Exercise Programming and Sports Participation for Individuals with Epilepsy
By Jennifer Green, MS
|Jennifer Green, NCHPAD Visiting Information Specialist
Epilepsy may not necessarily be a lifetime condition; some forms of this neurological disorder are limited to particular stages of childhood or events such as pregnancy. There is no cure per se, but epilepsy can generally be controlled with medication. Like any other chronic condition, epilepsy can often severely affect an individual's physical and mental health, including interfering with normal daily activities.
While some medical literature in the past reported that seizures could be induced by exercise, there are also more recent reports that exercise can be advantageous to those with epilepsy. Newly emerging recommendations concerning athletes and the risk of head injuries has once more raised the potential correlation between exercise and seizures. So there are really two imperative questions to be pondered: Can exercise be beneficial to those with seizures? And given new recommendations on avoiding the risks of concussions, now identified as traumatic brain injuries, can exercise be dangerous for those with epilepsy?
According to the literature, exercise, especially aerobic exercise, undoubtedly benefits people with epilepsy due to the fact that it often reduces seizure frequency, relieves depression, reduces social isolation, and promotes cardiac and general health. Aerobic exercise should focus on using large muscle groups with goals to increase VO2max, work rate, and endurance. An intensity goal should be 60% to 90% of their peak work rate for 3 to 5 days/week with sessions lasting 20 to 40 minutes in length. If a client cannot complete 20 minutes of consecutive physical activity, multiple, short bouts of activity can be done to reach that goal. The intensity and duration of the aerobic mode of exercise should be increased appropriately throughout the course of the exercise program.
Strengthening exercises are also encouraged and should be done to improve general fitness and prevent muscle atrophy. It is suggested to create a program that begins with low resistance and high repetitions. Appropriate exercise progression should be done throughout the course of the program.
With few exceptions, regular physical activity is recognized as beneficial to people, including those with epilepsy. Several studies have shown that exercise training in individuals with epilepsy improves functional capacity and confers psychological and social benefits as well. Exercise does not seem to influence the average frequency of seizures or the serum concentrations of antiepileptic drugs to a clinically important degree. If seizures are controlled, persons with epilepsy are encouraged to participate in most athletic activities, including collision and contact sports. It is important that the individual with epilepsy feel normal and reinforce a positive self-image.
Individuals with epilepsy can participate in almost all sports and physical activities, provided they do so using common sense and some restrictions when indicated. The critical factor in recommending and planning exercise programs for individuals with epilepsy is seizure control. The primary concern is that the individual could risk bodily harm if a seizure should occur, especially in light of the type of activity he or she is participating in. Thus, the risk of exercise depends on the type of seizure and type of activity.
When advising people with epilepsy on choosing physical and leisure activities, take into consideration three categories:
1.) Sports with no restrictions
2.) Sports with restrictions (safety precautions, e.g., helmet when bicycling, life jacket in boats)
3.) Sports that are prohibited (e.g., rock or rope climbing, hang gliding, parachuting, unsupervised swimming, diving, and motor sports)
According to research and statistics, many individuals with epilepsy are overprotected and lead isolated and sedentary lives. Thus, they tend to be physically unfit and to avoid sport participation. However, studies have also shown that people with epilepsy can achieve the same physiological and psychological benefits from regular physical activity as other individuals without epilepsy. By considering the type of activity an individual participates in using the categories above and taking proper safety precautions during those activities, individuals with epilepsy can take full advantage of the wide range of available sports, recreation, and exercise programs.
When creating an exercise program or sports participation for individuals with epilepsy, there are several elements to consider. The first is that if an exercise test is suggested based on the ACSM risk stratification prior to beginning an exercise program, standard exercise testing can be used as long as seizures are controlled. Some research has shown that strenuous exercise may precipitate seizures in unfit individuals; therefore, those administering the test should be alert, especially during and immediately after maximal testing. Some medications that may be used to control seizures and are commonly used by individuals with epilepsy may cause side effects that could affect the test or one's participation in an exercise program, such as lethargy, loss of coordination, tremors, weight changes, and inattention. Also, as training adaptations occur, for example, weight loss or gain, doses of medications may need to be adjusted. It is important that you advise your client to keep communication open with their doctors and alert them if there is a change in weight status.
Several factors that can influence or provoke seizures have been postulated, including fatigue, stress of competition, hypoxia, hypothermia, and hypoglycemia; however, no studies to date have shown conclusively that sport participation provokes seizures. While regular physical activity is beneficial to the individual with epilepsy, participation in certain sporting activities (e.g., scuba diving, rock climbing, boxing, and other combative sports) is contraindicated. However, it is important to keep in mind this list of contraindicated activities is small and individuals with epilepsy should take full advantage of their abilities to participate in sports, recreation, and exercise programming. However, if by chance, exercise is identified as a seizure precipitant, then an exercise program can typically be designed that will allow the person to exercise safely and possibly even avoid the factor that exacerbates seizures.
Arida, R. M., Cavalheiro, E. A., Silva, A. C. d., & Scorza, F. A. (2008). Physical activity and epilepsy: Proven and predicted benefits. Sports Medicine, 38(7), 607.
Arida, R. M., Scorzab, F. A., Gomes da Silvaa, S., Schachterc, S. C., & Abrão Cavalheirob, E. (2010). The potential role of physical exercise in the treatment of epilepsy. Epilepsy and Behavior, 17(4), 432.
Durstine, J. L., & Moore, G. E. (2003). ACSM exercise management for persons with chronic diseases and disabilities (2nd ed.). Champaign, IL: Human Kinetics.
Elliott, J. O., Lu, B., Moore, J. L., McAuley, J. W., & Long, L. (2008). Exercise, diet, health behaviors, and risk factors among persons with epilepsy based on the California Health Interview Survey, 2005. Epilepsy and Behavior, 2(307).
Please send any questions or comments to Jennifer Green at Jennifer Green.
Please send any questions or comments to Jennifer Green at Jennifer Green.