Role of exercise capacity on psychosocial function, physical activity, and cognition in people with epilepsy

In people with epilepsy (PWE), there is limited evidence regarding the role of exercise capacity on psychological function, fatigue, sleep, physical activity, and cognition. We aimed to determine the status of exercise capacity and factors such as seizure and epilepsy type, lifestyle factors, and type of antiseizure medication.

A total of 76 PWE and 83 age, sex, and BMI-matched healthy controls were included. Anxiety (Generalized Anxiety Disorder-7-GAD-7), depression (Beck Depression Inventory-BDI), fatigue (Fatigue Severity Scale-FSS), sleep quality (Pittsburgh Sleep Quality Index-PSQI), physical activity (International Physical Activity Questionnaire-Short Form-IPAQ-SF), cognition (Montreal Cognitive Assessment-MoCA), and exercise capacity (Six-Minute Walk test-6MWT) were evaluated. The VO_2max (maximal oxygen uptake) of the participants was predicted based on the distance walked during the 6MWT using Mänttäri equations. The sample was divided into low, moderate, and high-fitness groups on VO_2max estimated using the 6MWT for both groups.

Fifty-three PWE had low cardiorespiratory fitness. In PWE with low fitness, lower MoCA scores were found compared with the moderate fitness group (p = 0.031). Among the healthy controls, those with moderate fitness had significantly lower BDI scores compared with those with low fitness (p = 0.033). PWE who engaged in regular exercise had greater 6MWT distances and estimated VO_2max than those who did not exercise regularly (p < 0.05). There was no difference in the 6MWT and estimated VO_2max for smoking, physical activity level, types of seizure, epilepsy, and antiseizure medication in the PWE and healthy controls (p > 0.05). A shorter distance walked at 6MWT was correlated with lower MoCA, higher BMI, BDI, and FSS, and longer epilepsy duration in PWE (p < 0.05). Multivariable linear regression analysis also indicated that the 6MWT distance was independently associated with MoCA in PWE (B = 3.70, p = 0.028).

PWE appear to have low cardiorespiratory fitness. A decline in exercise capacity was associated with a greater risk of impaired cognitive function in PWE. Aerobic capacity should be encouraged due to its proven health benefits and role in maintaining exercise ability.