The word wellness can encompass many aspects of health, including both physical and mental well-being. While decades ago “wellness” may not have been considered attainable for individuals with a chronic illness, today we can define wellness as living your best life. This of course may take different forms for each individual, and include factors ranging from exercise to employment, insurance to accessibility, and much more. Where once the concept of wellness may have been considered among researchers and clinicians as a form of alternative therapy, today wellness is on the forefront of MS research and concepts of care.
In 2014 the National Multiple Sclerosis Society convened a group of individuals with MS, healthcare professionals, researchers and Society staff to review the then-current knowledge in the areas of diet, exercise and emotional wellness; identify gaps in knowledge in these areas; and suggest educational resources and support programs in these areas to better meet the needs and interests of people living with MS. At that time, the three priority areas were defined as diet, exercise, and emotional wellness.
Last fall the NMSS convened a second Wellness Research Work Group, made up of experts in their respective fields, and in February 2017 the group published an article on gaps and priorities in MS wellness research. The Group’s primary goals are stated as seeking, “scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (in other words, wellness) in people with MS as well as managing the disease and its consequences.”
Outside of disease management through medication and other clinical tools, the group focused, as before, on diet, exercise, and emotional wellness. They published a report in the MS Journal (online, January 12, 2017) revisiting these priority areas in wellness research in MS. Some of the findings include questions they encourage current and future researchers to answer.
Exercise in MS
Rob Motl, PhD, is a professor at the University of Alabama at Birmingham School of Health Professions who serves on the Work Group. Motl’s expertise is in exercise clinical trials for individuals with MS. He hopes the work this group is doing will result in high-quality clinical trials relating to wellness in treating people with MS, he says.
“We probably know the most about exercise and its benefits, and the least about diet and emotional wellness,” Motl says. “We need to improve the rigor of our clinical trials in these areas.”
Studies have established that exercise can help prevent cognitive decline and improve mood, and the extent of the benefits is still being examined. The Work Group suggests researchers focus on answering the following questions for exercise and MS:
What are the optimal ways to promote exercise and physical activity?
What safety issues are involved?
What are the best approaches to exercise and physical activity for people with MS, including those with more advanced disease?
What are the best methods for translating findings from exercise and physical activity research to the daily life of people with MS?
How can we increase participation in physical activity among people with MS?
And ultimately, to what extent does exercise and physical activity affect emotional health, physical health, quality of life, and the course of MS?
Motl’s research has helped confirm that individuals living with MS should do aerobic exercise and resistance training twice a week for 30 minutes each. Identifying similar prescriptions for diet and emotional well-being are the next frontiers in wellness with MS, Motl says. In addition to enhancing clinical trials in this area, Motl says training and mentoring future scientists and clinicians to focus on wellness is important.
“Guidelines are one thing, but how to implement them is the next step,” he says. “We need to develop strategies, tools, and resources to do so, and the NMSS will focus on these next.”
Another area of importance is providing increased options for “self-regulation,” Motl says. “People with MS are looking for ways to live a better life and be empowered. This research effort shows that we are listening to them, and to the scientific community, and now we need to prioritize these research efforts. We want to create programs that can turn around and benefit the patients.”