Randomized controlled trial of moderate cardiovascular exercise for patients with drug-resistant epilepsy

Sara Åkerlund; Emma Varkey; Judith Klecki; Johan Zelano; Elinor Ben-Menachem

doi:10.1016/j.yebeh.2021.108335

Randomized controlled trial of moderate cardiovascular exercise for patients with drug-resistant epilepsy

Epilepsy Behav. 2021 Sep 30:124:108335. doi: 10.1016/j.yebeh.2021.108335. Online ahead of print.

Authors

Sara Åkerlund¹, Emma Varkey¹, Judith Klecki², Johan Zelano³, Elinor Ben-Menachem⁴

Affiliations

¹ Region Västra Götaland, Sahlgrenska University Hospital/Östra, Department of Occupational and Physiotherapy, Gothenburg, Sweden; Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden.
³ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden.
⁴ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden. Electronic address: elinor.ben-menachem@neuro.gu.se.

PMID: 34601232
DOI: 10.1016/j.yebeh.2021.108335

Abstract

Objective: The primary research question of this study was whether a moderate cardiovascular exercise program can reduce seizure frequency in patients with focal drug-resistant epilepsy (DRE). The hypothesis is that cardiovascular fitness will reduce seizure frequency in persons with epilepsy (PWE).

Methods: Twenty-eight patients were randomized into two groups; exercise or relaxation. The exercise group were given an ergometric bicycle sent to their home to be used for 150 min/week, 30 min/day for 5 days a week for the study period of 6 months. Participants in the relaxation group were given audio muscular relaxation exercises to be performed for 20 min at least five times per week for the study period of 6 months. Seizure counts and exercise/relaxation sessions were registered daily in a written diary. Both groups received monthly motivational telephone calls. Seizures, anxiety, and depression symptom ratings (Hospital Anxiety and Depression Scale (HADS)), health status ratings (RAND-36), aerobic capacity (estimated VO₂max), self-efficacy for exercise (SEE), level of physical activity, and adverse events were measured at the baseline and after the 6 months of intervention. CONSORT guidelines were followed.

Results: Twenty-two patients completed the intervention. There were no significant changes in seizure frequency in either of the groups. Six months of moderate exercise did increase the level of physical activity and maximal oxygen uptake.

Significance: Moderate exercise did not affect seizure frequency in this study. The patients in the exercise group did increase their estimated VO_2max, which is an important indicator for health, without deterioration of seizure frequency. This was accomplished with only minimal support from a physiotherapist every month. To exercise at home at a moderate intensity level with regular support may therefore be an option for patients with epilepsy. The patients in the exercise group increased their level of physical activity significantly, which indicates that they were compliant to the treatment.

Keywords: Anti-seizure medication; Physical activity; Physical fitness; Physical training.