Physical activity and influencing factors in children with epilepsy_Journal of Epilepsy

Authors：

ZHANG Zhihui ¹ , WEI Zhimin ¹ , LIU Zihao ¹ , SHENG Guimei ² , SONG Wenxin ¹ , LI Yutong ¹ ,  LI Yuli ^1,3

1. School of Nursing and Rehabilitation, Shandong University, Jinan 250012, China;
2. Qilu Hospital, The Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan 250012, China;
3. The Second Qilu Hospital of Shandong University, Nursing Department, Jinan 250013, China;

Corresponding author：

LI Yuli, Email: liyuli2019@sdu.edu.cn

Keywords：

Child with epilepsy; Physical activity; Perceived behavioral control; Kinesiophobia; Parental attitudes toward physical activity

DOI：

10.7507/2096-0247.202508003

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Objective This study aimed to analyze the current status and influencing factors of physical activity in children with epilepsy, providing evidence for developing targeted intervention strategies. Methods A cross-sectional survey was conducted from July 2024 to March 2025, involving 97 children with epilepsy aged 6 ~ 19 years with undergoing 24-hour electroencephalogram monitoring and parents of pediatric patients from a tertiary hospital in Shandong Province, China. The General Information Questionnaire, the Physical Activity Intention Scale for Children and Adolescents with Cancer, the Godin Leisure Time Physical Activity Questionnaire, and Tampa Scale for Kinesiophobia-11 were used to investigate general information about children and adolescents with epilepsy and parents, attitudes, perceived behavioral control, and behavioral intentions, the physical activity, and kinesiophobia levels of children and adolescents with epilepsy. Multi-factor ordinal logistic regression analysis was employed to identify influencing factors of physical activity levels. Results The median physical activity score for children with epilepsy was 52.00 MET (IQR: 47.00 ~ 57.00). None of the children aged 6 ~ 17 years met the minimum weekly moderate-to-vigorous physical activity (MVPA) standards recommended by the Chinese Physical Activity Guidelines for Children and Adolescents or WHO (420 minutes/week, 60 minutes/day × 7 days). The daily average sedentary time was (6.79±3.24) hours, significantly exceeding the WHO-recommended threshold (<2 hours/day).Univariate analysis demonstrated statistically significant differences in the children's physical activity levels with epilepsy based on parental perceptions of activity importance and parental encouragement for physical activity (H=15.779; H=8.034, all P<0.05). Spearman correlation analysis revealed significant positive associations between physical activity levels and activity attitudes (r=0.275), perceived behavioral control (r=0.330), and behavioral intentions (r=0.281) (all P<0.01), while kinesiophobia exhibited a significant negative correlation (r=−0.237, P<0.05). Multi-factor ordinal logistic regression analysis identified perceived behavioral control [OR=0.751, 95%CI (−0.509, −0.065)], occasional parental companionship in physical activities [OR=0.157, 95%CI (−3.660, −0.043)], and frequent parental encouragement [OR=0.000, 95%CI (−16.577, −14.272)] as protective factors for adequate physical activity (all P<0.05). Conversely, kinesiophobia emerged as a significant risk factor [OR=1.113, 95%CI (0.007, 0.207), P<0.05]. Conclusion Insufficient physical activity levels and excessive sedentary behavior are prevalent among children with epilepsy. Enhancing perceived behavioral control, increasing parental companionship during and encouragement for children's engagement in physical activities and reducing kinesiophobia may serve as critical intervention targets to improve physical activity levels in this population.

Citation： ZHANG Zhihui, WEI Zhimin, LIU Zihao, SHENG Guimei, SONG Wenxin, LI Yutong, LI Yuli. Physical activity and influencing factors in children with epilepsy. Journal of Epilepsy, 2025, 11(6): 501-507. doi: 10.7507/2096-0247.202508003 Copy

1.	Moshe SL, Perucca E, Ryvlin P, et al. Epilepsy: new advances. Lancet, 2015, 385(9971): 884-898.
2.	李桃利, 王艺. 癫痫儿童神经精神共患病的研究进展. 复旦学报(医学版), 2018, 45(4): 578-584.
3.	Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep, 1985, 100(2): 126-131.
4.	Wong J, Wirrell E. Physical activity in children/teens with epilepsy compared with that in their siblings without epilepsy. Epilepsia, 2006, 47(3): 631-639.
5.	Do J, Webster RJ, Longmuir PE, et al. Poor adherence to sleep and physical activity guidelines among children with epilepsy. Epilepsy Behav, 2021, 115: 107722.
6.	Brown DMY, Ronen GM. Associations between 24-hour movement guideline adherence and mental health disorders among young people with active and inactive epilepsy. Epilepsy Behav, 2021, 125: 108386.
7.	Kuijer A. Epilepsy and exercise, electroencephalographical and biochemical studies. In: Wada JA, Penry JK, editors. Advances in epileptology: the 10th Epilepsy International Symposium. New York: Raven Press, 1980: 543.
8.	Pimentel J, Tojal R, Morgado J. Epilepsy and physical exercise. Seizure 2015, 25: 87–94.
9.	Eom S, Lee MK, Park JH, et al. The impact of an exercise therapy on psychosocial health of children with benign epilepsy: a pilot study. Epilepsy Behav, 2014, 37: 151-156.
10.	曹沅, 余立平, 唐蔚, 等. 癫痫儿童青少年身体活动现状及影响因素研究进展. 广东医学, 2024, 45(10): 1357-1361.
11.	Gregory J Wellc, Kherrin Wood. Parental influences on physical activity in children: an exploration of potential mechanism. Pediatr Exerc Sci, 2003, 15: 19-33.
12.	Kirsten Krahnstoever Davison. Activity-related support from parents, peers, and siblings and adolescents’ physical activity: are there gender differences? J Phys Act Health, 2004, 1: 363-376.
13.	Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process, 1991, 50(2): 179-211.
14.	Keats MR, Culos-Reed SN, Courneya KS, et al. Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior. Psychooncology, 2010, 16(5): 448-457.
15.	陈洛嵩, 余梓航. 使用智能手机运动软件对大学生体育锻炼态度、行为习惯的影响-基于计划行为理论的解释与质疑. 广州体育学院学报, 2019, 39(3): 105-107+67.
16.	商文杰. 基于计划行为理论的那曲市中学生体育锻炼行为特点及影响因素的研究. 宁波大学, 硕士学位论文, 2022.
17.	戚龙菊, 王庆华, 丁苇, 等. 基于计划行为理论的运动锻炼对肝癌患者运动依从性的影响. 中国康复医学杂志, 2021, 36(12): 1539-1544.
18.	蔡立柏, 刘延锦, 孙箫音, 等. 青少年癫痫患者疾病感受和体验的质性研究. 中华护理杂志, 2021, 56(1): 86-91.
19.	Collard SS, Ellis-Hill C. How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy. Epilepsy Behav, 2017, 70(Pt A): 66-71.
20.	Specchio N, Wirrell E C, Scheffer l E, et al. International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: position paper by the lLAE Task Force on Nosology and Definitions. Epilepsia, 2022, 63(6): 1398-1442.
21.	宋东玉. 基于父母扩展计划行为理论的儿童青少年癌症患者身体活动影响因素分析. 山东大学, 硕士学位论文, 2024.
22.	Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ, 2011, 2: 53-55.
23.	Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci, 1985, 10: 141-146.
24.	Amireault S, Godin G, Lacombe J, et al. Erratum to: The use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire in oncology research: a systematic review. BMC Med Res Methodol, 2016, 16: 30.
25.	Godin G. The Godin-Shephard leisure-time physical activity questionnaire. J Health Fitness Can, 2011, 4(1): 18-22.
26.	Sallis JF, Buono MJ, Roby J J, et al. Seven-day recall and other physical activity self-reports in children and adolescents. Med Sci Sports Exerc, 1993, 25(1): 99-108.
27.	Woby SR, Roach NK, Urmston M, et al. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain, 2005, 117(1/2): 137-144.
28.	蔡立柏, 刘延锦, 徐秋露, 等. 恐动症评估简表中文版在全膝关节置换患者中应用的信效度研究. 中华行为医学与脑科学杂志, 2019, 28(3): 269-273.
29.	Podsakoff PM, ackenzie SB, Lee JY, et al. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol, 2003, 88(5): 879-903.
30.	张云婷, 马生霞, 陈畅, 等. 中国儿童青少年身体活动指南. 中国循证儿科杂志, 2017, 12(6): 401-409.
31.	Bull FC, Al-Ansari ss, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med, 2020, 54(24): 1451-1462.
32.	van den Bongard F, Hamer HM, Sassen R, et al. Sport and physical activity in epilepsy: a systematic review. Dtsch Arztebl Int, 2020, 117(1-2): 1.
33.	Carrizosa-Moog J, Ladino LD, Benjumea-Cuartas V, et al. Epilepsy, physical activity and sports: a narrative review. Can J Neurol Sci, 2018, 45(6): 624-632.
34.	Ogwumike OO, Agboke MA, Adeniyi A F. Association between physical activity level and health-related quality of life of children with and without epilepsy. J Pediatr Neurol, 2016, 14(3): 95-101.
35.	Sırtbaş G, Yalnızoğlu D, Livanelioğlu A. Comparison of physical fitness, activity, and quality of life of the children with epilepsy and their healthy peers. Epilepsy Res, 2021, 178: 106795.
36.	Whitney R, Bhan H, Persadie N, et al. Feasibility of pedometer use to assess physical activity and its relationship with quality of life in children with epilepsy: a pilot study. Pediatr Neurol, 2013, 49(5): 370-373.
37.	Capovilla G, Kaufman KR, Perucca E, et al. Epilepsy, seizures, physical exercise, and sports: a report from the ILAE Task Force on Sports and Epilepsy. Epilepsia. 2016, 57(1): 6-12.
38.	Dimitri P, Joshi K, Jones N. Moving more: physical activity and its positive effects on long term conditions in children and young people. Arch Dis Child, 2020, 105(11): 1035-1040.
39.	国汐如, 蔡珊, 党佳佳, 等. 父母参与对儿童青少年身体活动影响的Meta分析. 中国预防医学杂志, 2023, 24(9): 941-948.
40.	李培红, 王梅. 中国儿童青少年身体活动现状及相关影响因素. 中国学校卫生, 2016, 37(6): 805-809+813.
41.	王富, 百慧. 家庭资本与教养方式: 青少年身体活动的家庭阶层差异. 体育科学, 2019, 39(3): 48-57.
42.	O'toole S, Benson A, Lambert V, et al. Family communication in the context of pediatric epilepsy: a systematic review. Epilepsy Behav, 2015, 51: 225-239.
43.	Collard SS, Ellis-Hill C. How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy. Epilepsy Behav, 2017, 70: 66-71.
44.	Ajzen l. From intentions to actions: a theory of planned behavior. Berlin and New York: Springer Verlag, 1985: 11-39.
45.	陈虹辛, 程喜荣, 陈立夏, 等. 运动自我效能在老年慢性阻塞性肺疾病患者运动恐惧和身体活动间的中介作用. 军事护理, 2024, 41(11): 53-56.
46.	席洁. 认知行为疗法对学龄期癫痫患儿负性情绪及服药依从性的影响. 南京医科大学, 硕士学位论文, 2019.
47.	王丽娟, 郑丹蘅. 习惯行为、执行意向与青少年身体活动意向与行为: 基于计划行为理论的扩展模型. 上海体育学院学报, 2020, 44(2): 22-32.
48.	阳家鹏, 徐信. 体育锻炼态度对青少年有氧体适能的影响--体育锻炼行为的中介作用. 广州体育学院学报, 2016, 36(1): 91-96.

1. Moshe SL, Perucca E, Ryvlin P, et al. Epilepsy: new advances. Lancet, 2015, 385(9971): 884-898.
2. 李桃利, 王艺. 癫痫儿童神经精神共患病的研究进展. 复旦学报(医学版), 2018, 45(4): 578-584.
3. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep, 1985, 100(2): 126-131.
4. Wong J, Wirrell E. Physical activity in children/teens with epilepsy compared with that in their siblings without epilepsy. Epilepsia, 2006, 47(3): 631-639.
5. Do J, Webster RJ, Longmuir PE, et al. Poor adherence to sleep and physical activity guidelines among children with epilepsy. Epilepsy Behav, 2021, 115: 107722.
6. Brown DMY, Ronen GM. Associations between 24-hour movement guideline adherence and mental health disorders among young people with active and inactive epilepsy. Epilepsy Behav, 2021, 125: 108386.
7. Kuijer A. Epilepsy and exercise, electroencephalographical and biochemical studies. In: Wada JA, Penry JK, editors. Advances in epileptology: the 10th Epilepsy International Symposium. New York: Raven Press, 1980: 543.
8. Pimentel J, Tojal R, Morgado J. Epilepsy and physical exercise. Seizure 2015, 25: 87–94.
9. Eom S, Lee MK, Park JH, et al. The impact of an exercise therapy on psychosocial health of children with benign epilepsy: a pilot study. Epilepsy Behav, 2014, 37: 151-156.
10. 曹沅, 余立平, 唐蔚, 等. 癫痫儿童青少年身体活动现状及影响因素研究进展. 广东医学, 2024, 45(10): 1357-1361.
11. Gregory J Wellc, Kherrin Wood. Parental influences on physical activity in children: an exploration of potential mechanism. Pediatr Exerc Sci, 2003, 15: 19-33.
12. Kirsten Krahnstoever Davison. Activity-related support from parents, peers, and siblings and adolescents’ physical activity: are there gender differences? J Phys Act Health, 2004, 1: 363-376.
13. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process, 1991, 50(2): 179-211.
14. Keats MR, Culos-Reed SN, Courneya KS, et al. Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior. Psychooncology, 2010, 16(5): 448-457.
15. 陈洛嵩, 余梓航. 使用智能手机运动软件对大学生体育锻炼态度、行为习惯的影响-基于计划行为理论的解释与质疑. 广州体育学院学报, 2019, 39(3): 105-107+67.
16. 商文杰. 基于计划行为理论的那曲市中学生体育锻炼行为特点及影响因素的研究. 宁波大学, 硕士学位论文, 2022.
17. 戚龙菊, 王庆华, 丁苇, 等. 基于计划行为理论的运动锻炼对肝癌患者运动依从性的影响. 中国康复医学杂志, 2021, 36(12): 1539-1544.
18. 蔡立柏, 刘延锦, 孙箫音, 等. 青少年癫痫患者疾病感受和体验的质性研究. 中华护理杂志, 2021, 56(1): 86-91.
19. Collard SS, Ellis-Hill C. How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy. Epilepsy Behav, 2017, 70(Pt A): 66-71.
20. Specchio N, Wirrell E C, Scheffer l E, et al. International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: position paper by the lLAE Task Force on Nosology and Definitions. Epilepsia, 2022, 63(6): 1398-1442.
21. 宋东玉. 基于父母扩展计划行为理论的儿童青少年癌症患者身体活动影响因素分析. 山东大学, 硕士学位论文, 2024.
22. Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ, 2011, 2: 53-55.
23. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci, 1985, 10: 141-146.
24. Amireault S, Godin G, Lacombe J, et al. Erratum to: The use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire in oncology research: a systematic review. BMC Med Res Methodol, 2016, 16: 30.
25. Godin G. The Godin-Shephard leisure-time physical activity questionnaire. J Health Fitness Can, 2011, 4(1): 18-22.
26. Sallis JF, Buono MJ, Roby J J, et al. Seven-day recall and other physical activity self-reports in children and adolescents. Med Sci Sports Exerc, 1993, 25(1): 99-108.
27. Woby SR, Roach NK, Urmston M, et al. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain, 2005, 117(1/2): 137-144.
28. 蔡立柏, 刘延锦, 徐秋露, 等. 恐动症评估简表中文版在全膝关节置换患者中应用的信效度研究. 中华行为医学与脑科学杂志, 2019, 28(3): 269-273.
29. Podsakoff PM, ackenzie SB, Lee JY, et al. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol, 2003, 88(5): 879-903.
30. 张云婷, 马生霞, 陈畅, 等. 中国儿童青少年身体活动指南. 中国循证儿科杂志, 2017, 12(6): 401-409.
31. Bull FC, Al-Ansari ss, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med, 2020, 54(24): 1451-1462.
32. van den Bongard F, Hamer HM, Sassen R, et al. Sport and physical activity in epilepsy: a systematic review. Dtsch Arztebl Int, 2020, 117(1-2): 1.
33. Carrizosa-Moog J, Ladino LD, Benjumea-Cuartas V, et al. Epilepsy, physical activity and sports: a narrative review. Can J Neurol Sci, 2018, 45(6): 624-632.
34. Ogwumike OO, Agboke MA, Adeniyi A F. Association between physical activity level and health-related quality of life of children with and without epilepsy. J Pediatr Neurol, 2016, 14(3): 95-101.
35. Sırtbaş G, Yalnızoğlu D, Livanelioğlu A. Comparison of physical fitness, activity, and quality of life of the children with epilepsy and their healthy peers. Epilepsy Res, 2021, 178: 106795.
36. Whitney R, Bhan H, Persadie N, et al. Feasibility of pedometer use to assess physical activity and its relationship with quality of life in children with epilepsy: a pilot study. Pediatr Neurol, 2013, 49(5): 370-373.
37. Capovilla G, Kaufman KR, Perucca E, et al. Epilepsy, seizures, physical exercise, and sports: a report from the ILAE Task Force on Sports and Epilepsy. Epilepsia. 2016, 57(1): 6-12.
38. Dimitri P, Joshi K, Jones N. Moving more: physical activity and its positive effects on long term conditions in children and young people. Arch Dis Child, 2020, 105(11): 1035-1040.
39. 国汐如, 蔡珊, 党佳佳, 等. 父母参与对儿童青少年身体活动影响的Meta分析. 中国预防医学杂志, 2023, 24(9): 941-948.
40. 李培红, 王梅. 中国儿童青少年身体活动现状及相关影响因素. 中国学校卫生, 2016, 37(6): 805-809+813.
41. 王富, 百慧. 家庭资本与教养方式: 青少年身体活动的家庭阶层差异. 体育科学, 2019, 39(3): 48-57.
42. O'toole S, Benson A, Lambert V, et al. Family communication in the context of pediatric epilepsy: a systematic review. Epilepsy Behav, 2015, 51: 225-239.
43. Collard SS, Ellis-Hill C. How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy. Epilepsy Behav, 2017, 70: 66-71.
44. Ajzen l. From intentions to actions: a theory of planned behavior. Berlin and New York: Springer Verlag, 1985: 11-39.
45. 陈虹辛, 程喜荣, 陈立夏, 等. 运动自我效能在老年慢性阻塞性肺疾病患者运动恐惧和身体活动间的中介作用. 军事护理, 2024, 41(11): 53-56.
46. 席洁. 认知行为疗法对学龄期癫痫患儿负性情绪及服药依从性的影响. 南京医科大学, 硕士学位论文, 2019.
47. 王丽娟, 郑丹蘅. 习惯行为、执行意向与青少年身体活动意向与行为: 基于计划行为理论的扩展模型. 上海体育学院学报, 2020, 44(2): 22-32.
48. 阳家鹏, 徐信. 体育锻炼态度对青少年有氧体适能的影响--体育锻炼行为的中介作用. 广州体育学院学报, 2016, 36(1): 91-96.

Journal of Epilepsy

Physical activity and influencing factors in children with epilepsy

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