Physical activity as a core component of integrative epilepsy care in low- and middle-income settings.

Epilepsy remains a major global health challenge, disproportionately affecting low- and middle-income countries (LMICs) where structural inequities and treatment gaps are persistent and impair the patient's outcomes. While integrative care models have increasingly explored complementary and alternative medicine, physical activity (PA) remains a neglected determinant of health in LMICs. This Brief Communication argues that PA can be a core, modifiable component of integrative care that mitigates the biopsychosocial burden of epilepsy. People with epilepsy (PWE) in LMICs face unique barriers to active living, including economic vulnerability, urban insecurity, low health literacy, and inconsistent professional counseling. These factors often lead to chronic physical inactivity and sedentary behavior, which may exacerbate comorbidities, impair mood, and deepen health inequities. Evidence suggests that PA is generally safe and associated with improved quality of life, physical fitness, and potentially better seizure-related outcomes. In resource-constrained environments, movement-based interventions offer a low-cost, scalable, and culturally adaptable strategy to enhance patient autonomy and social participation. We propose that a truly equitable model of epilepsy care must move beyond seizure control alone by incorporating safe, feasible, and context-sensitive opportunities for PA. Addressing the "physical inactivity gap" in LMICs is essential for exposing and mitigating the broader social determinants that prevent PWE from living well with their condition.