A West Virginia University assistant professor and occupational therapist — and hundreds of professional peers and colleagues around the world — are delving more deeply into wellness strategies beyond medication alone in the treatment and management of multiple sclerosis.

An incurable disease affecting the central nervous system, multiple sclerosis can include a panoply of symptoms, ranging from numbness and tingling throughout the body to blindness and paralysis. MS can also affect emotional health and cognitive abilities, but recent research is making inroads into restoring and retaining the quality of life for those with the condition.

According to the National Multiple Sclerosis Society, the specific symptoms, progression and severity of MS vary from individual to individual. An estimated one million Americans live with MS. Most are diagnosed between ages 20 and 50, the NMSS states, with women three times more likely than men to be diagnosed with the disease.

Jacob Greenfield, an assistant professor in the WVU School of Medicine’s Division of Occupational Therapy, works with MS patients and clinicians in Morgantown. He said several strategies are surfacing or resurfacing to treat MS patients.

Reducing depression through mindfulness

“Mindfulness is like an emerging practice. It’s been around for a while, but we’re starting to see it coming back a lot more. It’s being used pretty commonly in the MS population,” Greenfield said.

“It’s not necessarily getting rid of the symptoms,” he clarified, “but it is helping patients deal with the common symptoms: pain, depression, anxiety, and fatigue. For the newly diagnosed person, MS can be a kind of large pill to swallow.”

Greenfield said mindfulness can produce short-term pain management benefits, but “according to our research so far, it hasn’t shown a lot of long-term effects. It helps with pain management by helping the individual get in tune with their body. It helps them de-stress, relax a little bit.

“Mindfulness is just relaxing a patient. They feel a decrease in pain, a decrease in worry, and they don’t feel as depressed. That can be done in a clinic or in a guided way. They are some apps now that do that, and some physicians will integrate that into their practice,” he said.

The NMSS reported in mid-February that an eight-week, online mindfulness program reduced depression significantly more among participants than their untreated control group cohort. A component of a University of Sydney study that involved 132 people with MS, the program contributed to growing evidence that wellness strategies can help alleviate symptoms for people with MS.

“Mindfulness,” the NMSS explains, “is a form of meditation aimed at changing a person’s perception and creating awareness and acceptance of moment-to-moment experiences, with the goal of reducing reactions that may worsen pain or emotional distress related to health-related changes.”

John Kabat-Zinn defines mindfulness as “paying attention on purpose, without judgment, in the present moment and with a kind and compassionate awareness.”

Kabat-Zinn, a professor of medicine emeritus at the University of Massachusetts Medical School, has spent decades years writing about, teaching, and advocating mindfulness. In 1979, he founded the Mindfulness-Based Stress Reduction Clinic at the UMSM.

The Australian study team developed the program with five, interactive, 15-minute modules. Topics included dealing with stress, difficult sensations and emotions, mindful communication, self-compassion, and relapse prevention. The participants also received periodic telephone calls from a psychologist to assist them in the process.

According to the NMSS, the study’s primary goal was to measure the effect of mindfulness practice on depression. Secondary outcomes included pain, fatigue, anxiety, and quality of life, which were measured before the program and for three and six months afterward.

The results showed that depression was reduced and quality of life improved significantly more among those in the mindfulness program. Depression reduced even more among people who had a history of recurrent depression, with the benefits maintained after six months.

Closer to home, in Momentum, the NMSS’ online magazine and blog, author Aviva Patz cited a similar study funded by the NMSS at Ohio State University last year. The four-week study also compared results of mindfulness training between approximately 60 subjects with MS and two control groups. The mindfulness training program entailed breath awareness, sitting meditation and mental “body scans” (a meditative practice to focus attention and sensory awareness of various body parts). By the conclusion of the study, mindfulness meditation participants said they had significant improvements in their ability to manage their negative emotions, compared to the control groups.

“The results are very encouraging and could improve mood and cognition for people with MS,” said OSU Associate Professor of Psychology Ruchika Prakash, who co-authored the pilot study. “We can’t say it will apply to everybody,” Prakash said in the article. “But the data is promising evidence that mindfulness training can help MS patients deal with their emotions more constructively and positively, and improve some elements of cognition.”

Those recently diagnosed with MS are invited to participate in a virtual program, “New to MS: Navigating Your Journey,” from 8 to 9:15 p.m. on Thursday, April 14. The online program enables participants to connect with others recently diagnosed with MS and share experiences, questions and concerns among themselves and health care professionals who take part. Information is provided about MS and its symptoms and MS management.

“New to MS: Navigating Your Journey” virtual programs are offered on the third Thursday of every month. Other upcoming program dates are May 12 and June 9.

The online programs can be accessed via www.nationalmssociety.org. Registrations usually reach capacity, so timely registration is suggested.

Benefits of exercise

The mind-body connection is also linked to assisting those with MS in improving and maintaining their quality of life. As with everyone, regular exercise, a proper diet and good sleep hygiene promote optimum well-being. Exercise — movement, in general, such as moderate-level walking — can be especially beneficial in helping those with MS manage their symptoms.

According to studies, aerobic exercise programs can help improve cardiovascular fitness, strength, bone density and flexibility, and bowel and bladder functions. The studies add that exercise can also lower fatigue and elevate mood and cognitive abilities for those with MS.

Along with walking (with or without a dog), other physical activities that can benefit people with MS include gardening, swimming, or even cooking and other everyday household chores. Scientists also say a regular exercise regimen can slow the progression of MS for some individuals.

Greenfield concurs with the findings. “When I was in OT school, exercise was kind of a controversial topic,” he said, “but a study in 2021 showed aerobic and resistance training has a benefit for MS patients as long as they are physically capable. Aerobic exercise and conditioning can help with fatigue symptoms, and it has been shown to help with incontinence management. It increases bone density and helps with mood and cognitive function. When you strengthen the heart and lungs, you’re not as fatigued.

“We sometimes refer patients to the National MS Society website,” Greenfield said. “They have some beautiful videos that show adaptive exercises for them and offer home exercises for patients. They have more information at their fingertips than a clinical physician can provide.”

Greenfield also extols aquatic therapy for those with MS. “You want to make sure you’re not overheating and that you’re taking it at your own pace,” he cautioned. “My background is in aquatic therapy; I have worked with that population a lot. Their symptoms are alleviated in the short term, with cardiovascular endurance and bone density improvements.”

Benefits of a balanced diet

“Obviously, no diet is going to cure MS,” Greenfield said, “but it’s a big topic in research right now on a national basis. The biggest ‘take home’ message with diet is to promote more of a healthy eating lifestyle to reduce other co-morbidities.

“Try to incorporate those food colors into your diet. Hit the vegetable aisle, cook more at home, avoid processed foods and too much sugar, and choose whole grains over refined grains.”

Let the sun shine in, too, Greenfield advised.

“There’s a lot of research on vitamin D and Biotin (vitamin B₇). Even just being in the sun, spending 15 minutes in sunlight, doing physical activity can help. It goes back to exercise — gardening, planting flowers, doing a little bit of yard work. Vitamin D is going to help with symptom management.”