The case for multiple health behavior change interventions in multiple sclerosis

Background: Multiple sclerosis (MS) is a chronic, non-traumatic disease of the central nervous system (CNS). There is a growing need for alternative approaches to managing healthcare in MS. Targeting multiple, co-occurring health risk factors represents a holistic approach for managing comorbidities and many of the neuroperformance consequences of MS. Methods: Sixty-nine participants with MS completed self-report measures of smoking status, nutrition, alcohol use, physical activity levels, comorbidity and neuroperformance outcomes and sociodemographic and clinical characteristics. The data were analyzed using t-tests and chi-square analyses in SPSS Statistics 22.0. Results: Of participants with two or more risk factors, 90.3% were not meeting dietary and physical activity guidelines. Total number of comorbidities (z=2.36, p=0.02), cardiovascular disease symptoms (z=2.63, p=0.01), T25FW speed (z=2.53, p=0.01), and 6MW distance (z=2.61, p=0.01) had significant differences in the cluster of co-occurring poor nutrition and insufficient levels of physical activity. There was a significant difference between those reporting two vs. one risk factor for number of comorbidities (z=2.41, p=0.02), cardiovascular disease symptoms (z=2.40 p=0.02), T25FW speed (z=2.39, p=0.02) and 6MW distance (z=2.68, p=0.01). Conclusion: Our results suggest that a clustering of insufficient physical activity and poor nutrition was reported in 90.3% of participants with two or more risk factors. The presence of that cluster further appeared to be synergistically associated with comorbidity and neuroperformance markers. This research could inform future investigations of multiple health behavior change in persons with MS