Neighborhood social cohesion as a moderator of the association between epilepsy status and physical activity: Evidence from a nationally representative U.S. sample.
Zhang J, Yu Y, et al. • Epilepsy & behavior : E&B • 2026
Neighborhood social cohesion moderates the association between epilepsy status and physical activity, with high neighborhood social cohesion associated with greater aerobic guideline adherence only among people with inactive epilepsy, not active epilepsy.
Key Findings
Results
People with active epilepsy were significantly less likely than those with inactive epilepsy to meet aerobic physical activity guidelines.
OR = 0.69, 95% CI: 0.51–0.94
The outcome measure was meeting aerobic physical activity guidelines (≥150 min of moderate-intensity, ≥75 min of vigorous-intensity activity, or an equivalent combination per week)
Analysis was based on data from the National Health Interview Survey conducted in 2013, 2015, and 2017, involving 1,410 individuals with epilepsy
Binary logistic regression was used to explore the association
Results
Neighborhood social cohesion (NSC) did not moderate physical activity adherence among people with active epilepsy.
After adjustment, adherence among people with active epilepsy was similar for low versus high NSC: 33.3% (95% CI: 26.5–40.1) vs. 34.1% (95% CI: 25.9–42.2)
The difference in adherence rates between low and high NSC groups in active epilepsy was negligible (approximately 0.8 percentage points)
This suggests that the social environment does not compensate for barriers imposed by active seizure activity
Results
Among people with inactive epilepsy, high neighborhood social cohesion was associated with substantially greater aerobic physical activity guideline adherence compared to low neighborhood social cohesion.
Adherence was 34.4% (95% CI: 27.1–41.7) for low NSC versus 56.1% (95% CI: 46.4–65.7) for high NSC among people with inactive epilepsy
This represents a difference of approximately 21.7 percentage points between low and high NSC groups
The moderating effect of NSC remained significant after propensity score matching, which was used as a sensitivity analysis
Results
People with inactive epilepsy and high neighborhood social cohesion had the highest physical activity levels of all subgroups examined.
Adherence rate of 56.1% (95% CI: 46.4–65.7) in the high NSC/inactive epilepsy group exceeded adherence in all other groups
The authors conclude that 'the positive effect of NSC on physical activity only existed in this subgroup'
This pattern held after propensity score matching sensitivity analysis
Methods
The study used propensity score matching as a sensitivity analysis to validate the moderating effect of neighborhood social cohesion.
Propensity score matching was employed to address potential confounding in comparisons between active and inactive epilepsy groups
The moderating effect of NSC on the epilepsy status–physical activity association remained significant after propensity score matching
The study drew from a nationally representative U.S. sample via the National Health Interview Survey (2013, 2015, and 2017 waves)
Total sample size was 1,410 individuals with epilepsy
What This Means
This research suggests that people with epilepsy who still experience active seizures are less likely to meet recommended weekly exercise guidelines compared to people whose epilepsy is no longer active. Specifically, those with active epilepsy had about 31% lower odds of meeting aerobic exercise recommendations. This finding is important because regular physical activity is known to have health benefits for people with epilepsy, yet participation rates in this population are already lower than in the general public.
The study also found that the social environment of one's neighborhood plays an important role, but only for certain people with epilepsy. Among individuals with inactive epilepsy (i.e., no recent seizures), living in a neighborhood with strong social bonds and mutual support was associated with much higher rates of meeting exercise guidelines — about 56% adherence in high-cohesion neighborhoods versus about 34% in low-cohesion neighborhoods. However, this neighborhood effect was entirely absent among people with active epilepsy, where adherence rates were nearly identical regardless of neighborhood social cohesion (~33–34% in both cases).
This research suggests that strengthening neighborhood social support networks could be a practical way to help people with inactive epilepsy become more physically active, perhaps by reducing fear, providing encouragement, or creating opportunities for group activity. However, for people still experiencing active seizures, neighborhood-level social interventions alone may not be sufficient, and other targeted strategies may be needed to address the unique barriers they face.
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Zhang J, Yu Y, Tuo M, Chen Z, Wang Y. (2026). Neighborhood social cohesion as a moderator of the association between epilepsy status and physical activity: Evidence from a nationally representative U.S. sample.. Epilepsy & behavior : E&B. https://doi.org/10.1016/j.yebeh.2026.111068