Questions about Physical Fitness and Exercise in Children and Teens with Epilepsy
1.What are the physical benefits of regular exercise in children?
There is substantial evidence that promotion of regular exercise in children is associated with positive health outcomes in adulthood. Obesity is a growing epidemic and over one-third of children in North America are either overweight or obese. Regular physical exercise has been shown to reduce the risk of obesity, heart disease, high blood pressure, diabetes and osteoporosis. Studies have shown that adults with epilepsy have higher rates of many of these conditions compared to those without epilepsy. Therefore, regular physical exercise in children and teens has significant potential to reduce preventable diseases and improve physical health long-term.
2. What are the psychological benefits of regular exercise?
Most children enjoy physical activities such as riding their bicycles, team sports, swimming and running. Regular exercise has been shown to have positive effects on mood and self-esteem. Participation in team sports teaches children and teens cooperation and discipline, in addition to encouraging social interaction with their peers. Therefore, participation in regular physical activity has beneficial effects on emotional and social well-being.
3. Are there special concerns for children with epilepsy?
Parents of children with epilepsy or the children themselves are often reluctant to participate in physical activity for fear that exercise might provoke a seizure. While rare epilepsies can be provoked with overheating (Dravet syndrome), most children with epilepsy are able to participate in vigorous aerobic exercise such as running, aerobics, cycling, etc. without an increased risk of seizures. Some medications, such as topiramate (Topamax) or zonisamide (Zonegran), may reduce the body’s ability to sweat, increasing the risk of overheating. Patients taking these medications should ensure they take adequate hydration when exercising and watch for evidence of overheating.
Some people also worry that overbreathing (hyperventilating) may result in a seizure. The most common seizure that can be induced by overbreathing is an absence seizure. However, absence seizures occur very infrequently with exercise, as overbreathing in that setting is compensatory for the extra work the body is doing.
Many families also worry about contact sports, fearing that a head injury could provoke seizures or that there may be a higher risk of bodily injury. Again, the likelihood of head trauma and injury in supervised team sports is low. Most children with epilepsy should be encouraged to wear adequate safety gear and be permitted to play contact sports. However, children with vagal nerve stimulators should avoid direct traumatic impact with these devices in place.
There are certain physical activities that may carry higher risks amongst persons with epilepsy. Children and teens with poorly controlled seizures leading to falls should avoid activities such as working out on a treadmill, skiing, or rock-climbing, unless very specific safety measures are in place. Additionally, water sports require careful supervision because of the risk of drowning. Children and teens should wear a life jacket if boating or swimming in a lake or river. If swimming in a pool, a responsible teen or adult should be supervising (in addition to the lifeguard on duty), and that person should be close enough to “jump in” in the event of a seizure. Sports such as scuba diving, skydiving and bare hand rock climbing are best avoided, given the much higher risk of significant injury should a seizure occur.
4. What are the rules for the “average” child or teen with epilepsy?
Participation in regular physical activity is safe for most children and teens with epilepsy, and has beneficial effects on both physical and emotional well-being. Appropriate supervision is needed, particularly around water or other higher-risk activities. For many teens, a “buddy system”, with a responsible and educated peer will allow more independence. Team sports should be encouraged as they promote social interaction. The supervising adult (i.e. coach) should be made aware of the diagnosis of epilepsy, symptoms of seizures, and what to do should a seizure occur. Contact sports are safe for most children, as provoking a seizure with head injury is rare. All children, regardless of whether they have epilepsy require appropriate safety gear (i.e. helmets, knee and elbow pads).