In patients with multiple sclerosis (MS), lifestyle behaviors concerning diet, wellness, and physical activity had positive associations with quality of life (QOL), suggesting that implementing potential interventions and lifestyle modifications can improve MS management, according to a recent study.
The results of the observational study, published in Journal of Personalized Medicine, highlighted some differences in how lifestyle factors affect patients with relapsing-remitting MS (RRMS) vs progressive MS (ProgMS). The investigators predicted that phenotype-specific lifestyle modifications may be needed for proper MS management.
“Our findings show lifestyle behaviors are associated with QOL and appear to differ based on MS phenotype. Future studies assessing timing, duration, and adherence of adopting lifestyle behaviors may better inform their role in MS management,” wrote the investigators.
On initial diagnosis, 85% of people with MS receive a diagnosis of RRMS, and 10% to 15% of patients have primary ProgMS. Within 15 to 20 years after diagnosis, 50% to 75% of RRMS cases convert to secondary ProgMS.
Patients with RRMS or ProgMS experience physiological, psychological, and motor symptoms that can affect QOL. Improvement of symptoms through implementation of healthy lifestyle behaviors may improve QOL. However, less is known about whether healthy lifestyle behaviors on quality of life are similar across MS phenotypes, especially for patients with ProgMS, who may be less responsive to therapies, have greater disability, and have more severe symptoms compared with RRMS.
Of the 3374 patients who registered for the iConquerMS study, 1108 patients with MS aged 21 or older were eligible for inclusion. The cohort’s data were collected from November 2014 to July 2020. RRMS cases comprised 67.7% (n = 750) of the cohort and 32.3% (n = 358) had ProgMS. Among the participants with RRMS, the mean (SD) age was 49.9 (11) years and 83% were women. Among the patients with ProgMS, the mean age was 58.3 (9) years and 68% were women.
The investigators looked at 13 domains of QOL: 4 physical subdomains (mobility, fine motor, fatigue, and sleep disturbance), 7 mental subdomains (anxiety, depression, positive affect, emotional dyscontrol, stigma, cognitive function, communications), and 2 social subdomains (participation and satisfaction).
For QOL, compared with the general population, patients with MS reported similar T-score difference in 9 of the 13 QOL subdomains. Compared with patients with RRMS, those with ProgMS had significantly worse QOL in 7 of the 13 subdomains: mobility, fine motor, positive affect, participation, satisfaction, fatigue, and stigma. Anxiety was higher in RRMS.
Diet was found to have an association with physical and mental subdomains, but not social subdomains. In those with RRMS, anti-inflammatory, low-carbohydrate, and other diets were positively associated with stigma, fine motor, and/or cognitive function. In patients with ProgMS, anti-inflammatory diets were associated with higher mobility and positive affect. Also, a low-carbohydrate diet was associated with higher positive affect, a low–saturated fat diet was linked with higher ease of communication, and other diets were associated with higher mobility in ProgMS.
Wellness activities were linked with all 3 subdomain categories. In RRMS, mind activities had an association with lower fine motor skills, cognitive function, communication, social participation, and social satisfaction and higher fatigue, anxiety, emotional dyscontrol, and stigma. Mind-body activities were associated with higher positive affect and participation and lower emotional dyscontrol. Other wellness activities were linked with lower values in 10 of the 13 subdomains.
Physical activity was also observed to be linked with the 3 subdomain categories. Phenotype differences were seen for 8 of the 13 subdomains. For RRMS, dose-dependent physical activity was associated with higher mobility, positive affect, and satisfaction and lower anxiety, depression, and stigma. In ProgMS, moderate physical activity was linked with higher positive affect, cognitive function, and lower communication. Additionally, active physical activity was associated with higher mobility and lower fatigue in ProgMS.
The investigators did not observe associations between vitamin D and omega-3 supplements and QOL.
The study had several limitations, including self-reported optional survey responses, a potential selection bias, participant biases, and exclusion of information on socioeconomics, access to health services, and support networks.
Nag N, Yu M, Jelinek GA, Simpson-Yap S, Neate SL, Schmidt HK. Associations between lifestyle behaviors and quality of life differ based on multiple sclerosis phenotype. J Pers Med. Published online November 17, 2021. doi:10.3390/jpm11111218