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STUDY: Review of modifiable risk factor interventions on MS progression

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  • STUDY: Review of modifiable risk factor interventions on MS progression

    At first blush this is disappointing. Researchers found, based on "moderate quality of evidence," that diet likely has no effect on progression. They found similar results with exercise and vitamin D supplementation. But researchers admit after reviewing studies involving exercise and vitamin D supplementation that the "no effect" findings were based on "very low quality of evidence." So don't quit the gym just yet. -D

    A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

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    Susanne Hempel, Glenn D Graham, Ning Fu, Elena Estrada, Annie Y Chen, Isomi Miake-Lye, Jeremy N V Miles, Roberta Shanman, Paul G Shekelle, Jessica M Beroes, Mitchell T Wallin
    First Published February 2, 2017


    Several risk factors are associated with multiple sclerosis (MS) progression and may be amenable to intervention.

    To systematically review the evidence for interventions targeting risk factors for MS progression.

    We searched six databases and existing reviews till March 2015 and consulted with experts to identify randomized controlled trials (RCTs) of interventions targeting MS risk factors (PROSPERO 2015:CRD42015016461).

    In total, 37 RCTs met inclusion criteria. Expanded Disability Status Scale (EDSS) scores after exercise interventions did not differ compared with untreated controls (standardized mean differences (SMDs): 0.02; confidence interval (CI): −0.40, 0.44; I2: 0%; seven RCTs; very low quality of evidence (QoE)). Dietary interventions did not show a statistically significant effect on the relative risk (RR) of progression (RR: 0.86; CI: 0.67, 1.05; I2: 0%; four RCTs; moderate QoE) compared to placebo. EDSS scores after vitamin D supplementation were not significantly different from placebo (SMD: −0.15; CI: −0.33, 0.02; I2: 0%; five RCTs; very low QoE).

    We did not identify any risk factor interventions with significant effects on MS progression, but the overall QoE was limited. More adequately powered trials are needed on vitamin D supplementation, long-term exercise, and smoking cessation.

    Dave Bexfield

  • #2
    Surprised by these results...

    So, did a presentation recently with one of the world's foremost experts on MS and physical rehabilitation. Her first slide - "exercise is the closest thing we have to a magic pill". Until recently, she was based at the Johns Hopkins MS Center, so not exactly on the fringe of medical science.