Multiple Sclerosis (MS) affects over 20,000 Australians. It is a condition that affects the normal function of our central nervous system by interfering with nerve impulses between the brain and spinal cord. Different symptoms such as muscular spasms, vertigo and altered cognition affect people differently, and can change in regard to their nature as the disease progresses. Although no cure has been found for MS to date, having a well-balanced health care approach that encompasses medical, exercise and dietary interventions can help reduce the severity of MS symptoms and help promote an active life.
In brief, throughout our body, we have numerous nerves that transmit an impulse (message) from our brain and spinal cord that allow us control and perform numerous bodily functions e.g. movement. Within MS, the myelin sheath that surrounds these nerves become scarred, which causes a disruption and slowed response of the neural message that is being transmitted.
How Can Exercise Help?
Research on exercise and MS has shown positive and distinctive results. A review in 2015 outlined that MS patients who undertook an exercise program showed improvements in walking mobility, balance, cognition and fatigue, while also showing a reduction in depressive symptoms (1, 2). Combined with other benefits of exercise such as improved weight management, muscular strength and health literacy, an exercise intervention for people with MS can serve as a very important adjunct in helping people manage their symptoms.
Does it help slow the progression?
It has been suggested that exercise may have the capacity to impact on MS by slowing down the disease process itself. A literature review published in 2012(10) looked at the results of 25 studies to identify whether there was a link between physical exercise and MS disease progression. 1 study used in this review was Prakash et al (2009)(11) which evaluated the effects of cardiorespiratory fitness on brain function in MS patients via the use of MRI. They used the PVSAT (paced visual serial addition test) under MRI use to assess cognitive function, and found that MS participants who had higher fitness levels were able to perform the test quicker. The researchers concluded that this could be related to greater recruitment of the cerebral cortex, which is known to be an area of deterioration in people with MS.
Preliminary studies using rats have also shown that 1-2 days of intensive exercise (25-30 min/day) showed clinical signs of lowering the effect of the disease(12). Overall, the researchers concluded that although some evidence did suggest that exercise can slow down the progression of MS, the strength of the evidence needs to improve in order to make a definitive conclusion. Very positive so far though.
It is interesting to note that a study done in 2008(3) investigated whether worsening of MS symptoms is associated with low activity levels. Researchers found that lower levels of activity were associated with worsening symptoms, however with MS disease progression being different from person to person, the element of natural progression was hard to gauge. This however does shed some light on the benefits of exercise not only for improving patient outcomes but also the reduction of symptom severity.
Risks to training within MS
Exercise is not associated with accelerated disease progression or recurrence of relapse in people with MS. However, starting your exercise regime under the guidance of your Accredited Exercise Physiologist or Performance Coach that understand MS, your current movement capacity and your goals ensures that you begin your exercise routine with a program that is designed for you. There are certain things to consider when undertaking your exercise program to be wary of.
- Fatigue: Common amongst patients with MS, so understanding a time of day where you feel the most engaged and energised to undertake exercise is key for building consistency
- Heat: Some symptoms may be exacerbated with an increase in body heat. Exercising during the cool periods of the day (particularly during summer) and carrying a water bottle with you can aid in keeping your body temperature at a constant level
For more information, please view https://www.msaustralia.org.au/living-with-ms/expert-blog/exercise-and-ms
How Can Diet Help?
Currently there is little evidence from clinical studies that confirms certain foods or dietary patterns help reduce MS symptoms and disease progression. There are many claims made for different diets as treatments, even cures, for MS however it’s important to note that:
- They are usually based on personal accounts and not suitable for everyone with MS (e.g. often exclude key food groups and nutrients which can have a negative impact on general good health, energy levels and bowel function)
- They are most likely not subjected to rigorous, controlled scientific studies
- Most research for certain food and dietary patterns often has mixed and unclear results. Further studies are needed to evaluate the effects of these dietary components.
What do we know about diet and nutrition for MS?
In a recent study, researchers looked at the link between diet, disability and symptom severity in people with MS. The results showed that those with healthier diets had around a 20% lower chance of suffering from high disability and severe depression than those with the least healthy diets 8. It is generally recommended and advocated by MS Research Australia and MS Australia that anyone with MS establishes healthy eating basics.
More calcium and vitamin D (8-9)
Those with MS are at a higher risk to low bone mineral density and fracture, so high vitamin D levels are probably protective against these risk developments for people with MS. Calcium is a key bone forming mineral and vitamin D assist calcium absorption for optimal bone health. To add more calcium to your diet, try the following foods which contain the highest calcium content
- Seeds – poppy, sesame, chia
- Dairy – cheese, milk, yoghurt
- Oily fish – sardines, salmon
More omega 3 ‘healthy’ fats (4,5 & 7)
A 2015 study found a decreased risk of a first clinical diagnosis of CNS (central nervous system) demyelination (damage to the protective covering that surrounds nerve fibres) in those that ate a higher amount of omega-3s, particularly from fish. To add more omega 3’s to your diet, try the following foods which contain the highest omega 3 fatty acid content:
- Oily fish – Mackerel, Salmon, Herring, Sardines
- Plant foods – flaxseed, chia seeds, walnuts, soybeans
More coffee (6-7)
Although we do not understand well the possible different mechanisms for how coffee may help with MS, a 2012 and 2016 study found the higher the caffeine consumption, the slower the progression of disability in relapsing onset MS (although not in progressive onset MS).
For those severely affected by MS
Certain dietary approaches can be trialled under guidance from an Accredited Practising Dietitian for those with MS who have the following symptoms, which no doubt can lead to poor nutritional status and general health, in addition to unnecessary weight and muscle loss;
- Bladder and bowel problems
- Swallowing problems (Dysphagia)
The key is making the diet work for you! Individualised advice and support is always the best approach and can help manage the challenges anyone with MS may face.
Where is the Best Place to Start?
Having a consultation with an Accredited Exercise Physiologist and Accredited Practicing Dietitian is the first step. By doing this, both practitioners can:
- Understand your movement literacy to help make your program more specific
- Help set both dietary and exercise goals
- Help establish current exercise and dietary habits regarding areas of improvement
- Help design and implement exercise and dietary plans that help achieve these above goals
MS is a complex disorder and will affect everyone differently and their response to diet and exercise interventions will differ therefore they should obtain individualised tailored advice from a health professional.
Written by Accredited Exercise Physiologist Adam Luther and Accredited Practising Dietician Andrew Ho-Peng.
- Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8(9):487–97.
- Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta A, Mackibbon KA, et al. The 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(9):1800–28.
- Motl, R.W., Arnett, P.A., Smith, M.M., Barwick, F.H., Ahlstrom, B., and Stover, E.J. Worsening of symptoms is associated with lower physical activity levels in individuals with multiple sclerosis. Mult Scler. 2008; 14: 140–142
- Hoare S, et al, Higher intake of omega-3 polyunsaturated fatty acids is associated with a decreased risk of a first clinical diagnosis of central nervous system demyelination: Results from the Ausimmune Study, Mult Scler. 2016 Jun;22(7):884-92.
- Baker IDI, Accessed 10-11-2018 https://www.baker.edu.au/-/media/Documents/fact-sheets/Baker-Institute-factsheet-omega-3.ashx?la=en
- Hedström AK et al., High consumption of coffee is associated with decreased multiple sclerosis risk; results from two independent studies, J Neurol Neurosurg Psychiatry. 2016 May;87(5):454-60
- D’hooghe MB, et al., Alcohol, coffee, fish, smoking and disease progression in multiple sclerosis, Eur J Neurol. 2012 Apr;19(4):616-24.
- Fitzgerald KC, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis, 2018 Jan 2;90
- von Geldern G and Mowry EM, The influence of nutritional factors on the prognosis of multiple sclerosis, Nat Rev Neurol. 2012 Dec;8(12):678-89
- Dalgas, U., & Stenager, E. Exercise and disease progression in multiple sclerosis: can exercise slow down the progression of multiple sclerosis? Theraputic Advances in Neurological Disorders. (2012) 5(2): 81-95
- Prakash, R., Snook, E., Motl, R., & Kramer, A. Aerobic fitness is associated with grey matter volume and white matter integrity in multiple sclerosis. Journal of Brain Research. (2009) 41-51
- Le-Page, C., Bourdoulous, S., Beraud, E., Couraud, P., Rieu, M., & Ferry, A. Effect of physical exercise on adoptive experimental auto-immune encephalomyelitis in rats. Eur J Appl Physiol Occup Physiol (1996) 73: 130–135.