Health outcomes and adherence to a healthy lifestyle after a multimodal intervention in people with multiple sclerosis: Three year follow-up

Abstract

BackgroundModifiable risk factors such as smoking and sedentary lifestyle adversely affect multiple sclerosis (MS) progression. Few multimodal behavioural interventions have been conducted for people with MS, and follow-up beyond 1 year is rare for lifestyle interventions. This study assessed adoption and adherence to healthy lifestyle behaviours and health outcomes 3 years after a lifestyle modification intervention, using generalized estimating equation models to account for within-participant correlation over time.Methods95 people with MS completed baseline surveys before participating in 5-day MS lifestyle risk-factor modification workshops. 76 and 78 participants completed the 1-year and 3-year follow-up surveys respectively. Mean age at 3-year follow-up was 47 years, 72% were female, most (62.8%) had MS for 5 years or less, and 73% had relapsing remitting MS (RRMS).ResultsCompared to baseline, participants reported clinically meaningful increases in physical (mean difference (MD): 8.0, 95% Confidence Interval (CI): 5.2–10.8) and mental health (MD: 9.2, CI: 5.8–12.6) quality of life (QOL) at 1-year, and physical (MD: 8.7, CI: 5.3–12.2) and mental health (MD: 8.0, CI: 4.2–11.8) QOL at 3-year follow-up. There was a small decrease in disability from baseline to 1-year follow-up (MD: 0.9, CI: 0.9,1.0) and to 3-year follow-up (MD: 1.0, CI: 0.9,1.0), which was not clinically meaningful. Of those with RRMS, compared to baseline, fewer had a relapse during the year before 1-year follow-up (OR: 0.1, CI 0.0–0.2) and 3-year follow-up (OR: 0.15, CI 0.06–0.33). Participants’ healthy diet score, the proportion meditating ≥1 hours a week, supplementing with ≥ 5000IU vitamin D daily, and supplementing with omega-3 flaxseed oil increased at 1-year follow-up and was sustained, although slightly lower at 3-year follow-up. However, there was no evidence for a change in physical activity and not enough smokers to make meaningful comparisons. Medication use increased at 1-year follow-up and at 3-year follow-up.ConclusionThe results provide evidence that lifestyle risk factor modification is feasible and sustainable over time, in a small self-selected and motivated sample of people with MS. Furthermore, participation in a lifestyle intervention is not associated with a decrease in MS medication use.

Adherence to self-administering interferon-β1a using RebiSmart® device in Mexican patients with relapsing multiple sclerosis

“…Adherence to injectable DMTs and other interventional strategies is usually considered inferior in MS patients [10][11][12][13][14][15][16]; a retrospective study of MS patients initiating therapy with 1 of 4 injectable DMTs found that after 18 months, 11.2% of patients switched their medication, and 33.9% discontinued their treatment [17]. An adherence study on ambulatory patients carried out in Spain showed that after 2 years of starting DMT, INF-β was discontinued in 9.9% of patients, after 5 years discontinuation rose to 41.2% and after 8 years discontinuation rate was 58.7% [18].…”

On the path together: Experiences of partners of people with multiple sclerosis of the impact of lifestyle modification on their relationship

“…The dataset, the Health Outcomes and Lifestyle In a Sample of people with MS (HOLISM) dataset, is an international sample of 2,466 PwMS (Hadgkiss, Jelinek, Weiland, Pereira, et al, 2013). Of these, 345 PwMS had attended a workshop in Australia, New Zealand, the United Kingdom, or Europe between 2002 and 2016 (Marck et al, 2018). Of these, 280 were partnered.…”

“…PwMS who attended an intensive residential workshop regarding evidence‐based lifestyle interventions reported improved HRQOL 5 years post‐intervention (Hadgkiss, Jelinek, Weiland, Rumbold, et al, ; Li et al, ). In a subset with more complete data, PwMS reported improved HRQOL, reduced self‐reported doctor‐diagnosed relapse rate, and stabilised disability assessed by the Multiple Sclerosis Impact Scale Physical Component (MSIS‐20), at one and 3 years post‐intervention (Marck et al, ).…”

Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

“…Lifestyle intervention trials can be difficult to design and conduct [21], but such evidence is needed to enable a shift in MS management towards a more holistic approach [22]. We have previously published results of a multimodal lifestyle intervention for people with MS, showing significant improvements of QOL at 1, 3, and 5 years compared to baseline [23][24][25]. These data showed varying degrees of adherence to the recommendations of the intervention, in particular for physical activity, which on a group level did not change at 1 and 3 years after the intervention [25].…”

“…We have previously published results of a multimodal lifestyle intervention for people with MS, showing significant improvements of QOL at 1, 3, and 5 years compared to baseline [23][24][25]. These data showed varying degrees of adherence to the recommendations of the intervention, in particular for physical activity, which on a group level did not change at 1 and 3 years after the intervention [25]. Understanding long-term adherence to health behavior interventions is instrumental when designing future primary or secondary chronic disease interventions.…”