Healthy lifestyle behaviors are associated with better health outcomes in people with multiple sclerosis (pwMS). The study aimed to determine whether prospective associations between specific lifestyle factors and clinical outcomes over 2.5 years differ according to time since MS diagnosis. Understanding potential variation by disease duration could help inform optimal timing for lifestyle modification.
This analysis used data from the HOLISM study and included 1,401 pwMS who completed baseline and 2.5-year follow-up surveys. Five lifestyle exposures were assessed at baseline: high-quality diet, physical activity, smoking status, vitamin D supplementation, and meditation. Primary clinical outcomes at follow-up were fatigue, depression, and disability.
The investigators applied multivariable log-binomial regression to estimate prospective associations between individual lifestyle factors and outcomes. Analyses were stratified by time since diagnosis into two groups: ≤ 5 years and > 5 years. Models evaluated both individual exposures and the cumulative effect of meeting multiple healthy lifestyle criteria (with a focus on meeting 4–5 criteria).
Physical activity demonstrated the most consistent and duration-dependent associations. Among participants diagnosed ≤ 5 years, baseline physical activity was more strongly associated with reduced risk of fatigue, depression, and disability at 2.5 years than among those with > 5 years since diagnosis. Non-smoking status was associated with lower disability risk in the ≤ 5-year group but not in the longer-duration group. By contrast, a high-quality diet was associated with lower depression and disability in participants with > 5 years since diagnosis; however, the between-group difference did not reach statistical significance as reported in the abstract.
Participants meeting 4–5 healthy lifestyle criteria at baseline had lower risk of depression at 2.5 years in both the ≤ 5-year and > 5-year groups. Meeting 4–5 criteria was also associated with lower fatigue and disability risk in the ≤ 5-year group; the association with disability showed a between-group difference, indicating a stronger association in the earlier-diagnosis subgroup.
The study found no prospective associations between baseline vitamin D supplementation or meditation practice and the measured outcomes (fatigue, depression, disability) over 2.5 years in either time-since-diagnosis stratum.
The pattern of results suggests that the potential impact of some lifestyle factors on MS clinical outcomes may vary across the disease course. Specifically, physical activity and smoking status appeared more strongly related to outcomes when engaged earlier after diagnosis (≤ 5 years), while associations for diet quality emerged more clearly in those with longer disease duration. Meeting multiple healthy lifestyle criteria was generally favorable for depression irrespective of time since diagnosis, and beneficial for other outcomes predominantly in the earlier-diagnosis group.
These findings imply that timing and duration of lifestyle engagement may influence effectiveness and that stage-specific lifestyle strategies warrant further investigation. The authors recommend additional research to confirm these observations and to explore whether interventions tailored to disease stage yield different clinical benefits.
Strengths of the reported work include a prospective design, a relatively large sample (n = 1,401) and assessment of multiple lifestyle factors simultaneously. Limitations are not detailed in the abstract; the full text would be required to review potential measurement, confounding, or attrition issues. The study received ethical approval from The University of Melbourne Human Research Ethics Committee (ID: 1545102) and obtained informed consent from participants. A conflict of interest disclosure notes that one author (GJ) is the author of books related to MS and has received royalties and prior remuneration related to Overcoming MS activities. No other conflicts are reported in the abstract.
Overall, the prospective HOLISM analysis supports the hypothesis that associations between lifestyle factors and 2.5-year clinical outcomes in MS vary by time since diagnosis and highlights the need for further stage-specific lifestyle research and potentially tailored clinical guidance.