Living with MS: Reduce Risk of Fatigue with Diet and Exercise

Patient Expert

Fatigue is one of the most common symptoms of multiple sclerosis that affects up to 90% of patients at any one time. Approximately two thirds of people with MS describe fatigue as their most disturbing symptom. Fatigue may be described as the perception of decreased mental or physical energy that restricts daily activities. It surpasses general tiredness and affects people with MS more significantly than those who are healthy.

What causes MS-related fatigue?

Fatigue in MS can occur on its own, may be caused by inflammation, demyelination, axonal loss, or brain atrophy, or may be indirectly caused by other MS-related symptoms. MS-related fatigue is often associated with depression, emotional distress, disability, cognitive dysfunction and heat sensitivity, each of which can exacerbate the perception of fatigue which becomes a vicious cycle.

What factors influence fatigue in MS?

A recent study, conducted by surveying a large international cohort of people with MS (n=2138; 82% female), identified a wide range of modifiable lifestyle factors that may reduce or contribute to clinically significant fatigue. Among the people surveyed, 65.4% report experiencing MS-related fatigue. Researchers found strong associations between fatigue in people with MS and diet, exercise, omega 3 supplementation, fish consumption, vitamin D supplementation, BMI, alcohol intake, and use of disease-modifying therapy (Weiland, 2015).

  • Factors that increase odds of fatigue

After controlling for level of disability and socio-demographic variables, increased risk of fatigue was associated with poor diet, being overweight or obesity (increased odds of fatigue by 1.7 and 2.9 times, respectively), and current or previous use of a disease-modifying therapy (increased odds by 1.5 times). Additional lifestyle factors that increase risk of fatigue include lower levels of physical activity, alcohol consumption, and fish consumption (less than once/week).

  • Factors that reduce odds of fatigue

After controlling for level of disability and socio-demographic variables, reduced risk of fatigue was associated with exercise, high levels of physical activity, moderate alcohol use, healthy diet, frequent fish consumption (three or more times/week), supplementation with vitamin D, omega 3, and flaxseed oil, normal BMI, and never using a disease-modifying therapy. Persons with MS who exercised vigorously three times a week or undertook mild or moderate exercise seven days a week were almost three times less likely to experience fatigue.

  • Factors with little influence on fatigue

Researchers founds that meditation, social support, and current smoking were not associated with clinically significant fatigue after adjusting for stable factors.

What is the impact of fatigue in MS?

Fatigue can be associated with significant consequences in people with MS. It can be associated with lower quality of life, impaired social life, reduced work hours or loss of employment, and reduced ability to carry out daily tasks.

How is MS-related fatigue treated?

Traditional treatments for fatigue include exercise therapy, energy conservation strategies, cooling therapies, cognitive behavior therapy, mindfulness, and pharmacological interventions including antidepressant therapy and wake-promoting agents (such as modafinil or amantadine).

A recent meta-analysis found that a combination of exercise and educational approaches was more effective than pharmacological interventions in combatting MS-related fatigue (Asano, 2014). However, more research is necessary to determine what type of exercise may be the most effective and whether certain individuals would experience greater benefit over others.

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Asano M, Finlayson ML. Meta-Analysis of Three Different Types of Fatigue Management Interventions for People with Multiple Sclerosis: Exercise, Education, and Medication. Mult Scler Int. Vol. 2014, Article ID 798285, 12 pages, 2014. doi:10.1155/2014/798285

Weiland TJ, Jelinek GA, Marck CH, Hadgkiss EJ, van der Meer DM, Pereira NG, et al. Clinically Significant Fatigue: Prevalence and Associated Factors in an International Sample of Adults with Multiple Sclerosis Recruited via the Internet. PLoS One. 2015 Feb 18;10(2):e0115541. doi:10.1371/journal.pone.0115541