Health & Wellness

Wellness is defined as “a lifelong journey through which people develop an awareness of, and make positive choices about, their behaviors, lifestyle, and activities that enable them to lead their best lives.” 

More recently, the term “wellness” is often replaced with the concept of “brain health,” which involves seven core pillars – mental stimulation, physical activity, sleep, nutrition, cardiovascular health, social connection, and stress management. These concepts are vying for more attention as they are just as important as traditional medical management.

This is where multiple sclerosis day programs can be an important addition to MS care. They vary in how services are delivered, but the common thread is to create a community for those living with MS where education, adaptive exercise, cognitive stimulation, and social interaction take place. All of these are wellness interventions that provide tremendous benefits for those living with MS. 

Day program models

Some of the day programs follow a medical-rehabilitative model, combining structured wellness activities with access to clinical rehabilitation services. As Darcy Hager-Slavin, supervisor of M Health Fairview MS Achievement Center explained, “Our program is staffed by occupational therapists and offers convenient access to physical therapy, occupational therapy, and speech-language pathology services, should participants elect to utilize them.” 

According to Jennifer West, the Good Shepherd MS Wellness Program manager, “Our program is open to any individual with the diagnosis of MS regardless of age or ability level and offers social interaction, education and presentations, cognitively stimulating activities, and group exercise classes, twice a week for up to three hours each day. Program members also have access to meet rehabilitative needs through the Good Shepherd rehabilitation hospital system.” 
 

To learn more
• good shepherd.org/service/ms-wellness-program • leaguefor people.org/program/the-wellness-center • common spirit.org/find-a-location/john-a-schafer-md-multiple-sclerosis-achievement-center-dignity-health-884

Another model, offered by Dr. John A. Schafer of the Multiple Sclerosis Achievement Center, offers a five-hour or two-and-a-half hour wellness program for its members. Tiffany Malone, the program’s director, said, “Members attend one day per week, and both versions provide education, physical activities, cognitive stimulation, socialization, and emotional support through a structured curriculum. Members can attend the program for as long as they feel it is beneficial to them.” 

The MS day program at the League for People with Disabilities offers a four-hour program Monday through Thursday, each week. According to program manager Jessica Hutchison, “Group sessions are designed to provide peer connection, therapeutic services, and wellness education. The three daily groups are facilitated by skilled therapists, supervised graduate students with some volunteer support and currently offered in-person and virtually.” 

In addition to these core services, many programs offer additional services to the MS community, including education, adaptive recreational activities, and team-building challenges. Additional staff may include nurses, mental health professionals, exercise physiologists, and recreational therapists.

Important complement to medical care

According to Malone, “MS can be extremely isolating and lonely. The isolation and loneliness epidemic confers a greater risk of chronic health conditions such as heart disease, stroke, and premature death.” 

Both Malone and Hutchison report their day wellness programs are effective interventions in combating isolation and loneliness. West adds, “There is no better support than feeling heard and understood by others that can relate directly to your experiences by either listening and providing a sounding board or providing  recommendations and advice based on life experience. Family and friends can empathize and sympathize but only someone living with MS can truly understand the challenges and struggles involved.”

Along with the improved social and mental aspects there are additional tangible benefits of these programs. A key component of all programs is the inclusion of exercise. As West notes, “Regular physical activity is important in decreasing mortality; decreasing effects of comorbidities (cardiovascular risks); weight management; improving cognition, sleep, and mood; enhancing bone health; increasing strength and flexibility; 
decreasing risk of falling; and improving overall physical function and quality of life. Newer research studies are investigating possible neuroprotection, disease-modifying properties as a supplemental treatment strategy to slow disease progression and delaying disability.” 

Hager-Slavin believes “maintenance of cognitive and physical function can be important in allowing individuals to prevent further complications and maintain their current living situation.” 

Hutchison agrees, “We target high-level thinking skills, like metacognition. In other words, we think about our own thought processes. This helps support emotional wellness and problem-solving skills.” 

All the program leaders identified the benefit of members working at their current level and making changes as either an improvement or decline in function is noted. Because of the frequency of these programs, staff are often equipped to quickly identify changes in health status, allowing for referral to healthcare providers and possible avoidance of hospitalization.

Incorporating wellness into overall management

MS day programs strive to help lead its members on a lifelong journey of wellness, or brain health, with support and encouragement for success. Day programs consistently incorporate the physical, mental, emotional, social, and intellectual dimensions of wellness. Outcomes of these programs vary, but improvements in quality of life and other health-related outcomes are observed and reported in the literature. Most recently, a four-year analysis of individuals with MS participating in a day wellness  program reported statistically significant changes in quality of life, self-efficacy, and reported physical activity levels.

Despite the reported benefits, there are challenges with these programs. A majority of the funding is through private donations and grants from corporate or advocacy organizations, such as MS Focus: the 
Multiple Sclerosis Foundation. Often a nominal fee is charged to members and in some cases third-party reimbursement is available. However, the total cost to provide these services is usually not covered, even if reimbursement is available.

As evidence continues to grow around the benefits of wellness interventions, MS day programs offer an effective way to deliver services that matter to people living with MS. While continued measurement of the positive effects is necessary, it is apparent that creating a venue where people living with MS can come together and share their experiences is a prescription to combat loneliness and isolation. Adding in healthy lifestyle activities – such as exercise, cognitive stimulation, and emotional support – makes day programs an important component of comprehensive MS care.