Exploring Wellness Interventions in Progressive Multiple Sclerosis: an Evidence-Based Review
Purpose of review
There has been recent interest in the role of lifestyle and wellness-based approaches in the treatment and management of multiple sclerosis (MS). These approaches may be particularly relevant for patients with progressive MS, considering limited therapeutic options currently available. The purpose of this review is to examine the role of wellness-based interventions including exercise training, emotional well-being therapies, and dietary modification in patients with progressive MS.
We conducted a literature search on the efficacy of wellness-based interventions in patients with progressive MS published between 1985 and July 2017. The level of evidence for each trial was evaluated using the American Academy of Neurology criteria. Overall, 21 articles reporting on 16 wellness-based interventions were identified: ten trials involved exercise training, three involved emotional wellness therapies, two involved dietary modification, and one was a combined wellness intervention.
There is level C evidence (possibly effective; one class II study) for the efficacy of aerobic exercise training on cardiorespiratory fitness in patients with progressive MS. There is level B evidence (probably effective; one class I study) for the efficacy of mindfulness training on psychological distress, depression, anxiety, pain, and quality of life in patients with progressive MS. There is inadequate evidence (level U) for efficacy of dietary modification (one class III study and one class IV study) and combined wellness interventions involving exercise training, meditation, and dietary modification (one class IV study). High-quality research is needed to provide evidence-based recommendations for wellness behaviors and lifestyle change in patients with progressive MS.
KeywordsMultiple sclerosis Progressive Wellness Exercise Mindfulness Diet
Compliance with Ethical Standards
Conflict of Interest
Myriam Venasse and Thomas Edwards declare no conflict of interest. Lara A. Pilutti reports receiving research grants from the National Multiple Sclerosis Society and the Consortium of Multiple Sclerosis Centers outside of this work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.Giovannetti AM, Giordano A, Pietrolongo E, Confalonieri P, De Luca G, Tortorella C, et al. Managing the transition (ManTra): a resource for persons with secondary progressive multiple sclerosis and their health professionals: protocol for a mixed-methods study in Italy. BMJ Open. 2017;7:e017254.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.International Progressive MS Alliance [cited 2017 Nov 9]. Available from: http://www.progressivemsalliance.org/
- 9.• Motl RW, Mowry EM, Ehde DM, LaRocca NG, Smith KE, Costello K, et al. Wellness and multiple sclerosis: the National MS Society establishes a Wellness Research Working Group and research priorities. Mult Scler. 2017; https://doi.org/10.1177/1352458516687404. This paper reports on the development of a wellness research agenda by the MS Wellness Research Working Group
- 12.Multiple Sclerosis Society of Canada. MS Wellness Survey; 2015 [cited 2017 Oct 5]. Available from: https://mssociety.ca/ms-wellness-survey
- 13.Haselkorn JK, Hughes C, Rae-Grant A, Henson LJ, Bever CT, Lo AC, et al. Summary of comprehensive systematic review: rehabilitation in multiple sclerosis: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Neurology. 2015;85:1896–903.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.•• Briken S, Gold SM, Patra S, Vettorazzi E, Harbs D, Tallner A, et al. Effects of exercise on fitness and cognition in progressive MS: a randomized, controlled pilot trial. Mult Scler. 2014;20:382–90. This RCT reported that 8–10 weeks of aerobic exercise training improves aerobic fitness, walking endurance, symptoms of fatigue and depression, and some cognitive outcomes in patients with progressive MS.CrossRefPubMedGoogle Scholar
- 16.• Skjerbæk AG, Næsby M, Lützen K, Møller AB, Jensen E, Lamers I, et al. Endurance training is feasible in severely disabled patients with progressive multiple sclerosis. Mult Scler. 2014;20:627–30. This RCT reports that vigorous intensity aerobic exercise is safe in persons with progressive MS with severe mobility impairment, and may improve aerobic fitness.CrossRefPubMedGoogle Scholar
- 25.•• Bogosian A, Chadwick P, Windgassen S, Norton S, McCrone P, Mosweu I, et al. Distress improves after mindfulness training for progressive MS: a pilot randomised trial. Mult Scler J. 2015;21:1184–94. This Class I RCT demonstrated significant improvements in distress, depression, anxiety, pain, and quality of life following a mindfulness-based intervention in patients with progressive MS.CrossRefGoogle Scholar
- 29.• Mauriz E, Laliena A, Vallejo D, Tuñón MJ, Rodríguez-López JM, Rodríguez-Pérez R, et al. Effects of a low-fat diet with antioxidant supplementation on biochemical markers of multiple sclerosis long-term care residents. Nutr Hosp. 2013;28:2229–35. This paper reported anti-inflammatory benefits of caloric restriction, dietary modification, and supplementation in patients with progressive MS.PubMedGoogle Scholar
- 32.Bisht B, Darling WG, Shivapour ET, Lutgendor SK, Snetselaar LG, Chenard CA, et al. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2015;5:19–35.Google Scholar
- 33.Bisht B, Darling WG, White EC, White KA, Shivapour ET, Zimmerman MB, et al. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis. 2017;7:79–93.Google Scholar
- 35.Bouchard C, Blair SN, Haskell W. Physical activity and health. 2nd ed. Champaign: Human Kinetics; 2012.Google Scholar
- 37.Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon KA, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800–28.CrossRefPubMedGoogle Scholar
- 44.Heine M, van de Port I, Rietberg MB, van Wegen, EEH, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 2015;(9):CD009956.Google Scholar
- 47.• Latimer-Cheung AE, Martin Ginis KA, Hicks AL, Motl RW, Pilutti LA, Duggan M, et al. Development of evidence-informed physical activity guidelines for adults with multiple sclerosis. Arch Phys Med Rehabil. 2013;94:1829–36. This paper reports on the development of evidence-based physical activity guidelines for adults with MS.CrossRefPubMedGoogle Scholar
- 60.Carletto S, Borghi M, Francone D, Scavelli F, Bertino G, Cavallo M, et al. The efficacy of a mindfulness based intervention for depressive symptoms in patients with multiple sclerosis and their caregivers: study protocol for a randomized controlled clinical trial. BMC Neurol. 2016;16:7.CrossRefPubMedPubMedCentralGoogle Scholar
- 61.Kabat-Zinn J. Wherever you go, there you are: mindfulness meditation in everyday life. New York: Hyperion; 1994.Google Scholar
- 63.Simpson R, Byrne S, Wood K, Mair FS, Mercer SW. Optimising mindfulness-based stress reduction for people with multiple sclerosis. Chronic Illn. 2017; https://doi.org/10.1177/1742395317715504.
- 76.• Bagur MJ, Murcia MA, Jiménez-Monreal AM, Tur JA, Bibiloni MM, Alonso GL, et al. Influence of diet in multiple sclerosis: a systematic review. Adv Nutr. 2017;8:463–72. This systematic review provides an updated summary of cross-sectional and intervention-based research related to diet and nutrition in patients with MS.CrossRefPubMedGoogle Scholar
- 84.Esposito S, Bonavita S, Sparaco M, Gallo A, Tedeschi G. The role of diet in multiple sclerosis: a review. Nutr Neurosci. 2017:1–14.Google Scholar
- 85.Wingo BC, Young H-J, Motl RW. Body composition differences between adults with multiple sclerosis and BMI-matched controls without MS. Disabil Health J. 2017; https://doi.org/10.1016/j.dhjo.2017.10.003.