Multiple Sclerosis and Wellness 1 Multiple Sclerosis and

Multiple Sclerosis and Wellness 1

Multiple Sclerosis and Wellness Why Wellness, Why Now? • Wellness is a high priority for people living with multiple sclerosis (MS). • What can I do today to feel my best? • Will lifestyle interventions impact the course of the disease (when combined with conventional approaches)? • Top three wellness priorities identified in inquiries to MS Society call center: – Diet – Exercise – Emotional Well-being 2

What is Wellness? Wellness is a lifelong journey through which people develop an awareness of, and make positive choices about, their behaviors, lifestyle and activities that enable them to lead their best lives. Wellness is: – personal – multidimensional 3

What is Wellness? , continued • Each person has individual wellness priorities in one or more areas. • • • Diet and Exercise (Physical Well-being) Emotional Well-being Work and Home Spirituality Relationships (Social Well-being) Cognitive Health • Lifestyle and wellness approaches are meant to complement conventional medicine (e. g. DMTs, symptomatic therapies, rehabilitation). 4

What factors contribute to wellness? • • • Diet Activity level Stress level Sleep Social relationships Management of co-existing (co-morbid) medical conditions, e. g. hypertension, obesity, chronic lung problems, depression, anxiety • Healthy lifestyle choices, e. g. not smoking, minimizing drug or alcohol intake 5

What do we know about co-morbidities in MS? • Co-morbidities can: – delay diagnosis and treatment – reduce quality of life – hasten disease progression – contribute to shortened life span 6

How can lifestyle and wellness interventions impact co-morbidities and MS symptoms? • Diet may reduce the risk of obesity, cardio-vascular disease and diabetes • Exercise may reduce the risk of hypertension, obesity, and osteoporosis; improve strength, flexibility, mood and cognition; and reduce discomfort and stiffness • Stress management and mindfulness may reduce depression and anxiety • Smoking elimination reduces risk of lung disease and cancers and may impact risk and prognosis in MS • Attention to sleep disorders may improve emotional wellbeing, reduce fatigue 7

How can you optimize your overall health? • Have a primary care provider • Attend to general health needs • Stop smoking • Maintain a healthy weight • Reduce or eliminate the intake of alcohol or recreational drugs • Manage your stress • Attend to your emotional well-being 8

MS Wellness - Diet Key Diet Recommendations • • • Limit sugar and processed foods Increase fruits and vegetables Choose healthy fats Choose lean sources of protein Consume adequate fiber and fluids “Eat food, not too much, mostly plants” (In Defense of Food: An Eater’s Manifesto Michael Pollan) 9

MS Wellness-- Exercise • Many people with MS are sedentary, due to mobility limitations, fatigue and/or depression. • Exercise improves overall health and function as well as reducing co-morbidities. • Research in MS has demonstrated that exercise may improve aerobic capacity, muscle strength, mobility, quality of life, fatigue, cognitive impairment, bladder and bowel dysfunction, and depression. 10

MS Wellness – Additional diet considerations • Follow a balanced diet • Maintain healthy weight • Reduce obesity • Reduce dietary salt • Have your doctor monitor vitamin D levels • Use caution with use of all dietary supplements including vitamins, herbs and probiotics 11

MS Wellness – “MS Diets” • • • Paleolithic (Paleo/Wahls Diet) Mediterranean Mc. Dougall Gluten Free Swank DASH (Dietary Approaches to Stop Hypertension) When considering a particular diet, discuss the potential nutritional deficiencies, research evidence, and practicality with your healthcare provider 12

Barriers to regular exercise • • • Fatigue Weakness Incoordination Impaired balance Finding an accessible venue Public pools that are too warm… BUT • With modifications, almost all people with MS can benefit from exercise. • Many daily activities involve healthy physical activity. • Almost everyone can find some type of physical activity to enjoy. (yoga, swimming, bowling, gardening, and more) 13

Canadian MS Society Exercise Guidelines To achieve important fitness benefits, adults aged 18 -64 years with multiple sclerosis who have mild to moderate disability need at least: • 30 minutes of moderate intensity aerobic activity, 2 times per week, AND • Strength training exercises for major muscle groups, 2 times per week. Meeting these guidelines may also reduce fatigue, improve mobility and enhance elements of health-related quality of life. 14

Exercise vs Rehabilitation Distinguish regular exercise from rehabilitation: • Rehabilitation is prescribed for people with MS to: • preserve and enhance function and mobility affected by worsening MS • promote recovery from relapses • Exercise, as a lifestyle pursuit, involves engaging in regular physical activity to promote overall health and reduce MS symptoms and co-morbidities. 15

MS Wellness—Emotional Well-being In the face of a chronic, often progressive illness like MS, people may tend to focus primarily on their physical health and may neglect their emotional health, which is an essential component of overall well-being. 16

MS Wellness— What factors impact emotional well-being? • Disease factors – – Cognitive impairment Depression Impaired mobility, incontinence, other symptoms Advanced/progressing disease • History of mental illness • Social Isolation/Limited support system • Lack of access to knowledgeable mental health providers • Personal perspectives on illness 17

MS Wellness--Depression • One of the most common symptoms of MS • Also prevalent among carepartners • Depression risk is higher in people with poor diets, low level of exercise, obesity, social isolation, and smokers • Depression is treatable – medication, talk therapy, exercise (? ) • Untreated depression can be life-threatening 18

MS Emotional Wellness – Self-Management • Exercise • Mindfulness and meditation – may reduce mild to moderate depressive symptoms, anxiety and stress. • St. John’s wort – may be effective for treating mild to moderate depression. – St. John’s wort interacts with many prescription medications so discuss benefits and risks, with your clinician before starting. • Adaptive coping strategies – can enhance adaptation can be learned. • Stress management strategies • Peer support and social connectedness 19

MS Wellness – Additional dimensions • Relationships and Social Well-being – Importance of healthy relationships and social engagement-linked to positive health outcomes • Spirituality – Finding a sense of peace and harmony that enables one to cope and adapt; Finding meaning and purpose, particularly in the face of one’s personal challenges • Work and Home – Participating in meaningful activities and experiencing satisfaction in ones roles at work, at home, in the community • Cognitive Health and Intellectual Well-being – Engaging in mentally stimulating and challenging activities that lead to personal satisfaction, enhanced creativity and new learning 20

Developing new healthy habits • Choose personal goals that are “SMART”: – – – Specific Measureable Achievable Results-oriented Time-based • You can make habit change more achievable by: – – Identifying potential barriers and problem-solve solutions Aiming for tiny, do-able changes and celebrate success Tracking your progress Going public! Declare your intentions and recruit friends and family to support you 21

Other wellness topics of interest to the MS community • Cannabis • Complementary Therapies – Acupuncture – Homeopathy – Supplements Be an educated consumer. Have a discussion with your healthcare provider about complementary and alternative interventions and treatments. 22

MS Wellness Resources • Living Well with MS web pages: multiple resources, articles, video http: //www. nationalmssociety. org/Living-Well-With. MS • Wellness Discussion Guide for People with MS and their Healthcare Providers – Online version—has live links to references – Print version– contains references (URLs) – Feedback survey link http: //www. nationalmssociety. org/National. MSSociety/media/MSNational Files/Brochure-Wellness-Discussion-Guide-for-ppl-w. MS-and. HCPs. pdf 23

MS Wellness Resources, continued Everyday Matters – Positive Psychology – Applies the principles of positive psychology – Multiple formats: One day program, six week program, and two-part self help group meeting formats – Based on Happiness Advantage by Shawn Achor http: //www. nationalmssociety. org/Resources-Support/Library. Education-Programs/Everyday-Matters 24

MS Wellness Resources, continued • National MS Society/Can Do MS Wellness Webinar Series http: //www. nationalmssociety. org/Resources-Support/Library. Education-Programs/Telelearning-Program • Optimal Health with Multiple Sclerosis: A Guide to Integrating Lifestyle, Alternative and Conventional Medicine (Allen Bowling, MD, Ph. D) Demos Health 2014 25

MS Wellness Resources, continued • Connect with Others – Social networking for people with MS and their carepartners – National MS Society MSconnection. org • Connect with Information and Support – National MS Society Information and Resource Center – 1 -800 -FIGHT-MS 26

MS Wellness Resources • National MS Society MS Navigator – MS Navigators help people affected by MS access support, deal with crisis, connect with others, access resources to maintain independence, and more. – Phone 1 -800 -344 -4867 – Email Contact. Us. NMSS@nmss. org – Website www. National. MSSociety. org 27

Multiple Sclerosis and Wellness Questions? 28