Exercise as it relates to Disease/Barriers that prevent people with epilepsy from exercising

This is a critique of a journal article titled "How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy" by the authors Sarah S. Collard and Caroline Ellis-Hill. The article was published in 2017 in a transformative journal titled “Epilepsy and Behaviour”.

What is the background to this research?
People with epilepsy suffer from unprovoked seizures, making it more difficult to engage in physical activity when compared to non-epileptic people. There are many studies discussing barriers to exercise and how beneficial exercise is for the health of people with epilepsy. However, previous studies lack information about adaptations to exercise and methods to overcome these barriers.

The research by Caroline Ellis-Hill provides detailed, current methods used by people with epilepsy to aid in overcoming barriers to exercise. The new findings can guide further advancements in exercise techniques and explore medical professionals’ knowledge and ideas around exercising with epilepsy. epilepsy is a difficult condition to live with and there are differing opinions about the importance of exercise for this population and the overall effect on their health.

Where is the research from?
The research was conducted at Bournemouth University in England and online using video conferencing platforms. The study was published in 2017 in “Epilepsy and Behaviour”, an international journal involving the most current information about behavioural aspects of seizures and epilepsy.

Both the author and the corresponding author are from the Faculty of Health and Social Sciences at Bournemouth University. The Main author, Caroline Ellis-Hill has contributed to a total of 57 research articles about Caregiving, Dementia, Aphasia, Strokes and Men’s Health. The corresponding author, Sarah Collard has 11 published articles associated with Chronic Fatigue Syndrome, Physics and Chemistry Experiment in Space, Cognitive Behavioural Therapy and Knee Osteoarthritis. Their reputations continue to expand each year. The authors claim there has been no conflict of interest within the research, though, medical professionals have had contrasting opinions regarding physical activity recommendations.

What kind of research was this?
The research was an exploratory study, using qualitative methods to explore different coping strategies to improve exercise for people with epilepsy. To do this, current perceived barriers and adaptation techniques needed to be recognised. The research was conducted using three focus groups and three semi-structured interviews with 2-3 participants in each group. A focus group is a small group of participants engaging in an open discussion guided by the main researcher. Focus groups are most appropriate for situations that involve discussing detailed information and sensitive topics as it provides an accepting environment allowing participants to add meaning to discussion. Examining barriers to exercise provided qualitative data regarding ways to enhance physical activity for people with epilepsy and overcome barriers preventing exercise.

What did the research involve?
11 epileptic participants from England, aged 18-60 years engaged in the research. Most of these participants were White-British (n=10) and female (n=7).

The participants were prompted through a discussion about barriers preventing them from exercise and methods they use to overcome barriers. ‘Active people management’ was incorporated to avoid the conversation being dominated by a single participant. The focus groups were conducted for 1 ½ to 2 hours. The semi-structured were conducted using a videoconferencing platform for those who could not travel and ran for 1 to 1 ½ hours.

This research method was the most appropriate as the participants were able to freely discuss their situations without feeling uncomfortable or pressured by researchers. The participants were able to reveal more detail about their epilepsy that may be absent from current research by sharing common situations. Constructionist grounded theory was used to analyse the data collected and identified the effects of the researcher on the study and aims to give a voice to the subjects.

Study Limitations

 * Only 11 participants, so data cannot be generalised for the entire epileptic population.
 * All participants are from England so findings cannot reflect possible findings from other countries.
 * Lack of diversity (female to male ratio).
 * No information regarding socioeconomic status (demographics need to be considered).
 * We cannot assume the findings of this study apply to children under 18.

What were the basic results?
The study found the following key barriers to exercise: The study also explored methods to prevent seizures during exercise:
 * Fear of injury by triggering seizures with strenuous activity, overheating or high heart rate
 * Lack of social support and a feeling of being unsafe alone.
 * Conflicting advice from medical professionals, family, and friends.
 * Side effects of seizure medication
 * Modifying intensity level and type by identifying pre-seizure symptoms and understanding their boundaries.
 * Use of technology to track seizure activity and gain a sense of control
 * Exercising with others

The findings were analysed using Constructive grounded theory to introduce new understanding of the motivating factors, perceived barriers, and adaptations to exercise. There was no over-emphasis placed on the limitations of the study. The restraints to the study were all based upon the individuals rather than the research methods.

What conclusions can we take from this research?
From the study we can see that not all people with epilepsy are the same when exercising, a range of factors such as the type or severity of epilepsy that has been diagnosed, current PA status and triggers affect how they exercise. The biggest finding is that people with epilepsy need to find what works for them in terms of intensity, heart rate, temperature, and duration of exercise to avoid triggering a seizure. They must identify their boundaries and know when exercise needs to be ceased.

There have not been more recent studies as this research was conducted in 2017. However, there are many studies from different countries that present similar findings. In 2009, A study in Wichita, USA surveyed 193 people with epilepsy and found that the main barriers were: lack of motivation (41%), concern for personal safety (27%), fear of epileptic seizures (19%) and the conception of epilepsy itself as a barrier (29%). Another study was conducted in Seoul in 2011, the main barriers explored were fatigue after physical activity (73%), fear of seizures during exercise (65%) and advice from family or friends to not exercise (55%). When patients were asked about exercise restriction by a physician, the frequency was 0%. In 2015, The States Centre for Disease Control and Prevention found no differences in exercise recommendations between people with and without epilepsy (34% vs. 35%).

Practical advice
The participants discussed types of exercise that suits them and their seizure frequency, these involved walking, running, and swimming. Avoiding the midday sun when exercising is also most appropriate to prevent overheating and triggering seizures. This information varies for each person with epilepsy and exercises that work for one person may not work for another.

Any individuals with epilepsy should consult an Epilepsy Specialist to discuss their specific type of epilepsy and barriers/limitations specific to them. But epilepsy should not be a barrier to exercise, and physical activity is recommended daily, they just need to understand boundaries and how to monitor their triggers. There was also no information about the effects of age, gender, seizure medication on their ability to exercise.

Further Information and Resources
The Epilepsy Foundation aims to ensure that all individuals with epilepsy have access to information relevant to their age and condition by delivering support programs, education/training and community awareness programs.

Epilepsy Action Australia is an organisation that helps people self-manage and better understand their epilepsy. They also provide information to parents, teachers, and medical professionals to support people and their specific needs. Further information:
 * https://www.epsyhealth.com/seizure-epilepsy-blog/can-you-exercise-with-epilepsy
 * https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy-and-exercise
 * https://www.issaonline.com/blog/index.cfm/2017/people-with-seizures-can-train-heres-how-to-do-it-safely