Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

Figures & data

Table 1. Overcoming multiple sclerosis (OMS) lifestyle intervention recommendations.

Lifestyle factor	Recommendation
Diet	A plant-based wholefood diet plus seafood, with very low saturated fat (<20 g/day) No dairy, meat, palm or coconut oil, no fried foods
Dietary supplementation	Omega-3 fatty acid supplements: 20–40 ml of fish or flaxseed oil daily; can be omitted on days when oily fish is eaten Optional B group vitamins or B12 supplement if needed
Physical activity	20–30 minutes around five times a week, preferably vigorous and outdoors
Smoking	No tobacco smoking and avoid passive smoking
Vitamin D	Sunlight 15 minutes daily 3–5 times a week as close to all over body exposure as practical Vitamin D3 supplement of at least 5000 IU daily, adjusted to blood level Aim to keep blood level of vitamin D high, between 150-225 nmol/L (may require up to 10,000 IU daily)
Meditation or other stress reduction activity	30 minutes daily

Table 2. Participant characteristics.

Participant	Sex	Age at time of interview	Disease duration at time of interview	PDDS (time of assessment)^a
1.1	M	37	9	0 (Nov 2016)
1.2	F	65	42	3 (Nov 2016)
2.1	F	32	8	0 (Mar 2017)
2.2	F	41	5	1 (Mar 2015)
3.1	F	57	6	7 (July 2015)
3.2	F	57	4	1 (July 2015)
3.3	F	52	14	6 (Mar 2012)
3.4	F	68	7	6 (July 2015)
4.1	M	62	4	4 (July 2015)
4.2	M	46	4	1 (July 2015)
5.1	F	55	18	6 (Sept 2015)
5.2	M	44	5	2 (Sept 2015)
5.3	F	63	12	5 (Sept 2015)
6.1	F	55	5	1 (Mar 2016)
6.2	F	49	4	1 (Mar 2016)
6.3	F	39	6	1 (Mar 2016)
6.4	F	33	4	1 (Mar 2016)
7.1	M	51	12	2 (May 2016)

^aPatient determined disease steps was not assessed at time of interview, but as part of ongoing quantitative study. We report the PDDS score available that was collected closest to the interview time.