Table 1 Summary of recommendations of the Intervention Course (IC) arms and Standard Care Course (SCC) arms

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1. Introduction to the course

Welcome to the course, including how to proceed, and navigate what to expect, and to outline the endpoints for participants. An overview of MS will also be provided.

Welcome to the course, including how to proceed, how to navigate, what to expect, and to outline the endpoints for participants. An overview of MS will also be provided.

2. Eat well

Evidence behind the role of diet in MS risk, disease activity, and QOL, including saturated fat and its relationships with MS onset and progression. Recommends a plant-based wholefood diet plus seafood, with < 20 g/day saturated fat, as well as omega-3 fatty acid supplement use, or 20–40 ml of flaxseed oil (or equivalent) per day. Evidence supporting moderate caffeine and alcohol intake in MS

Information regarding the importance of a balanced diet. Public Health England Eatwell guide presented. Information from the US National MS society presenting a selection of diets used by people with MS including gluten free, Palaeolithic diet, McDougal diet, Mediterranean diet and Swank diet. Alcohol consumption should follow national guidelines.

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3. Sunlight and vitamin D

Detailed information about how vitamin D is made from skin exposure to sunlight, along with evidence supporting the potential role of vitamin D in MS risk and progression Recommendations for optimal levels of vitamin D supplementation and blood levels are presented. Recommends sun exposure of at least 15 min per day, 3–5 times a week, and vitamin D3 supplement use of at least 5,000 IU per day.

Information regarding Vitamin D and MS development, latitude gradient of MS and how the body produce vitamin D from sunlight. No specific recommendations on sun exposure or supplementation described. Three options presented: wait until more information is available, supplement ‘blindly’ or supplement if blood 25-hydroxyvitamin D levels are low.

4. Exercise

The benefits of exercise (neurological, cognitive, physical), how and why to implement an exercise plan with video examples provided. Recommends 20–30 min, 5 times/week exercise outdoor preferably.

Presented the critical role exercise plays in MS. Recommend 30 min or more of moderate aerobic activity and strength training at least twice per week

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5. Meditation and use the mind-body connection

Introduction to mental health and relevance in MS, to the science behind stress and its link to inflammation/MS. Mind-body connection, meditation and other stress reduction techniques along with a guided meditation video are delivered along with how to develop a mental health and wellbeing improvement strategy. Recommends 30 min or more of daily meditation.

No conclusive link between stress and MS, as the evidence to date is contradictory. Introduction to the associations between MS and chronic distress and stressful life events.

6. Medication and family prevention

Genetic, smoking, dietary and vitamin D related risks in MS development/progression. MS and pregnancy and breast feeding. Role of medication in MS discussed. Recommends minimize risks to self, family and during pregnancy via diet and vitamin D, no tobacco smoking and avoid passive smoke exposure

Genetic risk of getting MS. Smoking increases the risk of MS. The role of medication in MS discussed.

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7. Review and consolidation

Program overview and recap, and an outline of next steps to take. Follow-up questionnaires for longitudinal follow-up discussed and participants asked to complete, and link to forums for further engagement (aimed at enhancing retention).

Concluding remarks and closing ceremony.

Program overview and recap. Follow-up questionnaires for longitudinal follow-up discussed and participants asked to complete, and link to forums for further engagement (aimed at enhancing retention).

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Catch-up

Participants have 2 weeks to complete any modules missed.

Participants have 2 weeks to complete any modules missed.