Bisht B, et al. – This report enlightened the effects of a multimodal intervention, including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, and stress management on perceived fatigue and quality of life of persons with progressive multiple sclerosis (MS). Outcomes indicated that a multimodal intervention probably reduces fatigue and improves the quality of life of subjects with progressive MS.

Methods

• In the 12–month phase of the study, 20 subjects with progressive MS and average Expanded Disability Status Scale (EDSS) score of 6.2 (range: 3.5–8.0) participated. 
• At baseline and at 3 months, 6 months, 9 months, and 12 months assessments were completed.
• Safety analyses were based on monthly side effects questionnaires and blood analyses at 1 month, 3 months, 6 months, 9 months, and 12 months.

Results

• Subjects displayed good adherence (assessed from subjects' daily logs) with this intervention and did not report any serious side effects. 
• In 12 months, Fatigue Severity Scale (FSS) and Performance Scales–fatigue subscale scores decreased (P<0.0005). 
• Average FSS scores of 11 subjects showed clinically significant reduction (more than two points, high response) at 3 months, and this improvement was sustained until 12 months.
• In the 12 months, remaining subjects (n=9, low responders) either showed inconsistent or less than one point decrease in average FSS scores.
• During the study, energy and general health scores of RAND 36–item Health Survey (Short Form–36) increased (P<0.05).
• Decrease in FSS scores during the 12 months was associated with shorter disease duration (r=0.511, P=0.011), and lower baseline Patient Determined Disease Steps score (r_s=0.563, P=0.005) and EDSS scores (r_s=0.501,P=0.012).
• Compared to low responders, high responders had lower level of physical disability (P<0.05) and lower intake of gluten, dairy products, and eggs (P=0.036) at baseline.
• In 12 months, high responders undertook longer duration of massage and stretches per muscle (P<0.05).