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Liao W, Lu L, Xiong W, Mu J, Zhou D. Epileptologists' attitudes toward physical exercise and sports for persons with epilepsy in China. Epilepsy Behav Rep 2024; 27:100685. [PMID: 38953099 PMCID: PMC11215944 DOI: 10.1016/j.ebr.2024.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
We undertook a survey among epileptologists in China to explore their attitudes toward physical exercise and sports for persons with epilepsy (PWEs). A total of 288 epileptologists participated. Most recognized the potential benefits of physical exercise and sports for PWEs, including improved cognitive function (74.6 %), alleviation of mental disorders (73.2 %), and enhanced quality of life (83.8 %). Epileptologists overwhelmingly agreed on the importance of discussing and encouraging physical exercise and sports for PWEs (97.4 % and 95.2 %, respectively). Before engagement in physical exercise and sports, most epileptologists considered that the duration of seizure-free status could be shorter if the seizures were typically focal, non-motor, or without impaired awareness (p < 0.05). There was consensus (99.1 %) on the need to grade the risk of related activities. Opinions were divided regarding the use of health certificates for restricting PWEs (favored by 63.2 %). The majority (93.9 %) called for an expert consensus or clinical guidelines in China. In conclusion, epileptologists in China generally demonstrate a positive attitude toward physical exercise and sports for PWEs. Both benefits and risks of these activities have generally been acknowledged. It is recommended to prioritize activities with lower risks and higher benefits. However, the recommendations for PWEs with a lower likelihood of recurrence and less risky seizure types can be more liberal. Urgent development of normative guidance from governmental and professional bodies is warranted.
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Affiliation(s)
- Weihao Liao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan, China
| | - Lu Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Weixi Xiong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jie Mu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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Boylan KA, Dworetzky BA, Baslet G, Polich G, Angela O’Neal M, Reinsberger C. Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders. Epilepsy Behav Rep 2024; 27:100682. [PMID: 38953100 PMCID: PMC11215960 DOI: 10.1016/j.ebr.2024.100682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
Functional neurological disorder (FND) is a common neurologic disorder associated with many comorbid symptoms including fatigue, pain, headache, and orthostasis. These concurrent symptoms lead patients to accumulate multiple diagnoses comorbid with FND, including fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, persistent post-concussive symptoms, and chronic pain. The role of physical activity and exercise has not been evaluated in FND populations, though has been studied in certain comorbid conditions. In this traditional narrative literature review, we highlight some existing literature on physical activity in FND, then look to comorbid disorders to highlight the therapeutic potential of physical activity. We then consider abnormalities in the autonomic nervous system (ANS) as a potential pathophysiological explanation for symptoms in FND and comorbid disorders and postulate how physical activity and exercise may provide benefit via autonomic regulation.
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Affiliation(s)
- Kelly A. Boylan
- Division of Epilepsy and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Barbara A. Dworetzky
- Division of Epilepsy and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Ginger Polich
- Department of Physical Medicine and Rehabilitation, Mass General Brigham, Boston, MA, United States
| | - M. Angela O’Neal
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Claus Reinsberger
- Division of Sports Neurology and Neurosciences, Mass General Brigham Boston, MA, United States
- Institute of Sports Medicine, Paderborn University, Warburger Str. 100, 33098 Paderborn, Germany
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Mueller C, Thomas A, Amara AW, DeWolfe J, Thomas SJ. Effects of exercise on sleep in patients with epilepsy: A systematic review. Epilepsy Behav Rep 2024; 26:100675. [PMID: 38779424 PMCID: PMC11109323 DOI: 10.1016/j.ebr.2024.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Exercise interventions in epilepsy have been shown to improve seizure frequency, physical capacity, quality of life, mood, and cognitive functioning. However, the effectiveness of exercise in improving sleep in epilepsy is less clear. The purpose of this report is to identify the published literature regarding exercise interventions in people with epilepsy to determine 1) what proportion of published clinical trials assess sleep as an outcome, and 2) what benefits of exercise interventions on sleep have been observed. We searched the PubMed, PsycINFO, and SCOPUS electronic databases using the search terms "epilepsy AND [exercise OR physical activity]" and identified 23 articles reporting on 18 unique clinical trials. Nine studies were conducted in adults, five in children, and four in adults and children with active seizures, controlled seizures, or both. Exercise modalities included aerobic exercise, strength training, walking, and yoga, among others, and some also included educational and motivational components. Exercise effects on sleep were tested in four studies, two of which only included indirect measures of sleep- and rest-related fatigue, with mixed results. Of the two reports assessing sleep directly, one reported marginal non-significant improvements in subjective sleep quality and no improvements in objective sleep quality in children after twelve weeks of walking, and the other reported no benefits in subjective sleep quality after twelve weeks of combined aerobic, strength, and flexibility training in adults. Given the health benefits of sleep and detrimental effects of sleep deprivation in epilepsy, epilepsy researchers need to assess the effects of exercise interventions on sleep.
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Affiliation(s)
- Christina Mueller
- University of Alabama at Birmingham, Department of Neurology, 1720 University Blvd, Birmingham, AL 35233, USA
| | - Ashley Thomas
- University of Alabama at Birmingham, Department of Neurology, 1720 University Blvd, Birmingham, AL 35233, USA
| | - Amy W. Amara
- University of Colorado Anschutz Medical Campus, Fitzsimons Building, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Jennifer DeWolfe
- University of Alabama at Birmingham, Department of Neurology, 1720 University Blvd, Birmingham, AL 35233, USA
| | - S. Justin Thomas
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, 1720 University Blvd, Birmingham, AL, 35233, USA
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Kang HJ, Torres K, Kim MS. Differences in health-related quality of life and somatic symptoms in employed and unemployed patients with epilepsy. Epilepsy Behav Rep 2024; 26:100663. [PMID: 38708365 PMCID: PMC11067481 DOI: 10.1016/j.ebr.2024.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 05/07/2024] Open
Abstract
This study compared overall and specific aspects of health-related quality of life (HRQOL) and self-report of somatic, anxiety, and depressive symptoms between employed (n = 71) and unemployed (n = 48) patients with epilepsy (PWE). The Quality of Life in Epilepsy (QOLIE-89) and the Personality Assessment Inventory (PAI) were examined. The unemployed group reported significantly worse overall HRQOL including aspects of HRQOL related to epilepsy, physical health, mental health, and cognitive function. Among these four, physical health related HRQOL revealed the most difference between groups. While there were no differences between the groups in the level of social support and social isolation, the unemployed group reported worse social function with respect to work and driving. The unemployed group reported significantly greater somatic symptoms, but not anxiety and depressive symptoms. When specifically examining the subscales of the Somatic Concerns scale, conversion and health concerns, but not somatization, were greater in the unemployed group. Among the Depression subscales, the unemployed group reported greater physiologically manifested depressive symptoms. These findings suggest that along with optimizing seizure control, identifying and addressing presence of physical limitations, dysfunction, and somatic symptoms are also of importance in the care of PWE, particularly for those who are unemployed.
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Affiliation(s)
- Hyun Jin Kang
- Department of Neurology, University of Washington, United States
| | - Karen Torres
- Department of Neurology, University of Washington, United States
| | - Michelle S. Kim
- Department of Neurology, University of Washington, United States
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Jost J, Müther M, Brandt R, Altuner U, Lemcke L, Stummer W, Völker K, Wiewrodt R, Wiewrodt D. Conceptual development of an intensive exercise program for glioma patients (ActiNO): summary of clinical experience. J Neurooncol 2023:10.1007/s11060-023-04354-y. [PMID: 37306887 PMCID: PMC10322750 DOI: 10.1007/s11060-023-04354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Exercise proved to reduce cancer-related symptoms and prolong survival in some cancer types. However, brain tumor patients are often advised against strenuous exercise. Here, we summarize our experience with a submaximal exercise program for glioma patients: ActiNO (Active in Neuro-Oncology). METHODS Glioma patients were invited to participate in the program. Since 2011, a sports scientist individualized two one-hour sessions per week adapted to the patients' symptoms. One session consisted of bicycle ergometry (average workload: 75% of maximum heart rate), the other of whole-body resistance training. Both sessions were further complimented by coordinative elements. Cardiorespiratory fitness was assessed using the "Physical Work Capacity" procedure. Patients were followed up regularly to assess adherence to the program and disease activity. RESULTS Until December 2019, 45 glioma patients, median-aged 49 years (IQR 42-59), were included in the analysis. Most patients suffered from glioblastoma (58%), followed by diffuse lower-grade astrocytoma (29%). In overall 1828 training sessions, two minor epileptic events occurred (1 speech arrest; 1 focal seizure). During fitness assessment, all patients achieved at least 75% of their age-adjusted maximum heart rate. Peak workload averaged 172 W (95% CI 156-187). Median survival of participating glioblastoma patients was 24.1 months (95% CI 8.6-39.5). CONCLUSION This supervised training program with submaximal exertion was feasible and safe in glioma regardless of WHO grading. Based on these experiences, we initiated a prospective multicenter study to objectify improvements in physical performance and quality of life in patients with glioblastoma.
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Affiliation(s)
- Johanna Jost
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany.
| | - Michael Müther
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany
| | - Ralf Brandt
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany
| | - Ugur Altuner
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany
- Department of Medicine D, University Hospital, University Münster, Münster, Germany
| | - Lars Lemcke
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany
| | - Klaus Völker
- Institute of Sports Science, University Hospital, University Münster, Münster, Germany
| | - Rainer Wiewrodt
- Pulmonary Research Division, Department of Medicine A, University Hospital, University, Münster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, University Hospital, University Münster, Münster, Germany
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Babaei K, Khatiban M, Khazaei M, Tapak L, Shamsaei F. Self-Management and Its Predictors in adult Patients with Epilepsy: A Cross-Sectional Study. Ethiop J Health Sci 2023; 33:507-514. [PMID: 37576177 PMCID: PMC10416336 DOI: 10.4314/ejhs.v33i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Appropriate self-management (SM) is crucial in controlling epilepsy and improving self-efficacy, medication adherence and avoidance of seizure triggers in patients with epilepsy (PWE. The aim of this study was to evaluate SM and its predictors among adult PWE in Iran. Methods This cross-sectional study was conducted in 2021. The participants were 335 adult PWEs that were selected from healthcare settings in Hamadan, Iran. Epilepsy Self-Management Scale (ESMS) was used to measure patients' self-management behaviors. Data were analyzed using the independent samples t-test, Pearson's and Spearman's correlation analyses and multiple linear regression analysis. Results The mean score of SM was 114.37±11, indicating moderate level of SM, and the mean scores of SM in the medication management, seizure management, and safety management subscales were significantly more than the mean scores of the other subscales (P < 0.05). Age, place of residence, marital status, seizure type, seizure frequency, and epilepsy duration significantly predicted 53% of the variance of SM (adjusted R square = 0.532). Conclusion PWEs have moderate SM and need SM-related education, particularly about lifestyle management and information management. Predictors of SM should be considered to boost SM practice.
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Affiliation(s)
- Keivan Babaei
- Ph.D Candidate, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahnaz Khatiban
- Mother and Child Care Research Center, Department of Ethics Education in Medical Sciences, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojtaba Khazaei
- Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Department of Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
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Impact of exercise as a complementary management strategy in people with epilepsy: A randomized controlled trial. Epilepsy Behav 2022; 129:108616. [PMID: 35219171 DOI: 10.1016/j.yebeh.2022.108616] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/13/2022] [Accepted: 02/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To measure the impact of 12 weeks of physical exercise as complementary management strategy on quality of life (QOL) in people with epilepsy (PWE). METHODS In a parallel-group, randomized controlled study with blinded outcome assessment, PWE of 18-65 years old, smartphone users were randomized into two groups. The exercise group was advised minimum 150 min per week of moderate-intense aerobic activity, as per current WHO recommendation [1], in addition to standard medical care; the control group received only standard medical care. QOL was assessed using Quality of Life in Epilepsy (QOLIE-31) inventory [2,3]; physical activity, with Global Physical Activity Questionnaire version 2 (GPAQ), and Pedometer Step Counter (a smartphone-based activity tracker application), at baseline and after 12 weeks. Body weight, body mass index, seizure frequency, and stigma scores (Epilepsy Stigma Scale Austin and colleagues) [4] were also noted. RESULTS One hundred and seventeen PWE were recruited (58 exercise, 59 control). Although there was an improvement in the physical activity correlates after 12 weeks compared to mean values at baseline, the differences were not significant between the groups. The total QOL mean scores at baseline in the exercise and control groups were 64.9 and 63.7 (p = 0.597) and after 12 weeks, 68.4 and 66.9 (p = 0.660), respectively. However, intragroup comparison of energy/fatigue score in the exercise group showed significant change with a p value of 0.009 and intragroup comparison of Overall QOL score in the control group showed a significant change with a p value of 0.003. Similar improvement was seen in stigma scores (p = 0.500) and seizure frequency (p = 0.388) at 12 weeks in exercise and control groups. After 12 weeks, mean values of METS ((metabolic equivalents) were 794.81 and 714.27 (p = 0.159), steps per day were 4018.32 and 3730.0 (p = 0.314), calories spent per day were 173.85 and 159.68 (p = 0.320 and distance walked per day in meters were 2576.52 and 2198.42 (p = 0.072), in the exercise and control groups, respectively. SIGNIFICANCE Regular physical activity for at least 150 min per week, in the form of moderate-intense aerobic exercises resulted in positive yet non-significant improvement of QOL, seizure frequency, and stigma in PWE.
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A 10-day mild treadmill exercise performed before an epileptic seizure alleviates oxidative injury in the skeletal muscle and brain tissues of the rats. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1056192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Szałwińska K, Cyuńczyk M, Kochanowicz J, Witkowska AM. Dietary and lifestyle behavior in adults with epilepsy needs improvement: a case-control study from northeastern Poland. Nutr J 2021; 20:62. [PMID: 34187474 PMCID: PMC8243538 DOI: 10.1186/s12937-021-00704-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several factors predispose individuals with epilepsy to chronic diseases. Among them, nutrition and lifestyle factors have not been sufficiently studied. Therefore, the aim of this study was to evaluate patients with epilepsy in terms of diet, body composition and physical activity compared to healthy sex- and age-matched subjects to investigate whether there are risk factors for nutritional deficiencies and risk factors for the development of metabolic diseases. METHODS The case-control study involved 60 epileptic male and female volunteers and 70 healthy controls matched according to age and sex. Medical information was collected during the study, and a detailed questionnaire regarding eating and lifestyle habits was conducted. Physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ). Nutritional status was assessed by bioelectric impedance. Venous blood samples were taken for lipid and 25-hydroxyvitamin D3 (25(OH)D3) analyses. RESULTS A tendency toward an increase in LDL cholesterol was found in the individuals with epilepsy. Significantly higher body fat and insignificantly higher visceral fat were found in epileptic men than in healthy men. In epileptic women, a tendency toward a lower lean body mass was found. Patients with epilepsy were more sedentary, consumed less cottage cheese, fruit, pulses, nuts and seeds, vitamin C and potassium, and consumed more sugar-sweetened soda, fat and sodium than healthy people. On a positive note, individuals with epilepsy consumed less coffee and alcoholic beverages. More than 80% of the epileptic volunteers had diets that were low in folic acid, vitamin D and calcium, but a similar tendency was observed in the healthy volunteers. A higher percentage of the patients with epilepsy had diets that were low in niacin, vitamin C and potassium than the control group (25% vs. 7, 50% vs. 31% and 73 vs. 56%, respectively). A significantly lower serum concentration of 25(OH)D3 was observed in epileptic individuals and was found to be positively modulated by physical activity. CONCLUSIONS The results indicate that several behavior-related habits, which may predispose epileptic people to cardiovascular disease, need to be improved. For this reason, patients with epilepsy should be provided with more comprehensive medical care, including advice on nutrition and physical activity.
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Affiliation(s)
- Kamila Szałwińska
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland
| | - Monika Cyuńczyk
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Anna M Witkowska
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland.
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Affiliation(s)
- R Antunes
- ESECS, Polytechnic of Leiria, 2411, Portugal; CIEQV - Life Quality Research Centre, Polytechnic of Leiria, 2411, Leiria, Portugal.
| | - R Frontini
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411, Leiria, Portugal
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Feasibility, Safety and Effects of a One-Week, Ski-Based Exercise Intervention in Brain Tumor Patients and Their Relatives: A Pilot Study. J Clin Med 2020; 9:jcm9041006. [PMID: 32252441 PMCID: PMC7231125 DOI: 10.3390/jcm9041006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
A brain tumor diagnosis poses a significant psychological burden and it severely impacts quality of life (QOL), both in patients and relatives. However, comprehensive strategies addressing QOL in this setting remain rare. Here, we aim to share our findings of a one-week ski exercise intervention, with emphasis on feasibility, safety, QOL, and physical exercise. The intervention consisted of week-long daily ski sessions with professional ski guides as well as dedicated physicians present. The participants were handed questionnaires, including distress and QOL items before, during, and after the intervention. Using fitness watches, exercise intensity was also tracked at these timepoints. During the intervention, patients were checked for adverse events daily. Fifteen participants, nine patients after multidisciplinary treatment, and six relatives were included in the study. Additionally, 13 children participated in the exercise, but not in the study. All of the participants completed the entire program. No severe adverse events were documented during daily checks. There was a strong increase in quantified activity and QOL with a corresponding decrease in distress during the intervention, and, partly, afterwards. This prospective brain tumor rehabilitation study demonstrates the feasibility and safety of challenging ski exercise in brain tumor patients. The findings also underline the exercise-mediated QOL benefits, emphasizing the need for more comprehensive brain tumor rehabilitation programs.
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