“I have been banging ‘the holistic management of MS – brain health‘ drum for sometime now, hoping that the community will take the message seriously. If you repeat things enough people may start to say, yes I think this Giovannoni character is making a serious point. This is why the paper below is so important; it shows that MSers who exercise more and have higher self-rated health had lower levels of functional limitations 11 years later, i.e. less disability. Is this chicken or egg? Did the exercise result in better outcomes or did those MSers who were doing well simply able to exercise more? Is this observation an association or is it causal? For this we need to do randomised trials or look to animal models and other data to make the case that exercise is actually good for you. It is clear that exercise is more than just a manifestation of being physically able; exercise has biological effects that change the way the brain functions. Therefore I am going to stick my head out and state that exercise should be classified as a disease-modifying treatment for MS and that everyone with MS should be enrolled in an exercise programme of some description. It doesn’t matter how disabled you are there is always a form of exercise that you will be able to perform. If you don’t have MS and are reading this post you should also be doing regular exercise. The data linking regular exercise to a reduced risk of developing dementia, or age-related cognitive impairment, is overwhelming. The problem we face is that as our society gets more sedentary how do we get people to do more exercise? This is a big public health challenge. Any ideas? May be we need to formalise our Barts-MS Brain Health Challenge into something more concrete? A MS clinical nurse specialist from Australia contacted me about setting up a platform so that Australian MS Healthcare professionals and MSers can compete against UK MS HCPs & MSers. I think this is great idea, but have no idea how to do it and how we would judge the outcome. I would also expect the Aussies to whip the Brits they seem to be much more competitive by nature. This may have something to do with the ‘Empire always fights back’ and wins. However, going on the last haul of medals in the summer Olympics I may be incorrect. Mouse Doctor tells me even his beloved county of Yorkshire won more medals than Australia; ‘the times they are a-changin‘.
“Carpe Diem, seize the day, today will be yesterday tomorrow! You have don’t have time to waste, remember ‘time is brain’.”
OBJECTIVE: The purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS.
METHODS: Participants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year.
RESULTS: After adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11.
CONCLUSION: Findings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.