About 85% of people living with multiple sclerosis (MS) are first diagnosed with the relapsing-remitting form, also known as RRMS.

RRMS comes with periods of symptoms that include numbness, tingling, fatigue, vision changes, and trouble walking. These are followed by periods of remission, where you have few to no symptoms.

Most people living with RRMS progress to secondary progressive multiple sclerosis (SPMS). In SPMS, the disease gradually worsens and can lead to disability.

The time for RRMS to progress to SPMS is different for each person. According to one study, about half of people progress from RRMS to SPMS within 20 years.

Particular risk factors make RRMS more likely to progress to SPMS sooner, including:

  • being older at the time of diagnosis
  • smoking
  • having another disability
  • having more lesions in your brain and spinal cord

Though you can’t control all of these risk factors, you can protect your health. Here are six things to reduce symptoms and possibly slow disease progression.

Several disease-modifying therapies (DMTs) are approved by the Food and Drug Administration (FDA) to treat RRMS. Experts don’t know whether these medications slow the progression from RRMS to SPMS.

Some research has suggested that fewer people who take DMTs develop SPMS, but this finding still needs to be confirmed.

Still, there are many good reasons to continue your doctor-prescribed DMT. Researchers have found that DMTs reduce the number and severity of MS relapses.

Starting on one of these medications early and staying on it can help reduce new damage in your brain and spinal cord and slow the development of disability.

MS relapses that last a few days or weeks are part of living with RRMS. Experts are unsure whether relapses lead to long-term disability.

But because these flares bring on symptoms and may damage the brain and spinal cord in the short term, it helps to do everything you can to prevent them.

Taking your medications is one way to reduce the number of relapses. Finding and avoiding anything that sets off your flares is also important. Common relapse triggers include:

  • heat and other temperature changes
  • smoking
  • infections such as the flu
  • stress
  • fatigue

Avoiding these triggers can also help you remain healthy overall. When you’re healthy, you’ll have an easier time recovering if a relapse does occur.

In addition to the many other harmful health effects of tobacco smoke, smoking may speed MS progression.

The chemicals in tobacco smoke may increase inflammation and damage myelin — the insulation that covers and protects your nerves. Myelin is what MS gradually destroys.

People living with MS who smoke tend to have more symptoms, brain lesions, relapses, and disabilities than those with MS who don’t smoke.

Smoking can also affect how your body absorbs DMTs, making the medication less effective.

Smokers living with RRMS also progress to SPMS faster. For each year people continue to smoke after an MS diagnosis, their progression to SPMS speeds up by nearly 5% compared with those who quit, according to one study.

Quitting smoking isn’t easy, but going off cigarettes could change the course of your disease.

In a 2022 study, people who quit smoking slowed their rate of motor decline and disability to where it was the same as that of nonsmokers.

Experts don’t know whether consistent workouts might slow the progression of MS. Although some research has suggested that aerobic exercise fights inflammation and slows the disease, more studies are needed to establish any true benefit.

Even though the effects of exercise on SPMS progression aren’t clear, there are enough benefits to make exercise worth fitting into your routine.

Regular aerobic and muscle training workouts promote good health overall. They can help you maintain strength, fight MS fatigue, and preserve mental function.

Some research has also found that eating a healthy diet and following a healthy lifestyle can reduce MS symptom severity and disability. That includes eating plenty of fruits, vegetables, and whole grains and avoiding processed foods and added sugars.

Be sure to get plenty of vitamin D, which has been shown to lower the risk of developing MS and reduce the risk of relapse.

Obesity has also been linked to the onset of MS, as well as more severe symptoms and frequent relapses. Staying active and eating a nutritious diet can help you reach and maintain a healthy weight.

Alcohol has a complex relationship with MS. On the one hand, some research suggests that moderate drinking can dampen the overactive immune response that promotes inflammation. But heavier or more regular drinking might increase the inflammatory response and possibly worsen the disease.

Currently, there’s no consensus on the effects of alcohol on MS. Even moderate drinking can worsen symptoms such as unsteadiness and urinary urgency for a few hours until the effects of alcohol wear off.

Heavy drinking can cause neuropathy and changes in the liver that affect balance and sensation.

While these effects of alcohol differ from how MS impairs sensation and balance, having alcohol-induced neurological damage along with MS can severely impair your physical abilities.

Plus, alcohol can interfere with some medications used to manage MS symptoms.

The National MS Society recommends talking with your doctor about whether it’s safe for you to drink alcohol.

Regular visits with a doctor are part of the routine when you live with MS. These checkups give you a chance to review your medication list, discuss which parts of your treatment are working and which ones aren’t, and work together to prevent relapses.

Try not to skip these visits. If you miss too many appointments, your doctor won’t be able to accurately track your condition or manage your care appropriately.

Come to your checkups with a list of concerns and questions. Make the most of your time with your doctor by discussing any pressing issues related to your MS care.

Most people living with RRMS progress to SPMS, but that path differs from person to person. You can improve your outlook by following your treatment plan, seeing your doctor for all scheduled visits, and taking care of your health overall.

If you’re having trouble sticking with your medication plan or are unsure what else you should be doing to manage MS, ask your doctor for advice.