Lifestyle and complementary therapies in multiple sclerosis guidelines: Systematic review

Abstract

Management of multiple sclerosis (MS) may comprise clinical interventions and self‐management strategies, including complementary therapies and modifiable lifestyle factors such as exercise and smoking cessation. Lifestyle modifications and complementary therapies with proven safety and efficacy are essential as part of best‐practice MS management, especially when faced with limited access to healthcare services. However, it is unclear to what extent MS clinical practice guidelines and consensus statements address these strategies. A systematic review was conducted, wherein MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, guideline databases and developer sites were searched for guidelines and consensus statements that addressed lifestyle modifications and complementary therapies of interest. Two researchers independently screened articles, extracted data and assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation version II. Thirty‐one guidelines and consensus statements were included. Quality was high for ‘clarity of presentation’ (77%) and ‘scope and purpose’ (73%), moderate for ‘stakeholder development’ (56%), ‘rigour of development’ (48%) and ‘editorial independence’ (47%), and low for ‘applicability’ (29%). Two guidelines, related to physical activity and exercise, mindfulness, smoking cessation, and vitamin D and polyunsaturated fatty acid supplementation, scored high in all domains. These guidelines were two of only four guidelines intended for use by people with MS. High‐quality guidelines and consensus statements to guide lifestyle modifications and complementary therapies in MS management are limited. Our findings indicate the need for more guidelines intended for use by people with MS, and a further focus on implementation resources.

Can walking lower blood pressure in adults? - A Cochrane Review summary with commentary

“…Likewise, moderate-to-vigorous–intensity aerobic exercise may increase functioning and minimize secondary complications and cardiometabolic disorders in persons with spinal cord injury 11,12 . For persons with multiple sclerosis, regular physical activity may improve flexibility, decrease symptoms, and minimize risk of depression 13,14 …”

“…11,12 For persons with multiple sclerosis, regular physical activity may improve flexibility, decrease symptoms, and minimize risk of depression. 13,14 In general, people with or without disabilities can achieve significant fitness and health benefits from activity levels well below the 150 mins/wk recommended by the World Health Organization. 15,16 However, when developing and implementing guidelines for disability-specific physical activity, the needs, values, and preferences of the single individual must be considered.…”

Targeting gut microbiota: new therapeutic opportunities in multiple sclerosis

“…In the current therapeutic guidelines for MS, a trend for personalized and complex treatment strategies is highlighted, with disease-modifying therapies (DMT) complemented with modification of lifestyle. 16 , 17 In view of that, the gut microbiota profile could be considered as a signature of individual immune or metabolic properties, and thus a promising marker for choice of DMT or supportive therapeutic interventions.…”

Sección IV: Tratamiento sintomático en esclerosis múltiple<br>Capítulo 3<br>Alteraciones psicológicas y cognitivas

“…Por este motivo, se pueden presentar preocupaciones, desesperanza y miedo, 2 así como la presencia de cuadros clínicos de depresión, ansiedad y estrés. 3,4 Derivado de lo anterior, las intervenciones terapéuticas que han reportado efectividad en personas con esclerosis múltiple son el acompañamiento en psicoterapia cognitivo-conductual, principalmente en síntomas de ansiedad y estrés. 5,6 Además, se recomiendan terapias de relajación como relajación muscular progresiva, mindfulness, yoga y biofeedback que reducen la respuesta del sistema nervioso autónomo.…”

“…5,6 Además, se recomiendan terapias de relajación como relajación muscular progresiva, mindfulness, yoga y biofeedback que reducen la respuesta del sistema nervioso autónomo. [4][5][6][7][8][9] En los últimos años se ha trabajado con terapia asistida con animales en personas con esclerosis múltiple, los beneficios se han encontrado principalmente en la equinoterapia, que reporta una considera erróneamente concomitante el puntaje de EDSS con el desempeño cognitivo, lo que genera la necesidad de contar con una evaluación cognitiva adecuada. 16 Dentro de los instrumentos de screening que se pueden emplear para determinar la presencia de deterioro cognitivo se encuentra el Mini-Mental State Examination (MMSE), Evaluación Cognitiva de Montreal (MoCA) y Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS).…”