Exercise as it relates to Disease/The impact of physical activity on epilepsy outpatients

The following document is a critique of 'Exercise Training Results in Positive Outcomes in Persons with Epilpesy' by Jennifer Heise, Janet Buckworth, James McAuley, Lucretia Long and Timothy Kirby (2002) found in Human Kinetics: Clinical Exercise Physiology.

What is the Background to this Research?
Although the copious health benefits of exercise are very well known, typically, individuals suffering from epilepsy are discouraged from participating in high loads of exercise and sports in fear of inducing seizures or increasing seizure frequency. Those suffering with epilepsy often report feelings of isolation, depression, problems sleeping and fatigue; this is likely to be caused by anti-epileptic drugs and the occurrence of seizures.

Where is the Research from?
The Ohio State University College of Pharmacy conducted a study to assess whether the well-known benefits of regular exercise outweighed the impact exercise has on seizure frequency.

What Kind of Research was this?
This article reviews a randomised controlled study in which a group of epilepsy outpatients underwent an exercise intervention whilst a second group of controlled outpatients were also supervised over the 12-week trial.

What did the research involve?
The study undertaken required a group of epileptic outpatients to participate in a 12-week structured exercise training program to be observed for any positive changes in seizure frequency as well as general health. The initial group of 28 outpatients were divided into a control group in which the individuals were to continue their current loads of exercise and a supervised exercise group. The 12-week structured exercise program consisted of cardiovascular and resistance training three times per week for approximately 60 minutes per session. The assessments used to determine results included anti-epileptic drug (AED) concentration, a range of physiological tests, physical activity recalls, and questionnaires and lipid profiles and self-reported seizure frequency were taken pre-intervention (baseline), at week 4,8,12 and post-intervention. The physiological assessments undergone by both groups were peak oxygen consumption, body composition, submaximal endurance and 7 strength measurements. The Seven Day Physical Activity Recall interview was undergone weekly to obtain a record of exercise intensity, sleep time and exercise variation to be taken. In addition to this recall, the CARDIA physical activity history questionnaire was completed by all 28 participants at the beginning of the intervention to gain information regarding the patients’ activity levels from the 12 months prior to the study.

The participants in the exercise group met with an exercise physiologist and a nurse three times a week to complete cardiovascular, strength and flexibility training. The cardiovascular portion of the intervention included exercising at a specific percent of their VO2Max for 10–20 minutes on treadmills, stationary bikes and stair-climbers. The strength portion included completing 10-12 repetitions of each of the 7 exercises used in the strength assessment pre-intervention, these being leg press, shoulder press, lateral pulldown, leg extension, leg curl, chest press and bicep curl. 70% of the baseline 1RM established each participant’s baseline load for each exercise and this load increased relative to the participant’s strength throughout the 12 weeks. Flexibility was obtained through stretching circuits.

Seizure Frequency
After the follow-up results were obtained 4 weeks after the completion of the 12-week program, the professors from Ohio State University were able to determine that the exercise training program did not influence antiepileptic drug concentration nor did the physical activity cause an increase in seizure frequency.

Physiological Changes
Post-test (week 12), the members of the intervention group showed a significant increase strength, peak VO2 and cardiovascular endurance and a substantial decrease in body fat percentage. The members of the controlled group showed little changes in any of the physiological assessments.

Follow-up results (week 16) showed that those in the exercise group had experienced significant decreases in body fat percentage when compared to baseline records but no real change from the post-test results taken at week 12. Strength and cardiovascular endurance results were largely better than baseline records although again showed little variation to the post-test results. The participants showed a peak VO2 decrease from post-test records to similar values as the records taken at baseline. The members of the controlled group again showed little change in any physiological variables.

Physical Activity
The physical activity questionnaires showed significant increases in participation rates from baseline to post-test and remained similar through to the follow-up time period.

Lipid Profiles
Lipid profiles were collected from 7 individuals at random from each of the two groups at baseline and at post-test. The 7 exercise group participants showed a decrease in LDL, total cholesterol and triglycerides but no difference in HDL. The controlled group showed a slight increase in LDL, total cholesterol and triglycerides but again no change in HDL.

What Conclusions Can we Take from this Research?
In summary, this study has demonstrated the positive effects of an exercise program with both cardiovascular and resistance training in epilepsy outpatients. The participants who completed the 12-week intervention showed improvements in many general health aspects including strength, submaximal and maximal endurance capability, body fat percentage, lipid values and participation in higher loads of physical activity with no impacts on seizure frequency. This study is limited by such a small sample size with only 23 outpatients completing the entire 12-week program, half of these included in the controlled group. Such a small population doesn’t allow for very accurate conclusions to be made without the intervention being repeated with a much larger group of participants. In addition to this, the biggest limiting factor to this study is the lack of outpatients with active seizures. Majority of both the exercise and controlled population were living seizure-free and although no increase in either seizure frequency or anti-epileptic drug concentration was observed, it would be very beneficial to repeat this intervention with a population of epileptic patients with active seizures.

Practical Advice
This study and many others (,. ) indicate no negative effects of participating in regular exercise for epilepsy patients in controlled environments. For outpatients with active seizures it is very important for participants to be supervised by an accredited exercise physiologist and/or a registered nurse to limit the risks associated. A combination of both resistance and cardiovascular training, 2-3 times a week should be endured to achieve maximal health benefits and ensuring that patients are making accurate records of seizure frequency and wellness reports are very important.

Further Information/Resources
For further information regarding epilepsy and exercise, please click the links below:
 * Exercise and Epilpesy, Epilepsy Society https://www.epilepsysociety.org.uk/exercise-and-epilepsy#.XYvlspMzYfE
 * Benefits of Exercise, Epilepsy Foundation https://www.epilepsy.com/living-epilepsy/healthy-living/fitness-and-exercise/benefits-exercise
 * Epilepsy and Exercise, Better Health Channel https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/epilepsy-and-exercise