Effects of a Remote Multimodal Intervention Involving Diet, Walking Program, and Breathing Exercise on Quality of Life Among Newly Diagnosed People with Multiple Sclerosis: A Quasi-Experimental Non-Inferiority Pilot Study

Abstract

Background Interventions involving diet, physical activity, and breathing exercises are shown to be beneficial in managing both fatigue and quality of life (QoL) related to MS; however, the impact of such interventions among people newly diagnosed with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) who decline disease-modifying therapies (DMTs) is unknown. Methods A 12-month prospective quasi-experimental non-inferiority trial recruited people newly diagnosed with CIS or RRMS who voluntarily declined DMTs (health behavior group; HB, n = 29) or followed standard of care (SOC, n = 15). Participants in the HB group were remotely coached on the study diet, moderate-intensity walking, and breathing exercises. All participants completed questionnaires validated to assess MS symptoms, including perceived mental and physical QoL (MSQOL54); fatigue (Fatigue Severity Scale, FSS; and Modified Fatigue Impact Scale, MFIS); mood (Hospital Anxiety and Depression Scale, HADS); and cognitive function (Perceived Deficits Questionnaire, PDQ). Results During the 12 months, the HB group experienced improvement in scores for mental QoL (MSQOL54 – Mental, 0.24, 95% CI 0.01, 0.47; p = 0.04), fatigue (Total MFIS, −7.26, 95% CI −13.3,-1.18; p = 0.02), and perceived cognitive function (Total PDQ, PDQ–Attention, PDQ–Promemory, and PDQ–Planning, p ≤ 0.03 for all). A between-group difference was observed only for PDQ–Planning (p = 0.048). Non-inferiority analysis revealed that the 12-month changes in means for the HB group were not worse than those for the SOC group with respect to fatigue (FSS, p = 0.02), mood (HDS–Anxiety, p = 0.02; HADS–Depression, p < 0.0001), physical QoL (MSQOL54 – Physical, p = 0.02), or cognitive dysfunction (Total PDQ, p = 0.01). Conclusion The multimodal lifestyle intervention for individuals newly diagnosed with CIS or RRMS, who voluntarily decline DMTs, did not yield patient-reported outcomes worse than those observed in the SOC group regarding perceived mental quality of life, mood, fatigue, and cognitive function. Trial Registration clinicaltrials.gov identifier: NCT04009005.