Healthy lifestyle is associated with reduced fatigue, depression, and disability over 5 years in people with multiple...

People with multiple sclerosis (pwMS) commonly experience fatigue, depression, and mobility impairments. Lifestyle factors are associated with reduced frequency of these three outcomes. Understanding whether specific, or multiple, lifestyle factors have stronger effects may inform personalised care.

Data from 839 pwMS from the HOLISM observational study were analysed. Lifestyle factors assessed were physical activity, high-quality diet, meditation, non-smoking, and vitamin D intake (supplementation and sun exposure). Fatigue, depression, and disability were queried via validated tools. Linear regression and mixed effects models were used to assess cross-sectional and prospective associations respectively, between individual and total number of lifestyle factors, and outcomes.

Cross-sectionally, physical activity and high-quality diet were inversely associated with all outcomes; and non-smoking and vitamin D were associated with lower depression. Prospectively, associations between physical activity and outcomes were retained at 2.5- and 5-year follow-ups, and high-quality diet and non-smoking were associated with reduced disability and depression, respectively, at 5-years. Cross-sectionally, ≥3 healthy lifestyle factors was associated with reduced outcomes, with cumulative effects observed. Prospectively, ≥3 factors was associated with better outcomes at 2.5-year, and 4-5 factors associated with sustained benefits at 5-years.

Physical activity, diet, and non-smoking are independently associated with better clinical outcomes. Healthy lifestyle factors appear to have cumulative benefits. Intervention studies are required to add weight to these findings.