Self-reported health promotion and disability progression in multiple sclerosis

Background: Health behavior may be associated with disability progression in multiple sclerosis (MS). Objectives: To investigate health-promoting behavior as measured by the Health-Promoting Lifestyle Profile II, which includes the subscales of health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships and stress management. Methods: We conducted a cross-sectional survey among individuals with MS, registered by the Flemish MS society, Belgium. Scores for the total scale and subscales were categorized into quintiles. A time-to-event analysis and Cox proportional hazard regression were performed with time to Expanded Disability Status Score (EDSS) of 6 (requires a cane) as an outcome measure. Hazard ratios for the time from onset and the time from birth were adjusted for gender, age at onset and immunomodulatory treatment. The first category was the reference group (first quintile). Results: Data on 1372 respondents with definite MS were collected. Subjects with relapsing onset MS and higher scores for overall health-promoting behavior, and the subscales of physical activity, nutrition and spiritual growth, had a reduced risk of reaching EDSS 6 compared to the reference group. No associations were found for the subscales of health responsibility, stress management and interpersonal relations. In progressive onset MS, no significant associations were obtained. Conclusion: Our study shows an association of self-reported health promoting behavior with disability progression in subjects with relapsing onset MS. (C) 2012 Elsevier B.V. All rights reserved