Feasibility, Acceptability, and Appropriateness of an 8-Week Supervised Aerobic Exercise Intervention for Adults With Epilepsy: Pilot Randomized Controlled Trial

BACKGROUND Epilepsy affects multiple dimensions of health. Exercise may serve as a nonpharmacological strategy to improve health outcomes among adults with epilepsy; however, translating this potential into effective and scalable interventions remains challenging. Before advancing to efficacy trials, early-stage research is needed to establish whether exercise interventions are feasible, acceptable, and appropriate for this population. OBJECTIVE This study aimed to evaluate the feasibility, acceptability, and appropriateness of an 8-week supervised aerobic exercise intervention for adults with epilepsy, guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model. METHODS Adults with epilepsy aged 18-65 years were recruited between April 2024 and December 2024 and randomized to either a supervised aerobic exercise intervention (n=4) or a control group (n=2). The exercise group completed an 8-week supervised aerobic exercise program consisting of 50-minute sessions performed 3 days per week. The intervention incorporated behavior change techniques, including goal setting, action planning, habit formation, and commitment contracts to support exercise adherence. Process feasibility outcomes included recruitment, retention, adherence, survey completion, protocol compliance, and safety. Self-reported feasibility, acceptability, and appropriateness were assessed using the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure. RESULTS Overall, 34 individuals expressed interest in the study, 25 completed the screening survey, 10 were preliminarily eligible, and 6 were enrolled in the study over 8 months. Recruitment was low, with a recruitment rate of 0.75 participants per month and enrollment achievement of 16.7% of the target sample (target n=36). Retention and adherence were 100%. All exercise participants completed 24/24 sessions, with 100% weekly survey completion. Protocol compliance was high. No seizures occurred during exercise sessions. Mean scores for self-reported feasibility, acceptability, and appropriateness were high (>4 out of 5). CONCLUSIONS The results of this Phase IIb pilot study suggest that a supervised aerobic exercise intervention for adults with epilepsy is feasible, acceptable, and appropriate to implement among participants who enroll. Recruitment remains the primary challenge to progressing this line of research and may represent a broader field-level barrier. Future trials should focus on improving how adults with epilepsy are reached and engaged in exercise research while preserving intervention strategies that support strong engagement among those who enroll.