in the Omega group.
The findings “support the hypothesis that this specific dietary formula (Neuroaspis PLP10) … can act protectively against functional deterioration of patients with a progressive disease such as RRMS,” the researchers wrote.
This study may have been limited by its small sample size and the non-standardized method to measure walking speed.
Future studies should assess the effectiveness of this supplement in a larger cohort of MS patients with more advanced disability. It also will be useful to study the combined effects of exercise and these supplements in patients.