A lifestyle programme in multiple sclerosis gave modest, mostly short-term gains

Design

Uncontrolled longitudinal cohort of a 3-month digital lifestyle programme with 21-month maintenance

Population

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

Primary outcome

MS Impact Scale-29 (MSIS-29) over 24 months

Effect

Month 24 within-group change: physical -0.8 (95% CI -1.7 to 0.3), psychological -3.4 (95% CI -4.6 to -2.3)

The LIMS study followed 659 people with multiple sclerosis (mean age 46, 84% women) through a three-month digital lifestyle programme covering a Mediterranean-style diet, physical activity, sleep and stress, then a 21-month maintenance phase. There was no control group. The primary outcome was the MS Impact Scale-29.

During the programme, the physical and psychological MSIS-29 scores fell by about 0.8 and 1.1 points a month. The improvement then levelled off. Within-group changes at 24 months were -0.8 (95% CI -1.7 to 0.3) for physical and -3.4 (-4.6 to -2.3) for psychological scores, relative to baseline. Only 4% to 7% of participants exceeded the smallest detectable change. Diet adherence and body mass index improved most and partly persisted, while physical activity did not change.

Without a control group, natural fluctuation and the expectations of a motivated, self-selected group cannot be separated from the programme's effect. It is reasonable as a complement to disease-modifying treatment, not as a replacement.

• MSIS-29 scores improved during the 3-month programme, then plateaued over 21 months of maintenance.
• Only 4% to 7% of participants had a change larger than the smallest detectable change.
• Diet adherence and body mass index improved most; physical activity did not change.
• There was no control group, so changes cannot be attributed to the programme.
• Lifestyle advice is a reasonable addition but not a substitute for disease-modifying therapy.

Why it matters

Patients ask about diet and lifestyle, and this gives a realistic picture of what a structured programme did and did not achieve.

Don't overread it

This was an uncontrolled, self-selected cohort and the benefit was small and attenuated after the programme.

The statistics, in plain English

A change in a score can be statistically significant without being large enough for a person to notice. The smallest detectable change is the threshold above which a change is more than measurement noise, and only a small minority of participants crossed it.

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