Best lifestyle habits for MS may shift over time, study finds

Some lifestyle habits, such as engaging in physical activity and not smoking, may provide the greatest health benefits earlier in the course of multiple sclerosis (MS), while others, such as eating a healthy diet, may be of more help to those who have been living with the disease for longer, a study found.

The findings suggest that the relationship between lifestyle factors and MS outcomes may vary depending on how long a person has had the condition, supporting the idea that lifestyle management strategies for MS should be tailored to each person’s disease stage.

“Encouraging and supporting a healthy lifestyle through shared decision-making, realistic goal-setting, and regular review may therefore form an important component of comprehensive MS management,” the researchers wrote.

The study, “Associations between lifestyle factors and 2.5-year clinical outcomes differ by time since multiple sclerosis diagnosis,” was published in Neurological Sciences.

MS is a chronic condition marked by inflammation and damage to certain parts of the brain and spinal cord, leading to a range of MS symptoms that can include fatigue, depression, trouble walking, and vision problems.

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It’s well established that starting disease-modifying therapies as early as possible after an MS diagnosis is crucial to improve long-term outcomes in people with MS. Lifestyle habits have also been associated with better health outcomes in people with MS, but whether their benefits also vary depending on when during the disease course they are adopted remains unclear.

Researchers at the University of Melbourne in Australia analyzed data from 1,401 adults with MS who participated in the Health Outcomes and Lifestyle In a Sample of people with Multiple Sclerosis (HOLISM) study. Participants completed surveys at the start of the study and again about 2.5 years later.

At the start of the study, researchers assessed five lifestyle factors: eating a high-quality diet, being physically active, not smoking, taking vitamin D supplements, and practicing meditation. Two and a half years later, they looked at fatigue, depression, and self-reported disability.

Participants were split into two groups based on the time since diagnosis: those diagnosed within the previous five years and those who had been living with MS for more than five years. The groups had an average disease duration of 2.4 and 12.5 years, respectively.

The results showed that physical activity was strongly associated with a lower risk of fatigue, depression, and disability at follow-up in those diagnosed within the previous five years. Among those who had lived with MS for longer, physical activity was also associated with lower disability risk, but the relationship was weaker.

Refraining from smoking followed a similar pattern, being associated with lower disability risk in the group with a shorter time from diagnosis.

The findings suggest that physical activity and smoking cessation may be particularly important early in the disease course, when there may be greater opportunities to preserve function and prevent disability.

Diet showed the opposite pattern. A high-quality diet was linked to lower depression and disability among participants who had lived with MS for more than five years.

The researchers suggested this might mean that diet’s benefits take longer to appear and may depend on maintaining a healthy diet over an extended period. This result was consistent with prior findings from the same researchers showing that at least 2.5 years of dietary adherence was needed before benefits on fatigue, depression, and disability became apparent.

Vitamin D supplementation and meditation were not linked to any of the three outcomes in either group.

The researchers also looked at the combined effect of the five lifestyle factors. Meeting four or five healthy lifestyle criteria was associated with a lower risk of depression regardless of disease duration. Among those diagnosed within five years, it was also associated with lower risk of fatigue and disability.

Overall, the findings support what the researchers called a “time matters” perspective, in which the associations between lifestyle habits and MS outcomes may differ across the disease course.

“These findings support a personalised, stage-appropriate approach in which [people with MS] are supported to prioritise different healthy lifestyle behaviours across the disease course,” the team wrote.