Participating in physical activity and exercise has significant benefits, including treating, preventing, and reducing risk factors for chronic conditions such as diabetes, hypertension, coronary heart disease, and osteoarthritis. Physical activity can also positively play a role in palliative care among individuals with terminal diseases. [1–3] Epilepsy is a chronic disease with repercussions extending beyond the negative impact of recurrent seizures. Persons with epilepsy (PWE) may also present cognitive dysfunction and psychosocial impairment, including high rates of anxiety and depression. [4–6] It is therefore not surprising that there is a sub-optimal quality of life (QOL) in some of these subjects, given the complex interaction among seizures, adverse effects of anti-epileptic drugs, comorbidities, and stigma. Efforts to improve QOL in epilepsy should not focus merely on seizure control but rather approach different aspects of life, including both physical and psychosocial well-being. [7] Many epileptic patients are physically inactive owing to fears of exercise-induced seizures or advice given by caregivers and health professionals. [8,9] Some PWE also have concerns that seizures will make exercise unsafe. In addition, as with the general population, lack of motivation and energy from health professionals are barriers for PWE to exercise. [8,9] PWE who overcome these barriers and concerns, however, stand to benefit from physical activity in several ways, with improved cardiovascular health and reduction in diabetes mellitus prevalence among the most prominent. [10] Exercise can also counteract the effects of some anti-epileptic medications that cause bone mineral density loss. In addition, exercise among patients with epilepsy has lowered the incidence of depression and improved social integration. [11,12] Moreover, individuals with epilepsy involved in exercise programs exhibit an improved mental state, become more sociable, and improve their psychosocial functioning and quality of life. [13]

Physiotherapists are very well informed about physical activity and are conscious about the overall welfare of the physical body. They are professionals that help improve the quality of movement, physical performance, sensory awareness, response, balance, coordination, strength, and mobility and increase range of motion and sphere of movement using physical methods. [14] For this reason, PWE need physiotherapy services. Thus, fundamental knowledge on the influence of physical activity and exercise in the rehabilitation of PWE is essential for physiotherapists especially those treating epileptic patients.

The poor knowledge of epilepsy among rehabilitation professionals has been suggested as a contributing cause to the epilepsy treatment gap. [15] Proper knowledge of health professionals is difficult to evaluate and is rarely assessed. Surveys [16–20] were carried out on health professionals Physiotherapists included, but mainly evaluated their knowledge and attitude towards epilepsy. It has already been shown that health professionals lack knowledge on many neurological diseases, and our research group has conducted a study regarding the knowledge and current practice on epilepsy:  Yakasai and colleagues [21] evaluated the Knowledge and current practices of Physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures. The Physiotherapists (n=117) answered a questionnaire composed by three domains: “personnel information, knowledge about epilepsy, and current practice and role of physical activity in epileptic seizures.

The number of codes for the physiotherapists' knowledge and the themes that emerged was illustrated in Table 1. The codes were labeled and classified into 3 categories (sufficient knowledge, insufficient knowledge, lack of knowledge). High numbers of codes were found in the category “sufficient knowledge”. When the codes for each category were summed up for judgment, there were 79.5% (n = 93) physiotherapists in the “sufficient knowledge” group, 6.0% (n=7) physiotherapists in the “insufficient knowledge” group, and 14.5% (n = 17) physiotherapists in the “lack of knowledge” group. Physiotherapists in the sufficient knowledge category had adequate awareness about the physical activity and exercise rehabilitation of PWE. Those in the insufficient knowledge category had some level but inadequate awareness about physical activity and exercise rehabilitation of PWE. Those in the lack of knowledge category had no awareness about the need for physical activity and exercise rehabilitation of children with epileptic seizures. However, the number of codes for the physiotherapists' practice and the categories that emerged were illustrated in Table 2. Just like in the knowledge section, the codes were labeled and classified into 3 categories (standard practice, substandard practice, lack of practice), with the standard group having the highest numbers of codes. When the codes for each category were summed up for judgment, there were 86.3% (n = 101) physiotherapists in the “standard practice” group, 9.4% (n = 11) in the “substandard practice” group, and 4.3% (n = 5) in the “lack of practice” group. Physiotherapists in the standard practice group had adequate management skills about the physical activity and exercise in the rehabilitation of PWE. Those in the substandard practice group had some level but inadequate management skills about physical activity and exercise rehabilitation of PWE. Those in the lack of practice group had no management skills about the need for physical activity and exercise in the rehabilitation of PWE.

These findings indicate an important improvement in training and practice on epilepsy among the physiotherapists and, therefore, motivate the inclusion of formal programs for education in epilepsy at the undergraduate level, especially because the majority of the participants had post-graduate qualifications. Finally, some of the Physiotherapists were found to have insufficient/lack knowledge and substandard practice about epilepsy and the use of exercise to rehabilitate PWE. This lack of knowledge and substandard practice among Physiotherapists invariably leads PWE engaged in an exercise program not to achieve the so claimed benefits of exercise already described, or even to completely withdraw from participating in the exercise training.

In conclusion, Physiotherapists are considered to be among those highly educated health professionals in the society, especially with regard to clinical rehabilitation. Thus, it is important that they also have accurate and sufficient knowledge about exercise in the rehabilitation of persons with epilepsy. The findings of this study indicate that physiotherapists have sufficient knowledge about epilepsy and were using current skills/ physical activity in the rehabilitation of PWE. we wish to reinforce the importance of continuing education and training programs for Physiotherapists and other health professionals on epilepsy and physical activity.