# Targeting Lifestyle in CNS Inflammatory Demyelinating Diseases: Insights from Diet and Exercise as Potential Disease Modifiers

## TL;DR

This review discusses how diet and exercise may help manage and modify the course of central nervous system inflammatory diseases like MS, NMOSD, and MOGAD.

## Contribution

The paper introduces lifestyle interventions as potential disease modifiers in CNS inflammatory demyelinating diseases.

## Key findings

- Healthy diets like Mediterranean and MIND may reduce MS relapse rates and disease severity.
- Exercise promotes neuroprotection in MS by upregulating neurotrophic factors and preserving brain volume.
- The ketogenic diet and intermittent caloric restriction show promise in preclinical models of CNS diseases.

## Abstract

This narrative review explores the impact of diet and physical exercise both as a risk factor of central nervous system inflammatory diseases, but more importantly as potential adjunctive disease modifiers in Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorders (NMOSD), and Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated disease (MOGAD). The majority of evidence relies on MS preclinical and clinical studies, but preclinical studies also support the benefit of lifestyle intervention in NMOSD and MOGAD. In MS, adherence to healthy diets (particularly Mediterranean and MIND diets) could lead to a milder disease course with reduced relapse rates, while structured exercise from early disease stages promotes neuroprotection by upregulating neurotrophic factors and preserving brain volume, possibly impacting disease progression. The ketogenic diet and intermittent caloric restriction also showed promising results. Physical activity, including both aerobic training and resistance training, emerges as a potential disease-modifying strategy by promoting neuroprotection, reducing inflammation, and supporting functional and cognitive outcomes, particularly when implemented early in the disease course. A synergistic approach alongside disease-modifying treatments (DMTs) would further positively modulate core pathological processes. Evidence for NMOSD and MOGAD warrants further investigation. We highlight that integrating personalized lifestyle strategies would be beneficial from the early stages. However, future large-scale, standardized trials are required to fully confirm the neuroprotective potential of diet and exercise across the entire spectrum of CNS disorders.