Research Article| Volume 131, 108705, June 2022

Download started.


Neurologists’ knowledge of and attitudes toward physical exercise for people with epilepsy in Latin America


      • One-third of neurologists had no information about physical exercise and PWE.
      • Neurologists are not aware of Physical/Sports Task Force of the ILAE recommendations.
      • Neurologists believe in the beneficial effects of exercise for PWE.



      Despite the favorable effects of exercise in people with epilepsy (PWE), the lower participation in physical/sports activities may be partly due to inadequate knowledge and attitudes of health professional about their benefits. In this regard, in 2016, the International League Against Epilepsy (ILAE) through its Task Force on Sports and Epilepsy published a consensus paper that provided general guidance concerning participation in exercise/sport activities for PWE. We investigated views and attitudes toward physical exercise practice among neurologists in Latin America.


      A 22-item cross-sectional online questionnaire-based study among neurologists included the following: (1) profile of participating neurologists, (2) doctors’ attitudes and perceptions about physical/sport activities for PWE, and (3) neurologist experience concerning patient’s report about their involvement in physical/sport activities.


      In total, 215 of 519 neurologists from 16 different countries returned the questionnaire. Although about one-third of neurologists had no information about the effect of exercise on epilepsy, and 60% of them did not know the published recommendations of the ILAE Task Force on Sports and Epilepsy, the majority (92.5%) advised the practice of exercise, were aware of sport activities for their patients and agreed that exercise can reduce comorbidities associated with epilepsy (X2 = 249.34; p < 0.001). Most of the neurologists did not believe that exercise is a seizure-inducing factor, but more than half would restrict their patients with uncontrolled seizures for exercise practice (X2 = 250.77; p < 0.001). Most barriers considered by PWE in the past, currently are not viewed by neurologists and their patients (X2 = 249.34; p < 0.001).


      While this study reveals that neurologists have some knowledge gaps in attitudes toward physical exercise for PWE, encouraging attitudes were observed by neurologists. Considering that physicians can impact on patient confidence and decision, a better communication between neurologists and their patients concerning the benefits of exercise can increase PWE participation in physical/sports activities. To improve this scenario, more efforts should be made to increase the neurologists’ knowledge and perceptions on this issue.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kerrr M.
        The impact of epilepsy on patients' lives.
        Acta Neurol Scand Suppl. 2012; 194: 1-9
        • Perucca E.
        • Tomson T.
        The pharmacological treatment of epilepsy in adults.
        Lancet Neurol. 2011; 10: 446-456
        • Kwan P.
        • Arzimanoglou A.
        • Berg A.T.
        • Brodie M.J.
        • Allen Hauser W.
        • Mathern G.
        • et al.
        Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.
        Epilepsia. 2010; 51: 1069-1077
        • Arida R.M.
        • de Almeida A.-C.
        • Cavalheiro E.A.
        • Scorza F.A.
        Experimental and clinical findings from physical exercise as complementary therapy for epilepsy.
        Epilepsy Behav. 2013; 26: 273-278
        • Hartmann N.
        • Neininger M.P.
        • Bernhard M.K.
        • Syrbe S.
        • Nickel P.
        • Merkenschlager A.
        • et al.
        Use of complementary and alternative medicine (CAM) by parents in their children and adolescents with epilepsy – prevelance, predictors and parents’ assessment.
        Eur J Paediatr Neurol. 2016; 20: 11-19
        • Arida R.M.
        • Scorza F.A.
        • Cavalheiro E.A.
        Favorable effects of physical activity for recovery in temporal lobe epilepsy.
        Epilepsia. 2010; 51: 76-79
        • Arida R.M.
        Physical exercise and seizure activity.
        Biochim Biophys Acta Mol Basis Dis. 2021; 1867
        • Capovilla G.
        • Kaufman K.R.
        • Perucca E.
        • Moshé S.L.
        • Arida R.M.
        Epilepsy, seizures, physical exercise, and sports: A report from the ILAE Task Force on Sports and Epilepsy.
        Epilepsia. 2016; 57: 6-12
        • Carrizosa-Moog J.
        • Ladino L.D.
        • Benjumea-Cuartas V.
        • Orozco-Hernández J.P.
        • Castrillón-Velilla D.M.
        • Rizvi S.
        • et al.
        Epilepsy, physical activity and sports: a narrative review.
        Can J Neurol Sci. 2018; 45: 624-632
        • Ogunyemi A.O.
        • Gomez M.R.
        • Klass D.W.
        Seizures induced by exercise.
        Neurology. 1988; 38: 633-634
        • Kamel J.T.
        • Badawy R.A.
        • Cook M.J.
        Exercise-induced seizures and lateral asymmetry in patients with temporal lobe epilepsy.
        Epilepsy Behav Case Rep. 2014; 2: 26-30
        • Steinhoff B.J.
        • Neusiiss K.
        • Thegeder H.
        • Reimers C.D.
        Leisure time activity and physical fitness in patients with epilepsy.
        Epilepsia. 1996; 37: 1221-1227
        • Arida R.M.
        • Scorza F.A.
        • de Albuquerque M.
        • Cysneiros R.M.
        • de Oliveira R.J.
        • Cavalheiro E.A.
        Evaluation of physical exercise habits in Brazilian patients with epilepsy.
        Epilepsy Behav. 2003; 4: 507-510
      1. ILAE, 2012.

        • Judge M.
        How to interpret chi-squared.
        (Retrieved from)
      2. Shen C, Panda S, Vogelstein JT. The chi-square test of distance correlation. J Comput Graph Stat 2021; arXiv: 1912.12150.

        • Shawahna R.
        • Abdelhaq I.
        Important knowledge items with regard to the benefits of exercise for patients with epilepsy: Findings of a qualitative study from Palestine.
        Epilepsy Behav. 2020; 108
        • Dubow J.S.
        • Kelly J.P.
        Epilepsy in sports and recreation.
        Sports Med. 2003; 33: 499-516
        • Howard G.M.
        • Radloff M.
        • Sevier T.L.
        Epilepsy and sports participation.
        Curr Sports Med Rep. 2004; 3: 15-19
        • Arida R.M.
        • Cavalheiro E.A.
        • da Silva A.C.
        • Scorza F.A.
        Physical activity and epilepsy: proven and predicted benefits.
        Sports Med. 2008; 38: 607-615
        • Asadi-Pooya A.A.
        • Homayoun M.
        • Sharifi S.
        Complementary and integrative medicine in epilepsy: What patients and physicians perceive.
        Epilepsy Behav. 2019; 101
        • Asadi-Pooya A.A.
        • Brigo F.
        • Lattanzi S.
        • Karakis I.
        • Asadollahi M.
        • Trinka E.
        • et al.
        Complementary and alternative medicine in epilepsy: A global survey of physicians' opinions.
        Epilepsy Behav. 2021; 117
        • Nakken K.O.
        • Bjørholt P.G.
        • Johannessen S.I.
        • LoSyning T.
        • Lind E.
        Effect of physical training on aerobic capacity, seizure occurrence, and serum level of antiepileptic drugs in adults with epilepsy.
        Epilepsia. 1990; 31: 88-94
        • McAuley J.W.
        • Long L.
        • Heise J.
        • Kirby T.
        • Buckworth J.
        • Pitt C.
        • et al.
        A prospective evaluation of the effects of a 12-week outpatient exercise program on clinical and behavioral outcomes in patients with epilepsy.
        Epilepsy Behav. 2001; 2: 592-600
        • Biddle S.
        Physical activity and mental health: evidence is growing.
        World Psychiatry. 2016; 15: 176-177
        • Allendorfer J.B.
        • Brokamp G.A.
        • Nenert R.
        • Szaflarski J.P.
        • Morgan C.J.
        • Tuggle S.C.
        • et al.
        A pilot study of combined endurance and resistance exercise rehabilitation for verbal memory and functional connectivity improvement in epilepsy.
        Epilepsy Behav. 2019; 96: 44-56
        • Feter N.
        • Alt R.
        • Häfele C.A.
        • da Silva M.C.
        • Rombaldi A.J.
        Effect of combined physical training on cognitive function in people with epilepsy: Results from a randomized controlled trial.
        Epilepsia. 2020; 61: 1649-1658
        • Arida R.M.
        • Teixeira-Machado L.
        The contribution of physical exercise to brain resilience.
        Front Behav Neurosci. 2021; 14626769
        • Vancini R.L.
        • de Lira C.A.B.
        • Scorza F.A.
        • de Albuquerque M.
        • Sousa B.S.
        • de Lima C.
        • et al.
        Cardiorespiratory and electroencephalographic responses to exhaustive acute physical exercise in people with temporal lobe epilepsy.
        Epilepsy Behav. 2010; 19: 504-508
        • de Lima C.
        • Vancini R.L.
        • Arida R.M.
        • Guilhoto L.M.F.F.
        • de Mello M.T.
        • Barreto A.T.
        • et al.
        Physiological and electroencephalographic responses to acute exhaustive physical exercise in people with juvenile myoclonic epilepsy.
        Epilepsy Behav. 2011; 22: 718-722
        • Gotze W.
        • Kubicki S.
        • Munter M.
        • et al.
        Effect of physical exercise on seizure threshold.
        Dis Nerv Syst. 1967; 28: 664-667
        • Gordon K.E.
        • Dooley J.M.
        • Brna P.M.
        Epilepsy and activity–a population-based study.
        Epilepsia. 2010; 51: 2254-2259
        • Alexander H.B.
        • Wright C.J.
        • Taplinger D.H.
        • Fountain N.B.
        Incidence of seizure exacerbation and injury related to football participation in people with epilepsy.
        Epilepsy Behav. 2020; 104106888
        • Roth D.L.
        • Goode K.T.
        • Williams V.L.
        • Faught E.
        Physical exercise, stressful life experience, and depression in adults with epilepsy.
        Epilepsia. 1994; 35: 1248-1255
        • de Lima C.
        • de Lira C.A.B.
        • Arida R.M.
        • Andersen M.L.
        • Matos G.
        • de Figueiredo Ferreira Guilhoto L.M.
        • et al.
        Association between leisure time, physical activity, and mood disorder levels in individuals with epilepsy.
        Epilepsy Behav. 2013; 28: 47-51
        • Häfele C.A.
        • Freitas M.P.
        • da Silva M.C.
        • Rombaldi A.J.
        Are physical activity levels associated with better health outcomes in people with epilepsy?.
        Epilepsy Behav. 2017; 72: 28-34
        • Arida R.M.
        • Cavalheiro E.A.
        • Scorza F.A.
        From depressive symptoms to depression in people with epilepsy: contribution of physical exercise to improve this picture.
        Epilepsy Res. 2012; 99: 1-13
        • Wong J.
        • Wirrell E.
        Physical activity in children/teens with epilepsy compared with that in their siblings without epilepsy.
        Epilepsia. 2006; 47: 631-639
        • Noble A.J.
        • Marson A.G.
        Which outcomes should we measure in adult epilepsy trials? The views of people with epilepsy and informal carers.
        Epilesy Behav. 2016; 59: 105-110
        • Eriksen H.R.
        • Ellertsen B.
        • Gronningsaeter H.
        • Nakken K.O.
        • Loyning Y.
        • Ursin H.
        Physical exercise in women with intractable epilepsy.
        Epilepsia. 1994; 35: 1256-1264