MS Research Australia recently held a workshop on modifiable lifestyle factors in MS, with delegates attending from around the world and representing a large variety of research disciplines and people with MS. The Research Priorities survey conducted in 2016 confirmed this as a theme of strong interest. It is an area that people with MS can control themselves to help manage and potentially minimise the impact of MS on their lives, providing a sense of empowerment and hope.
While much is already known about the role of lifestyle factors in the risk of developing MS, this workshop focussed on whether lifestyle factors could impact progression and disease course in MS. The workshop aimed to discuss the current evidence for the effect of modifiable lifestyle factors on MS, determine the knowledge gaps and identify priorities and opportunities for both further research to strengthen the evidence and the best way to design this type of research for the most meaningful outcomes. A key aim of the workshop was also to identify opportunities to translate and implement the current evidence to provide the most appropriate advice to the MS community.
The workshop opened with a brief overview of the current evidence on the environmental risk factors that contribute to MS onset and progression and also included a presentation from Tara King about her personal MS journey and the positive lifestyle changes that she has made. She discussed the difference it has made to her and her thoughts on what the MS community are looking for in the way of guidance and support to make positive lifestyle changes for themselves.
The first session covered the current evidence for the role of lifestyle factors such as diet and physical exercise in MS. While research in this area is difficult, studies have shown that a healthy diet and exercise is of benefit for quality of life and disease outcomes in MS. Delegates heard from Associate Professor Ingrid van der Mei, Menzies Institute of Medical Research TAS, about her research into lipids in MS and the influence that other health conditions (known as co-morbidities) can have on MS outcomes. Dr Lucinda Black, Curtin University WA, discussed the role of diet in MS and the evidence that diets with higher levels of fruit and vegetables, less fat and sugar can improve outcomes such as disability and quality of life.
The second session covered ways that evidence of lifestyle factors had been implemented into the MS community and aimed to learn from similar initiatives in other diseases and in the general population. Ms Jodi Haartsen, from Eastern Health VIC, spoke about the Brain Health Initiative which aims to improve the understanding of people with MS on how they can keep their brains as healthy as possible and request the highest possible standard of care from healthcare professionals. Professor Mark Harris, University of NSW, described the implementation of SNAP, which are guidelines for smoking, nutrition, alcohol and physical activity for use by general practitioners to help people manage general health and long term health conditions. Professor Kaarin Anstey from NeuRA, NSW, spoke about the successes and failures of implementation of lifestyle research outcomes in dementia.
The final session discussed different types of study design for lifestyle factors in MS, as this has a major impact on the quality of the conclusions that can be drawn from the research. In this session, Professor Anne-Louise Ponsonby, Murdoch Children’s Research Institute VIC, spoke about her upcoming clinical trial which will investigate if specific supplements that support mitochondria (the energy powerplants of cells) could improve fatigue and depression in MS. Professor Terry Wahls, University of Iowa, USA spoke about her clinical trial design which will compare two specific diets, the Wahls Diet and the Swank Diet, on outcomes in MS, especially fatigue. Professor George Jelinek, University of Melbourne, VIC discussed research into lifestyle interventions that combine several aspects, such as nutrition, exercise, medications and stress reduction. This type of research can be very complex as many lifestyle factors are considered at once, providing additional challenges for study design. Dr Yvonne Learmonth from Murdoch University, WA spoke about the points to consider when designing research studies into physical activity in MS.
Following each session, time was set aside for in depth discussion on the many points raised, allowing all delegates to contribute their perspectives, thoughts and expertise. Themes of the discussion included the strength of the current evidence for various modifiable lifestyle factors such as diets and exercise, as well as the best ways to improve this area of research and fill the gaps. The final discussion session aimed to draw together all the threads and themes that had been explored during the day, to arrive at some clear next steps to move the field forward.
One clear outcome was the imperative for MS professionals to develop communication materials to provide consistent guidance to people with MS based on the best-available evidence about modifiable lifestyle factors. Following the workshop, a working group will be convened to develop and produce these guidelines.
There was also much discussion of future research avenues. These included controlled clinical trials of interventions in MS that could compare people making changes to diet or exercise or both with others who did not make the changes or make smaller changes. Some of the simplest interventions would be to find ways to support people with MS to follow the current Australian Healthy Eating Guidelines and physical activity guidelines. Ultimately developing a framework for use in the MS clinic to identify what changes would be beneficial and achievable for individuals and assist them to stick with these changes in the long-term, to give them the best chance of success.
MS Research Australia considers it incredibly important to bring together the MS scientific community to discuss this important topic and believes the outcomes of the workshop will help people with MS to live as well as possible with their MS.