**Can lifestyle interventions delay conversion from RIS to MS?**
Radiologically Isolated Syndrome (RIS) refers to a condition where individuals have MRI findings suggestive of multiple sclerosis (MS) but do not yet show clinical symptoms. The question of whether lifestyle changes can delay or prevent the progression from RIS to clinically definite MS is an area of growing interest. While definitive clinical trial evidence is still emerging, current understanding and related research on MS suggest that certain lifestyle interventions may play a supportive role in delaying disease progression and improving overall neurological health.
**Physical Activity and Exercise**
Exercise is widely recognized as a cornerstone for managing MS and may also be beneficial for those with RIS. Regular physical activity has anti-inflammatory effects that support the immune system and help maintain brain health. Exercise improves muscle strength, flexibility, balance, and cardiovascular fitness, all of which are crucial for maintaining function and potentially slowing neurological decline. Importantly, exercise promotes brain microstructural integrity and helps preserve gray matter volume, including the myelin sheath that protects nerve fibers. This preservation is critical because MS involves demyelination. Exercise also supports mood and cognitive function, which can be affected early in MS. Tailoring exercise programs with the help of physiotherapists ensures safety and maximizes benefits, especially for those at risk of MS[1].
**Dietary Patterns**
Nutrition plays a significant role in modulating inflammation and neurodegeneration, both central to MS pathology. The Mediterranean diet, rich in fruits, vegetables, whole grains, nuts, olive oil, and moderate fish intake, is associated with cardiovascular and metabolic benefits and shows promise in MS management. This diet provides antioxidants, polyphenols, and anti-inflammatory compounds that may protect nerve cells and reduce oxidative stress, a contributor to neurodegeneration. Epidemiological studies suggest adherence to such diets may lower the risk of developing MS and slow disease progression by supporting mitochondrial function and reducing disability. The Mediterranean diet’s emphasis on nutrient-dense, minimally processed foods aligns well with brain health and immune regulation[3].
Emerging dietary patterns like the MIND diet, which combines Mediterranean and DASH (Dietary Approaches to Stop Hypertension) principles, emphasize leafy greens, berries, nuts, and fish, and limit processed foods and red meats. These diets are under investigation for their potential to delay neurodegenerative diseases, including MS, by reducing inflammation and supporting cognitive function[5].
**Cardiovascular Health and Risk Factor Management**
People with MS and those at risk often face increased cardiovascular risks, including heart disease and stroke. Since cardiovascular health influences brain health and inflammation, managing heart health is crucial. Lifestyle interventions that promote heart health—such as eating a balanced diet, engaging in regular exercise, managing stress, avoiding smoking, limiting alcohol, and ensuring adequate sleep—may indirectly delay MS progression by reducing systemic inflammation and improving blood flow to the brain[1].
**Sleep and Stress Management**
Quality sleep is essential for immune regulation and brain repair processes. Poor sleep can exacerbate inflammation and fatigue, common issues in MS. Establishing good sleep hygiene, reducing evening screen time, and managing stress through mindfulness, meditation, or relaxation techniques can support neurological health and potentially delay symptom onset in RIS.
**Hydration and Nutritional Balance**
Maintaining hydration and balanced nutrition is important to avoid energy crashes and support metabolic needs. Avoiding excessive sugar intake, including from fruits, helps prevent fluctuations in energy that can worsen fatigue. Regular meals with nutrient-dense foods provide sustained energy and support immune function[4].
**Mental Health and Cognitive Engagement**
Engaging in mentally stimulating activities, social interaction, and emotional support can improve quality of life and cognitive resilience. Cognitive reserve may help delay the clinical manifestation of MS symptoms by strengthening neural networks.
**Rehabilitation and Symptom Management**
For those with RIS, early engagement with rehabilitation specialists can help maintain physical function and prepare for potential symptom onset. Physical, occupational, an
