Exercise as it relates to Disease/How exercise may impact the health of people with epilepsy

< Exercise as it relates to Disease

This wikibook is a critical appraisal of the research article 'Effects of an exercise program on health of people with epilepsy: A randomized clinical trial'.

Contents

 * 1) What is the background to this research?
 * 2) Where is the research from?
 * 3) What kind of research was this?
 * 4) What did the research involve?
 * 5) What were the basic results?
 * 6) What conclusions can we take from this research?
 * 7) Practical advice
 * 8) Further information/resources
 * 9) References

What is the background to this research?
Epilepsy is a disease which affects electrical signals in the brain and is characterized by recurring seizures, affecting an estimated 50 million people worldwide. Epilepsy is most commonly treated with prescribed medication, which may eliminate the occurrence of seizures in about 70% of cases. However, this method of treatment is not always effective. For example, some cases of epilepsy are resistant to medication. In addition, people with epilepsy living in low-income countries may have limited financial and/or physical access to receiving medication needed to control their seizures. The potential for exercise to act as a complementary treatment method has been explored previously, with exercise shown to reduce the severity and/or frequency of seizures in animal studies. This study was conducted with the aim to investigate the effects of exercise when combined with anti-epileptic medication on the health outcomes of people with epilepsy, with a focus on seizure frequency and quality of life.

Where is the research from?
This study was conducted in Pelotas, a city located in southern Brazil. The population of participants included people with epilepsy who were part of the Brazilian Public Health System within the primary care unit. Secondly, participants from a previous study were invited to participate, followed by social and local media outlet advertisement.

Eligible participant criteria included the following:


 * Documented evidence from a physician of an epilepsy diagnosis
 * Currently taking anti-epileptic medication
 * Sedentary for 3 months prior to participation
 * Aged between 18-60 years

Eligible participants were asked to recall whether they had any epileptic seizures in the 3 months prior to the beginning of the study and if so, how many. This was then used to determine whether a significant difference in seizure frequency had occurred after the exercise intervention.

What kind of research was this?
This study was a randomized control trial (RCT) design.

The authors appeared to possess a wide variety of experience in terms of previous studies which have been documented, the majority of which included human physiology-based research. However, no author had been involved in more than 3 articles which involved research in the field of epilepsy.

The level of evidence produced by this study also differs from others with similar aims. For example, a recent RCT published in 2022 found non-significant improvements in seizure frequency after exercise intervention. In addition, a 2021 study on patients with drug-resistant epilepsy did not see a reduction in seizure frequency after a 6-month period of moderate intensity cardiovascular training. The results of this study differ in it results, and the authors of this study claim it to be the first of its kind to find significant reductions in seizure frequency in an RCT.

What did the research involve?
A total of 20 participants completed the study and were randomly allocated into either a 12-week exercise intervention, or the control group who received no intervention. The exercise intervention group participated in 1-hour sessions, twice a week, taking place at Pelotas University gymnasium. These sessions involved aerobic, strength and stretching exercises supervised and directed by exercise science professionals for each participant. Training sessions were available between 6am-9pm on weekdays, and 9am-5pm on Saturdays. All participants were also provided with transport from their homes to the gymnasium for every session.

Some limitations may be noted in terms of the practicality of the exercise intervention used in this study. For example, the use of direct transport to and from the gymnasium, as well as exercise science professionals' supervision for each participant may not be an affordable option for people with epilepsy to replicate the exercise levels of the intervention. This is particularly relevant to this population, as most included were of low socioeconomic status, with about 50% unemployed and 80% earning low incomes. In addition, an estimated 80% of people with epilepsy live in low to middle income countries. Considering this, it is unlikely that the training program used in this study would be realistically attainable for this population in a real-world setting.

What were the basic results?
The results of this study found that exercise programs may reduce seizure frequency, improve quality of life, and improve overall health in people with epilepsy. In addition to improved quality of life, the stress levels of the exercise group were also significantly lower than the control group post-intervention. These results are particularly relevant to people with epilepsy, as both are known to have potential effects on the frequency of seizures.

The authors state that the main limitations of this study included the potential for error in recall bias in self-reported seizure occurrence in the 3 months prior to the trial, as well as the small number of participants.

What conclusions can we take from this research?
The results from this study show that people with epilepsy may benefit from physical exercise via reduced seizure frequency and improved quality of life, when used in addition to anti-epileptic medication. However, such a small sample group may make the findings difficult to apply to the general population of people with epilepsy. This makes it unclear whether all people with epilepsy will see the reductions in seizure frequency as shown in this study, and discrepancies in the current literature have not changed this uncertainty. A recent example of this is seen in the aforementioned 2022 study which saw reductions in seizure-frequency to a non-significant degree where a larger population was used. Nevertheless, this study is one amongst numerous others which show that exercise can improve the health of people with epilepsy, and that people with epilepsy should be encouraged and assisted to take part in exercising in a safe manner.

Practical advice
Results from this study raise questions about whether future research should aim to discover how different types of epilepsy may be affected by physical exercise. For example, the International League Against Epilepsy (ILAE) recommends different levels of physical activity participation in people with epilepsy depending on type of seizure occurrence and risk. This may also benefit health professionals in designing and recommending safe methods of achieving adequate physical activity that are more affordable and accessible for people with epilepsy. Examples may include:


 * Group exercise sessions
 * Education for others involved (e.g., team-mates, family, friends, coaches) to both improve safety and reduce stigma around people with epilepsy.

In summary, this study should be considered in future research into this topic, as its results showed a significant reduction in seizure frequency which has not been seen in previous RCTs. However, the risks of exercising as a person with epilepsy is highly individual to each case of epilepsy and advice should be sought from health professionals before participating in exercise.

Further information/resources

 * Visit Epilepsy Action Australia: https://www.epilepsy.org.au/about-epilepsy/ or call 1300 374 537 (National Epilepsy Line)
 * Local Epilepsy Australia Organizations: https://epilepsyaustralia.net/ or call 1300 761 487 (National Epilepsy Support Service)
 * See Basic First Aid for Seizures: https://vimeo.com/278258527.
 * First Aid for Seizures Poster. (for use at the workplace, home, gym or schools)