Table 3.

Principle recommendations for wellness interventions

Vitamin D supplementation	• Maintain a minimum 25(OH)D level of 30 ng/ml • Vitamin D3 supplementation is preferred over vitamin D2 • Although there is no established treatment approach, supplementation with 1000 IU vitamin D3 for levels between 20 and 30 ng/ml and 2000 IU of vitamin D3 for levels < 20 ng/ml is one general treatment approach
Tobacco-smoking cessation	• A combination program incorporating behavioral and pharmacologic interventions for smoking cessation can be beneficial • Behavioral interventions: written materials containing advice on quitting, multisession group therapy, individual counseling sessions • Pharmacologic interventions: NRT, varenicline, bupropion, cystine, nortriptyline
Exercise	• Follow the minimum recommendations for exercise according to the US NCHPAD guidelines: 1) 20–60-min sessions of moderate-intensity aerobic training 3–4 days/week 2) 10–15-min sessions of strength training 2–3 days/week 3) 10–15-min sessions of stretching exercises daily
Diet	• Eat a plant-based diet consistent with USDA guidelines
Screening for psychiatric comorbidities and referral to mental health services	• Use a validated screening tool for depression in routine clinical practice (2-item screen, BDI, CES-D, CMDI, HADS, PHQ-9) • Follow general-practice guidelines for the treatment of depression, BPD, and anxiety • There is no evidence supporting the use of one psychotropic medication over another in the MS population • Stress-management programs may be offered to those interested

25(OH)D = 25-hydroxyvitamin D; NRT = nicotine-replacement therapy; NCHPAD = National Center on Health, Physical Activity and Disability; USDA = United States Department of Agriculture; BDI = Beck Depression Inventory; CES-D = Center for Epidemiologic Studies Depression Scale; CMDI = Chicago Multiscale Depression Inventory; HADS = Hospital Anxiety and Depression Scale; PHQ-9 = Patient Health Questionnaire-9; BPD = bipolar disorder