For people with epilepsy, doing yoga may help reduce feelings of stigma about the disease along with reducing seizure frequency and anxiety, according to new research published in the November 8, 2023, online issue of Neurology, the medical journal of the American Academy of Neurology.

“People with epilepsy often face stigma that can cause them to feel different than others due to their own health condition and that can have a significant impact on their quality of life,” said study author Manjari Tripathi, MD, DM, of All India Institute of Medical Sciences in New Delhi. “This stigma can affect a person’s life in many ways including treatment, emergency department visits and poor mental health. Our study showed that doing yoga can alleviate the burden of epilepsy and improve the overall quality of life by reducing this perceived stigma.” 

For the study, researchers looked at people with epilepsy with an average age of 30 in India.

Researchers measured stigma based on participants’ answers to questions such as: “Do you feel other people discriminate against you?” “Do you feel you cannot contribute anything in society?” and “Do you feel different from other people?”

Researchers then identified 160 people who met the criteria for experiencing stigma. Participants had an average of one seizure per week and on average took at least two anti-seizure medications.

Researchers then randomly assigned participants to receive yoga therapy or sham yoga therapy. Yoga therapy included exercises in loosening muscles, breathing, meditation and positive affirmations. Sham yoga consisted of exercises that mimic the same yoga exercises, but participants were not given instructions on two key components of yoga believed to induce a relaxation response: slow and synchronized breathing, and attention to the body movements and sensations during practice.

Each group received seven supervised group sessions of 45 to 60 minutes over three months. Participants were also asked to practice sessions at home at least five times a week for 30 minutes. They tracked seizures and yoga sessions in a journal. After the three months of therapy, participants were followed for another three months.

Researchers found when compared to people who did sham yoga, people who did yoga were more likely to reduce their perceived stigma of the disease. People who did yoga had an average score of seven at the start of the study and an average score of four at the end of the study, while people who did sham yoga had an increase from an average score of six at the start of the study to an average score of seven at the end.

Researchers also found that people who did yoga were more than four times as likely to have more than a 50% reduction in their seizure frequency after six months than the people who did sham yoga.

In addition, people who did yoga were more than seven times more likely to no longer have seizures than those who did sham yoga.

There was also a significant decrease in anxiety symptoms for people who did yoga versus people who did not. They saw improvements in quality of life measures and mindfulness.

“These study findings elevate the need to consider alternative therapies and activities for people with epilepsy facing stigma,” said Tripathi. “Yoga may not only help reduce stigma, but also improve quality of life and mindfulness. Plus, yoga can be easily prerecorded and shared with patients online using minimal resources and costs.”

Physical activity has positive effects on mental health and yet, activity rates are declining. This is particularly worrying because the mental well-being of teenagers continues to deteriorate. In the US, one in six school children is diagnosed with some type of mental disorder.

Riding bikes is a promising approach to introduce school-aged children to physical activity. Now, researchers in the US have investigated how adolescents’ psychosocial well-being changed after participating in a school-based cycling program.

“Participation in a school cycling education program during the Covid-19 pandemic was associated with improved psychosocial well-being among middle schoolers,” said Dr Esther Walker, research director at the non-profit organization Outride. “While we saw promising increases in some student subgroups, certain groups had higher levels of self-reported mental well-being both before and after participating in the program.”

“It was really encouraging to see such a positive student response to a cycling-specific physical education program,” said Fletcher Dementyev, a research assistant at Loma Linda University and first author of the study published in Frontiers in Sports and Active Living. “This motivates us, and hopefully others, to continue investigating and developing cycling as a pathway to improved health and well-being in adolescents.”

Riding out for better mental health

Outride is a not-for-profit organization partnering with schools to provide cycling programs. “The Riding for Focus (R4F) program aims to equip students with basic cycling knowledge and experience, so that they may ride safely and confidently,” Walker explained.

“A bicycle can be used for leisure activities, competition, and transportation. Thus, not only are students participating in an activity that improves their health and wellbeing, but also one that empowers them to explore the world,” said Dr Sean Wilson, a researcher at Loma Linda University and the study’s senior author.

More than 1,200 middle schoolers, aged 11 to 14 years, participated in the program’s surveys. Before and after cycling, they completed two surveys that included measures of current mental well-being and psychological functioning. Given the improvement in teenagers’ mental well-being scores, short term physical activity programs hold promise of having a positive influence on mental health and well-being in adolescents, the team said.

Privilege determines well-being

Next to overall well-being, the scientists examined social risk factors that influenced well-being pre- and post-program participation. “We focused on a number of key risk factors that affect mental health and well-being in middle school aged children in the US, including socio-economic status, gender, and race,” Wilson explained.

Relative risk assessments indicated that males, white students, and those from high socio-economic status families still had reduced relative risk of developing psychosocial disorders post-intervention. For example, female students’ well-being improved significantly; male students, however, still had higher well-being scores compared to females after the program. There also was a significant post-program increase in the well-being of non-white students. This positive impact is supported by studies showing that physical activity programs can positively influence the psychosocial well-being of ethnic minorities, particularly those from low-income families.

“While participating can certainly contribute positively to one’s day-to-day life, ultimately, to see large scale improvements, changes in policy, reductions in systematic disparities in access to nutrition, health services, safe environments, and beyond need to be put in motion,” said Walker.

The authors also pointed to limitations of their study, one being a study population that is different from the countrywide student population. “This means that our results, though insightful, aren’t fully reflective of the national youth physical education context,” said Dementyev. “We see this study as the beginning of a national dialogue surrounding investment in cycling education and its potential returns.”

“We find that people who are in better shape fill fewer prescriptions for anxiety and depression medications,” says Linda Ernstsen, the senior author of the article and an associate professor from the Department of Public Health and Nursing at the Norwegian University of Science and Technology (NTNU).

The research group based its work on the  Trøndelag Health Study (HUNT). Since 1984, 250,000 Trøndelag residents have voluntarily contributed their health data to this comprehensive research project. The data are available to researchers, who can use the data to estimate people’s fitness levels, among other things.

The figures were taken from the third data collection round, called HUNT3, which was conducted from 2006 to 2008.

The research group compared the data from HUNT3 with data from the Norwegian Prescribed Drug Registry, which provides an overview of medications that have been dispensed in Norway.

Reduces the need for medication

“Being in better physical shape appears to reduce the need for anxiolytic drugs and antidepressants,” Ernstsen said.

In a previous study, Ernstsen and her co-authors found that people who were in good physical shape during the second HUNT study had a lower prevalence of depressive symptoms when they were participants in HUNT3 ten years later. However, at the time, the researchers found no correlation between good physical shape and anxiety.

But the new study design, which allows the researchers to look at what kinds of medication HUNT3 participants obtained from pharmacies as late as 2018, allowed the researchers to find the correlation.

However, the study does have a theoretical catch. The researchers can only see what kinds of medication were dispensed to people by pharmacies. They cannot see whether people actually took the medication — there’s no way to monitor people at their medicine cabinets.

“Nevertheless, there is reason to believe that people who are prescribed medication have more symptoms than those who do not see a doctor,” according to first author Audun Havnen, an associate professor at the Department of Psychology at NTNU.

Greatest effect for men and young people

Being in good physical shape helps all age groups and both genders. However, some people get greater benefits from exercise and being in good physical shape than others.

“We find that men experience a greater effect from exercise than women. The correlations are also less clear for the elderly,” Ernstsen says.

But that doesn’t mean that it isn’t important for women and the elderly to exercise.

What came first?

We can, of course, ask what triggers what. Is it actually the case that good physical health helps prevent anxiety and depression? Or is it the case that people who suffer from anxiety and depression exercise less and are therefore in poorer shape?

In order to not include anyone who was already experiencing anxiety or depression at the start of the study, the researchers excluded anyone who had filled prescriptions for these conditions before participating in HUNT3, as well as for three months afterwards.

“We also adjusted for symptoms of anxiety and depression in statistical analyses. To the extent that the figures can be believed, we also feel fairly confident that we started with a relatively anxiety and depression-free cohort in HUNT3,” Ernstsen said.

In other words, the subjects were unlikely to have suffered from anxiety or depression beforehand.

Unfortunately there are no shortcuts for people who can’t be bothered to exercise. We simply have to get started — unless we decide to give up. But is there really no other alternative?

“The results indicate that you can achieve a protective effect by improving your physical shape from poor to moderate, so any activity is beneficial,”  Havnen says.

You should be physically active in a way that leaves you breathless and sweaty if you want to improve or maintain your physical condition. The Norwegian health authorities recommend that adults be physically active for at least 150 to 300 minutes at moderate intensity each week.

However, one option for people who are short on time is to aim for 75 minutes of high-intensity training each week or a combination of moderate and high-intensity training.

“Research reinforces the finding that each minute of physical activity counts,” Ernstsen said.

Authored by Audun Havnen, Ekaterina Zotcheva, Ottar Bjerkeset, Xuemei Sui, and Linda Ernstsen, “Cardiorespiratory fitness and incident use of anxiolytics and antidepressants in adults. A linkage study between HUNT and the Norwegian Prescription Database” appeared in the Journal of Affective Disorders.