Abstract
Epilepsy affects over 70 million individuals worldwide, with optimal physical activity (PA) levels remaining challenging to determine due to potential negative outcomes from both insufficient and excessive activity. To quantify the associations between objective PA and mortality in people with epilepsy, we analyzed accelerometer data from 98,561 UK Biobank participants, including 1167 with epilepsy, to quantify associations between objectively measured PA and mortality. During a median follow-up of 7.1 years, people with epilepsy had significantly higher mortality rate (Standardized mortality ratio: 2.39, 1.97-2.86). Higher sedentary behavior duration was associated with lower all-cause mortality (hazard ratio: 0.87, 0.78-0.97). Dose-response analyses identified sedentary durations of 7-13 h/day (p nonlinear=0.025) and moderate-to-vigorous PA of 0.1-0.2 h/day (p nonlinear=0.005) were associated with lower mortality. An explainable machine-learning model that combined multi-dimensional PA with demographic and health information effectively stratified individual risk (Area Under the Receiver Operating Characteristic curve: 0.87 ± 0.08) and could support personalized activity guidance through a wearable system.