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Effects of physical exercise in people with epilepsy: A systematic review and meta-analysis

Published:November 15, 2022DOI:https://doi.org/10.1016/j.yebeh.2022.108959

      Highlights

      • Exercise is a feasible therapy for people with epilepsy.
      • The quality of life of people with epilepsy can be improved through exercising.
      • Exercise does not reduce the frequency of seizures in people with drug resistant epilepsy.

      Abstract

      Background

      Studies suggest that physical exercise lead to improvements in the psychosocial dimension, associated comorbidities as well as to a higher quality of life (QoL) in people with epilepsy. However, there is a need to provide evidence-based guidelines for its prescription. Therefore, this review aimed to systematically evaluate and meta-analyze the available data on the potential effects of physical exercise training programs in people with epilepsy.

      Methods

      Four electronic databases (MEDLINE/PubMed, PEDro, SPORTDiscuss and Scopus) were searched systematically from their inception until April 2022 for randomized controlled trials (RCTs), comparative studies and non-controlled studies that provided information regarding the effects of physical exercise training programs on people with epilepsy. The studies’ methodological quality assessment was performed using the PEDro, the MINORS and the Quality Assessment Tool for Before–After Studies with No Control Group scales. For the meta-analysis, inverse variance or generic inverse variance was use to report mean difference or standardized mean difference for continuous data and their 95% confidence intervals (CI). Heterogeneity was assessed with the Chi-squared test and I2 test.

      Results

      After removing duplicated studies, 82 results were retrieved by the literature search and 14 were eligible for full text search. Finally, 14 studies with a methodological quality ranging from good to low quality met the inclusion criteria. Totally, 331 people with epilepsy were evaluated. Significant changes between preand post-intervention results in the exercise intervention groups were observed for QoL, fitness level, psycho-affective and neurocognitive outcomes. Findings from the meta-analysis indicated that moderate exercise led to a non-significant decrease (p = 0.08, Chi-squared test) in seizure frequency (SMD 0.33 95% CI 0.04; 0.70), while a significant effect of exercise was observed on QoL with a mean improvement of 4.72 percentage points (95% CI 0.58; 8.86, p = 0.03).

      Conclusion

      Improvements on QoL, fitness level, psycho-affective and neurocognitive outcomes can be achieved through exercise training in people with epilepsy. Altogether, the findings suggest that people with epilepsy can benefit from exercising.

      Keywords

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      References

        • Falco-Walter J.
        Epilepsy-definition, classification, pathophysiology, and epidemiology.
        Semin Neurol. 2020; 40: 617-623https://doi.org/10.1055/s-0040-1718719
        • Uepping P.
        • Hamer H.
        • Scholten J.
        • Kostev K.
        Physical and mental health comorbidities of patients with epilepsy in Germany - A retrospective cohort study.
        Epilepsy Behav. 2021; 117: 107857https://doi.org/10.1016/j.yebeh.2021.107857
        • Murray C.J.L.
        • Vos T.
        • Lozano R.
        • Naghavi M.
        • Flaxman A.D.
        • Michaud C.
        • et al.
        Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2197-2223
        • Löscher W.
        • Klein P.
        The pharmacology and clinical efficacy of Antiseizure medications: from bromide salts to cenobamate and beyond.
        CNS Drugs. 2021; 35: 935-963https://doi.org/10.1007/s40263-021-00827-8
        • Chen B.
        • Choi H.
        • Hirsch L.J.
        • Katz A.
        • Legge A.
        • Buchsbaum R.
        • et al.
        Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy.
        Epilepsy Behav EB. 2017; 76: 24-31
        • Svalheim S.
        • Sveberg L.
        • Mochol M.
        • Taubøll E.
        Interactions between antiepileptic drugs and hormones.
        Seizure. 2015; 28: 12-17https://doi.org/10.1016/j.seizure.2015.02.022
        • Engel Jr., J.
        The current place of epilepsy surgery.
        Curr Opin Neurol. 2018; 31: 192-197https://doi.org/10.1097/WCO.0000000000000528
        • Liu G.
        • Slater N.
        • Perkins A.
        Epilepsy: treatment options.
        Am Fam Physician. 2017; 96: 87-96
        • Johnson E.C.
        • Helen Cross J.
        • Reilly C.
        Physical activity in people with epilepsy: A systematic review.
        Epilepsia. 2020; 61: 1062-1081https://doi.org/10.1111/epi.16517
        • Cartagena Y.
        • Cardona-Gallón D.C.
        • Isaza S.P.
        • Ladino L.D.
        Exercise as a therapeutic strategy in epilepsy: a literature review.
        Rev Neurol. 2020; 71: 31-37https://doi.org/10.33588/rn.7101.2020028
        • 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
        • van den Bogard F.
        • Hamer H.M.
        • Sassen R.
        • Reinsberger C.
        Sport and physical activity in epilepsy.
        Dtsch Arztebl Int. 2020; 117: 1-6https://doi.org/10.3238/arztebl.2020.0001
      1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 10(1):89. https://doi.org/10.1136/bmj.n71.

        • Silverman S.R.
        • Schertz L.A.
        • Yuen H.K.
        • Lowman J.D.
        • Bickel C.S.
        Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury.
        Spinal Cord. 2012; 50: 718-727https://doi.org/10.1038/sc.2012.78
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological Index for Non-Randomized Studies (MINORS): development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716https://doi.org/10.1046/j.1445-2197.2003.02748.x
        • Malgie J.
        • Schoones J.W.
        • Pijls B.G.
        Decreased mortality in COVID-19 patients treated with Tocilizumab: A rapid systematic review and meta-analysis of observational studies.
        Clin Infect Dis. 2020; 72: e742-e749https://doi.org/10.1093/cid/ciaa1445
      2. National Institutes of Health [Internet]. Bethesda (MD): Quality assessment tool for studies with no control group; [cited 2022 June 20]. Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/before-after.

        • Vitagliano A.
        • Noventa M.
        • Di Spiezio S.A.
        • Saccone G.
        • Gizzo S.
        • Borgato S.
        • et al.
        Uterine fibroid size modifications during pregnancy and puerperium: evidence from the first systematic review of literature.
        Arch Gynecol Obstet. 2018; 297: 823-835https://doi.org/10.1007/s00404-017-4621-4
        • Åkerlund S.
        • Varkey E.
        • Klecki J.
        • Zelano J.
        • Ben-Menachem E.
        Randomized controlled trial of moderate cardiovascular exercise for patients with drug-resistant epilepsy.
        Epilepsy Behav. 2021; 124: 108335https://doi.org/10.1016/j.yebeh.2021.108335
        • 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: 44-56https://doi.org/10.1016/j.yebeh.2019.04.020
        • 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: 1649-1658https://doi.org/10.1111/epi.16588
        • Häfele C.A.
        • Rombaldi A.J.
        • Feter N.
        • Häfele V.
        • Gervini B.L.
        • Domingues M.R.
        • et al.
        Effects of an exercise program on health of people with epilepsy: A randomized clinical trial.
        Epilepsy Behav. 2021; 117: 107904https://doi.org/10.1016/j.yebeh.2021.107904
        • Heise J.
        • Buckworth J.
        • McAuley J.W.
        • Long L.
        • Kirby T.E.
        Exercise training results in positive outcomes in persons with epilepsy.
        J Clin Exerc Physiol. 2002; 4: 79-84https://doi.org/10.1006/ebeh.2001.0271
        • Lundgren T.
        • Dahl J.
        • Yardi N.
        • Melin L.
        Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial.
        Epilepsy Behav. 2008; 13: 102-108https://doi.org/10.1016/j.yebeh.2008.02.009
        • 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: 592-600https://doi.org/10.1006/ebeh.2001.0271
        • Vooturi S.
        • Lakshmi A.R.
        • Jayalakshmi S.
        Adherence to exercise in people with epilepsy.
        Eur J Physiother. 2022; : 1-6https://doi.org/10.1080/21679169.2022.2038264
        • Sathyaprabha T.N.
        • Satishchandra P.
        • Pradhan C.
        • Sinha S.
        • Kaveri B.
        • Thennarasu K.
        • et al.
        Modulation of cardiac autonomic balance with adjuvant yoga therapy in patients with refractory epilepsy.
        Epilepsy Behav. 2008; 12: 245-252https://doi.org/10.1016/j.yebeh.2007.09.006
        • Eom S.
        • Lee M.K.
        • Park J.-H.
        • Jeon J.Y.
        • Kang H.-C.
        • Lee J.S.
        • et al.
        The impact of an exercise therapy on psychosocial health of children with benign epilepsy: a pilot study.
        Epilepsy Behav. 2014; 37: 151-156https://doi.org/10.1016/j.yebeh.2014.06.017
        • Eom S.
        • Lee M.K.
        • Park J.-H.
        • Lee D.
        • Kang H.-C.
        • Lee J.S.
        • et al.
        The impact of a 35-week long-term exercise therapy on psychosocial health of children with benign epilepsy.
        Pediatr Neurol. 2016; 31: 985-990https://doi.org/10.1177/0883073816634859
        • Eriksen H.R.
        • Ellertsen B.
        • Grønningsæter H.
        • Nakken K.O.
        • Løyning Y.
        • Ursin H.
        Physical exercise in women with intractable epilepsy.
        Epilepsia. 1994; 35: 1256-1264https://doi.org/10.1111/j.1528-1157.1994.tb01797.x
        • 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: 88-94https://doi.org/10.1111/j.1528-1157.1990.tb05365.x
        • Conant K.D.
        • Morgan A.K.
        • Muzykewicz D.
        • Clark D.C.
        • Thiele E.A.
        A karate program for improving self-concept and quality of life in childhood epilepsy: Results of a pilot study.
        Epilepsy Behav. 2008; 12: 61-65https://doi.org/10.1016/j.yebeh.2007.08.011
        • Scheffer I.E.
        • Berkovic S.
        • Capovilla G.
        • Connolly M.B.
        • French J.
        • Guilhoto L.
        • et al.
        ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology.
        Epilepsia. 2017; 58: 512-521https://doi.org/10.1111/epi.13709
        • Sánchez-Lastra M.A.
        • Martínez-Aldao D.
        • Molina A.J.
        • Ayán C.
        Pilates for people with multiple sclerosis: A systematic review and meta-analysis.
        Mult Scler Relat Disord. 2019; 28: 199-212https://doi.org/10.1016/j.msard.2019.01.006
        • Arida R.M.
        • Scorza F.A.
        • da Silva S.G.
        • Schachter S.C.
        • Cavalheiro E.A.
        The potential role of physical exercise in the treatment of epilepsy.
        Epilepsy Behav. 2010; 17: 432-435https://doi.org/10.1016/j.yebeh.2010.01.013
        • Reilly C.
        • Atkinson P.
        • Das K.B.
        • Chin R.F.
        • Aylett S.E.
        • Burch V.
        • et al.
        Academic achievement in school-aged children with active epilepsy: a population-based study.
        Epilepsia. 2014; 55: 1910-1917https://doi.org/10.1111/epi.12826
        • Partanen E.
        • Laari S.
        • Kantele O.
        • Kämppi L.
        • Nybo T.
        Associations between cognition and employment outcomes after epilepsy surgery.
        Epilepsy Behav. 2022; 131108709https://doi.org/10.1016/j.yebeh.2022.108709
        • Ayanda K.A.
        • Sulyman D.
        Determinants of quality of life in adults living with epilepsy.
        Ann Afr Med. 2020; 19: 164-169https://doi.org/10.4103/aam.aam_20_18
      3. Celis-Morales CA, Lyall DM, Anderson J, Iliodromiti S, Fan Y, Ntuk UE, et al. The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: evidence from 498 135 UK-Biobank participants. Eur Heart J 2017; 38(2):116–22. https://doi.org/10.1093/eurheartj/ehw249.

        • Chen M.
        • Wu X.
        • Zhang B.
        • Shen S.
        • He L.
        • Zhou D.
        Associations of overweight and obesity with drug-resistant epilepsy.
        Seizure. 2021; 92: 94-99https://doi.org/10.1016/j.seizure.2021.07.019
        • Collard S.S.
        • Ellis-Hill C.
        How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy.
        Epilepsy Behav. 2017; 70: 66-71https://doi.org/10.1016/j.yebeh.2017.03.004
        • Brna P.M.
        • Gordon K.E.
        • Woolridge E.
        • Dooley J.M.
        • Wood E.
        Perceived need for restrictions on activity for children with epilepsy.
        Epilepsy Behav EB. 2017; 73: 236-239https://doi.org/10.1016/j.yebeh.2017.05.012