A digital lifestyle programme in multiple sclerosis: modest gains that partly held at 24 months

Design

Single-arm, real-world cohort with 24-month follow-up of a digital lifestyle programme

Population

659 people with multiple sclerosis (mean age 46, 84% women)

Primary outcome

MS Impact Scale-29 (MSIS-29)

Effect

Physical -2.7 (95% CI -3.7 to -1.8) after programme, -0.8 (-1.7 to 0.3) at 24 months; psychological -3.7 (-4.8 to -1.6) and -3.4 (-4.6 to -2.3)

The LIMS study followed 659 people with multiple sclerosis (mean age 46, 84% women) through a three-month digital multimodal lifestyle programme covering a Mediterranean-style diet, physical activity, and sleep and stress, then a 21-month maintenance phase. The primary outcome was the MS Impact Scale-29 (MSIS-29).

During the programme, the physical and psychological MSIS-29 scores fell by about 0.8 and 1.1 points a month. Changes then attenuated. Within-group changes at the end of the programme were -2.7 (95% CI -3.7 to -1.8) and -3.7 (-4.8 to -1.6) points, and at month 24 they were -0.8 (-1.7 to 0.3) and -3.4 (-4.6 to -2.3). Only about 4% to 7% of participants exceeded the smallest detectable change. Diet adherence and body mass index showed the clearest improvements and partly lasted, while physical activity adherence did not change significantly.

There was no control group, so improvement cannot be attributed to the programme, and participants who volunteer for a lifestyle study may differ from the average patient. The authors position lifestyle work as complementary to disease-modifying therapy.

• Offer diet, activity, sleep and stress support alongside disease-modifying treatment, not instead of it.
• Set realistic expectations: benefits in this study were modest and mostly short-term.
• Plan for maintenance; gains attenuated after the structured programme ended.
• Track diet and weight, where the clearest and most lasting changes occurred.

Why it matters

It tests whether a digital lifestyle programme can deliver benefit at scale and finds modest, partly sustained effects.

Don't overread it

This was an uncontrolled, real-world study; it does not show that lifestyle change slows disability progression.

The statistics, in plain English

A within-group change compares people with their own starting point and cannot show what would have happened without the programme. The smallest detectable change is the amount that exceeds measurement noise; only 4% to 7% of people crossed it, so for most individuals the change was within what the scale cannot reliably detect.

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