OVERVIEW
Since there is no known cure for MS, treatments are reduced to the management of symptoms with a combination of neurological rehabilitation, and disease modifying drugs (DMD), (See 'treatment for MS').
Despite the benefits of Disease Modifying therapy, It is widely accepted that these pharmaceutical interventions have the potential to incur side effects, that can exacerbate symptoms such as chronic fatigue, muscle weakness and insomnia. Negative side effects such as these impact mobility and reduce the quality of day to life. Further, they have been shown to intensify psychological conditions in MS patients, such as anxiety and depression (NHS England, 2023).
Therefore, much of the research directed at mitigating the debilitating effects of MS, advocates the need for a more holistic approach to treatment. Health promoting practices and behaviors among MS patients can complement medication, and help to manage difficult symptoms.
For instance, presentation of the disease can vary between patients and on an individual basis. The intensity of symptoms can vary from day to day, or even by the hour. Holistic treatments can offer a more individualistic approach, and design care plans to target key behaviours that act as determinants for health promoting activities (Yildrim, H, et al, 2020).
HOW DOES THIS WORK IN PRACTICE?
The good news is that research has adopted theories that combine cognitive interventions to address behaviours that may reduce a person's opportunity to maintain a healthy lifestyle (Fifolt, M. et al, 2020).
SOCIAL COGNITIVE THEORY
Social Cognitive Theory (SCT), was developed from Alfred Bandura’s Social Learning theory, where observation, modelling and imitation were key factors in behaviour reinforcement (Yildrim, H. et al, 2020). The premise of SCT is that the environment, the individual and their behaviour will determine health promoting practices (Fifolt, M. et al 2020). For example, self efficacy, personal goals, motivation and self reflection are some of the primary determinants that influence health behaviour.
LOCUS OF CONTROL
Locus of control (LOC) is a theory that was proposed by Julian Rotter in 1954 and describes the way an individual perceives their level of control over events in their lives. Generally people fall into two groups: those who believe their fate is controlled by what they do, and others who believe they have little or no control over external factors (Bijoux, L.J, 2022).
This is where individual life history is important, as people develop their perception of themselves due to positive or negative experiences. A person who regularly manages to meet their needs and personal goals will reinforce for themselves that they are capable of dealing with any situations that arise and have a high internal LOC. For others, who experience hardship or repeated setbacks they will form the belief that they cannot handle their own life circumstances.
RESEARCH
A recent cross sectional study of MS patients revealed that self perception is a key element of coping with the disease. Patients with a higher internal locus of control are more inclined towards positive health practices, such as exercising and eating healthily. Overall, this promotes better long term outcomes. However, some people may find comfort in believing that their fate is down to a higher power, or God. For example, the assumption that any causality about the events in their lives is due to factors outside of their control, they may not internalise stress or negative thoughts. This could positively impact their behaviour and quality of life.
Whilst there may not be a right way for patients to approach MS , individuals will adopt their own psychological coping skills. These social learning theories have been utilised by healthcare practitioners to facilitate patients in adopting new behaviours, and assess the need for individual treatment plans. They can positively influence the patient's aspirations for a better quality of life, by setting new goals, and reinforcing activities with verbal assessment and appraisal (Warutkar, V. et al.2022).
BENEFITS OF EXERCISE
There is growing evidence that physical activity has numerous benefits for MS patients, and can provide relief from ongoing symptoms and improve quality of life. For example, a systematic review of 4362 MS patients across 54 studies in the UK, looked at the effects of exercise on mobility problems (Latimer-Cheung, A.E, et al, 2013). Results showed that moderate exercise just twice per week increased muscle strength, and improved overall walking ability in patients with mild to moderate disability (Latimer, A.E, et al, 2013).
More recent research from a study conducted in Switzerland, can also attest to the similar findings. This study also demonstrated how regular exercise over a 12 week period was able to boost mood, and improve cognitive performance of MS patients suffering with poor sleep, and depression (Bahmani, D.S, et al, 2019).
So far there is a great deal of evidence that even moderate physical activity can overall mental functioning on a day to day basis. This is found to be true of all people, healthy or otherwise. However, if you are suffering with a chronic disease, exercise can become an invaluable tool for coping (Stephanou, M. 2022). Many patients report that walking impairment contributes to issues with attending social functions, and employment opportunities (Vijayasingham, L. 2020).
This can be a prerequisite for becoming isolated and lonely, increasing feelings of anxiety and depression (Kasikci, E. 2020). Further, patients feel reliant upon caregiving family members, who themselves report struggling emotionally to adapt to the lifestyle changes inflicted upon them (Maguire, R. 2020). This may increase feelings of guilt and shame and exacerbate any existing tendency towards negative thought patterns. Therefore, evidence for how muscle conditioning can contribute to the improvement of mobility issues, indicates a multitude of benefits for the mental well-being of both patients and their carers (Brian, et al, 2015).
EXERCISE & MS
Suffering from a chronic illness such as MS, may render patients inactive, making physical activity more challenging. Despite the evidence for how exercise can produce some meaningful benefits to people with MS, a recent meta-analysis indicated that physical activity among this group is significantly less than in the general population (Kinnet-Hopkins, D. 2017). This is entirely understandable given the daily challenges patients are confronted with, such as fatigue, mobility problems and mental impairment.
Many patients who suffer with MS report that a lack of control over their disease is a central contributing factor towards psychological health (Mikula, P. et al 2021). SCT has been shown to encourage a sense of control over accomplishments, and increase motivation for exercise. Further, by overcoming perceived obstacles it is possible to change patterns involving low self esteem, negative self belief, and the clear associations with mental illness.
However, it is important to consider how that each persons obstacles towards achieving a healthy lifestyle may be different. For example, if a persons life history has been emotionally challenging and complex, then it may naturally become more difficult to prioritise diet and exercise and other forms of self care. Studies show that patients with a history of trauma and abuse experience chronic stress disorders and subsequently engage less easily with self care (Pompili, et al, 2012). Support networks may also affected by parental neglect or familial contention, so that childcare, or employment commitments become more difficult to manage up against the challenges of living with MS.
If social cognitive approaches to exercise are utilised to their full potential, then patients may be able to work with their therapists to address barriers that prevent them from achieving self care behaviours, and empower them with the tools to accomplish self directed exercise in their own homes (Hecker, M. et al. 2021).
There are many ways to adopt an exercise routine that fits beside all situations and capabilities. For example, your GP can organise physiotherapy sessions where a fitness instructor can address issues with mobility or balance. They can give you suitable exercises in a seated position, and monitor your level of exertion (Latimer-Cheung, A.E, et al, 2013). The frequency and intensity of exercise will be tailored to your personal needs. Further, if you are suffering with your ability to remember information, or other cognitive deficits, they can offer written instructions, diagrams or frequent verbal cues. Daily adjustments in line with the variance of symptoms becomes reachable, and can make a huge difference to your well-being.
DIET
There is no specific dietary advice for people with MS. Although MS specialists suggest foods that are high in fibre, and low in saturated fat. This is the same recommendation for all adults, however, symptoms of MS can be increased in patients with other medical conditions, such as high blood pressure or heart problems (NHS England, 2023). A healthy diet is important for many reasons, but researchers have found compelling evidence to suggest that our gut microbiome is linked to increased inflammation and autoimmune responses (Corereale, J. et al, 2022).
Among the studies linking diet and MS exacerbations, is 'The Australian Multi Centre Study of Environment and Immune Function' conducted between 2004-2006. Patient questionnaires detailed how the quality of foods have implications for the severity of symptoms, reinforcing the need to consider our environment as a significant factor in the onset and worsening of MS (Waubant. E. et al, 2021). Currently, the majority of studies accumulating knowledge in this area focus on non-human research, indicating the need for further investigations (Correale, J, et al. 2022). However, this type of research may help you to facilitate health promoting activities, such as keeping a food diary, to measure how symptoms behave in response to changes in your diet.
ACUPUNCTURE
This form of treatment may be considered alternative if not accompanied by conventional medicine. Many patients incorporate acupuncture as a method of managing pain alongside their prescribed treatments. Studies conducted over many decades indicate that complementary approaches to treatment are not a new phenomenon. However, due to a shortage of clinical trials supporting complementary alternative medicines (CAM), it may be important for you to inform health care practitioners of any additional treatments including vitamins or herbs, so that they can define a comprehensive symptom management plan, and reduce the chance of drug interactions (Esmonde. L, 2008).
PATIENT FEEDBACK
The importance of an integrated holistic approach to MS treatment, can be supported by patient feedback. Many describe how feeling in control of their drug side effects, and observing outcomes of their behaviour were able to make them feel empowered to manage relapses. By identifying patterns alongside their GP etc they could make small changes that made a big difference. The benefits of a holistic approach on life show improvements on a physical and emotional level with a reduction in the negative impact associated with the effects of social stigma (Hecker, M. et al. 2021).