Musculoskeletal, Obesity

Modified Ketogenic Diet and Exercise Program on Weight Reduction in Obese Patient with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system that leads to demyelination, neurodegeneration, and progressive neurological disability. Obesity may worsen MS symptoms and disease progression by promoting systemic inflammation, making weight management an important aspect of care.

This single-blind, randomized controlled trial assessed the effects of a modified ketogenic diet (MKD) combined with aerobic exercise on weight and Body Mass Index (BMI) in obese MS patients. Forty participants (aged 18–50 years, majority female) were randomly assigned to one of two groups: Group A received a modified ketogenic diet alongside aerobic exercise, while Group B received aerobic exercise alone. Both interventions were delivered three times per week for 12 weeks.

The MKD limited carbohydrate intake to <50 g/day and emphasized fats (70–80% of total energy), moderate protein (15–20%), and calorie intake of 1400–1500 kcal/day. A nutritionist tailored diets weekly. The aerobic exercise protocol used progressive treadmill training, starting with low-duration sessions and increasing in duration and intensity based on tolerance, with heart rate and perceived exertion used for monitoring.

Anthropometric data were collected pre- and post-intervention. Statistical analysis was conducted using a two-way mixed MANOVA, followed by univariate ANOVAs, with significance set at p<0.05. Both intention-to-treat and per-protocol analyses were performed.

Results/Key Findings

Weight Loss

• Group A (MKD + exercise): Mean reduction of 21.6 lbs (9.8 kg)
• Group B (exercise only): Mean reduction of 7.2 lbs (3.25 kg)
• Difference between groups was statistically significant (p = 0.001, partial η² = 0.39)

BMI Reduction

• Group A: Mean reduction of 3.58 kg/m²
• Group B: Mean reduction of 1.16 kg/m²
• Between-group difference was significant (p = 0.001, partial η² = 0.50)

No significant baseline differences in age, height, or gender distribution were observed between groups.

Conclusions

Combining a modified ketogenic diet with aerobic exercise produced greater weight and BMI reductions than exercise alone in obese MS patients, likely due to metabolic and anti-inflammatory effects. Despite the study’s short duration and small sample, results support this combined approach as a potential strategy for MS-related weight management. Larger, longer-term studies are needed to confirm these findings.