Exercise guide
Most people with epilepsy can and should be active. For most people, exercise doesn't bring on seizures: in a survey of 204 adults with active epilepsy, only 2% had seizures in more than half of their exercise sessions. Whether exercise reduces seizures isn't proven, but exercise programmes have improved quality of life.
If you still have seizures, what matters is the set-up: choosing activities by what would happen if a seizure struck, having someone with you who knows what to do, and taking extra care in water and at heights. After 12 months without seizures, international experts say you can take part in any sport.
This guide covers the evidence, the international sports risk groups, swimming, cycling, climbing and the gym, seizure first aid, and how some epilepsy medicines affect bones and heat, with moves and workouts to follow on the 3D figure.
An international task force says people with epilepsy have often been advised against sport "because of fear, overprotection, and ignorance", and that children should be encouraged to take part. Schools in England must actively support pupils with medical conditions to take part in sport.
In 204 adults with active epilepsy, only 2% had seizures in more than half of their exercise sessions, mostly during hard effort. Experts call a direct link in the reported cases "speculative". Missing medicine, lack of sleep, tiredness and stress are much more common triggers.
In a review of small trials, seizures fell a little with exercise, but the authors judged the result not statistically clear. Quality of life did improve, and in most studies exercise didn't increase seizures.
The International League Against Epilepsy (ILAE) sorts sports into 3 risk groups. Most team sports, racquet sports, running and dancing add no significant risk; swimming, cycling and horse riding carry a moderate risk to you; climbing, scuba diving and motor sports carry a high risk. UK sports bodies have their own rules too.
People with epilepsy are 15 to 19 times more likely to drown than others. If your seizures aren't fully controlled, never swim alone, have someone in the water who knows what to do, tell the lifeguard, and have showers rather than baths at home.
Move dangers away, cushion the head and time the seizure; once the jerking stops, roll the person onto their side. Never hold them down or put anything in their mouth. Call 999 for a first seizure, one lasting over 5 minutes, one after another, an injury or trouble breathing, or if they may have breathed in water.
The UK National Health Service (NHS) describes epilepsy as "a condition that affects your brain and causes seizures (sometimes called fits)". Seizures range from brief staring spells or unusual feelings to losing consciousness with stiffening and jerking (a tonic-clonic seizure). Most tonic-clonic seizures last 1 to 3 minutes, and recovery can take hours or days.
Around 630,000 people in the UK have epilepsy, almost 1 in 100, and about 87 are diagnosed every day. In the US, about 2.9 million adults and 456,000 children have active epilepsy. About 1 in 5 people with a learning disability have epilepsy.
Medicines are the main treatment. Around 3 in 10 people have seizures that don't respond well to medicine, and a few have surgery, nerve stimulation or a special diet. Exercise sits alongside treatment, never instead of it.
Missing medicine is one of the most common triggers. Others include tiredness and poor sleep, stress, illness with a high temperature, periods and alcohol, and about 3% to 5% of people with epilepsy are sensitive to flashing or flickering lights. In a survey of 1,677 people, stress, lack of sleep and tiredness were named most often.
Studies have linked exercise with fewer abnormal brain discharges on EEG (a test of the brain's electrical activity), and seizures are unlikely during hard effort. In children with absence epilepsy, most absences came at rest, in recovery or during deliberate over-breathing rather than during exercise.
Adults with epilepsy are less likely to meet activity guidelines than others. Most exercise injuries are mild, and sports injuries aren't more common than in other people. Drowning is the exception: the risk is 15 to 19 times higher, and in one Canadian series, 44% of drownings in people with epilepsy happened in a bath.
Brief jerking can happen in an ordinary faint, and losing consciousness during exercise can come from the heart. The National Institute for Health and Care Excellence (NICE) treats a collapse during exertion as a sign to check the heart urgently.
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In 204 Norwegian adults with active epilepsy, 53% had never had a seizure during exercise; about 10% said they often had seizures linked to exercise, but only 2% had seizures in more than half of their sessions, mostly people with focal epilepsy caused by an underlying problem in the brain, and mostly during strenuous activity. The ILAE task force says sport is unlikely to bring on seizures. Epilepsy Action: "A very small number of people with epilepsy find that doing strenuous exercise increases their risk of having seizures."
In a review of small trials (14 studies, 331 people), seizures fell a little with exercise, but the authors judged the result not statistically clear. A review of 42 studies, most of them low quality, concluded that "in most cases, physical exercise did not increase seizure frequency".
They're small and point different ways. 21 adults on a 12-week programme had fewer seizures; 117 adults advised to do 150 minutes a week showed no clear difference; 29 children with drug-resistant epilepsy doing an hour of aerobic activity 3 days a week for 6 months had no increase in seizures; and no seizures were reported during a 12-week home programme for 110 adults.
In the review of 14 studies, exercise programmes improved quality of life (by 4.7 points). Studies link being more active with better quality of life and less depression and anxiety, though most are low quality.
In the Norwegian survey, 36% felt regular exercise improved their seizure control and 10% felt it made it worse.
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Medicines prevent seizures for most people, and "Do not change your dose or stop taking your medicine without talking to your specialist", says the NHS. Exercise is for fitness, mood and quality of life alongside treatment.
Children: an average of at least 60 minutes a day across the week. Adults: 150 minutes a week of moderate activity, plus strength on at least 2 days. Epilepsy doesn't change these.
The ILAE says children with epilepsy should be encouraged to take part in sport at school and outside it, with the right supervision. Schools in England must support pupils with medical conditions to take part in sport and not prevent them.
For an adult whose seizures are controlled, or who has agreed activities with their team: 3 to 5 sessions of brisk walking, cycling (indoors if seizures aren't controlled), swimming with the precautions below, or a sport you enjoy, building to 150 minutes; 2 strength sessions, with some impact such as heel drops or step-ups if you take a medicine linked to bone loss; and the basics that matter most, which are medicine on time, regular sleep and no exercise when you have a fever.
The ILAE groups are expert opinion, based on what would happen if a seizure struck, and the task force calls them a work in progress.
A seizure adds no extra risk to you or others: athletics (except pole vault), bowling, judo and wrestling, team sports on the ground such as football, rugby, hockey, basketball, cricket and volleyball, cross-country skiing, curling, dancing, golf and racquet sports.
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A seizure could injure you, but not others: alpine skiing, archery, pole vault, triathlon, canoeing, boxing and karate, cycling, fencing, gymnastics, horse riding, ice hockey, shooting, skateboarding, skating, snowboarding, swimming, water skiing and weightlifting.
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A seizure could be fatal, and for some sports risk others too: flying, climbing, platform and springboard diving, horse racing, motor sports, parachuting, rodeo, scuba diving, ski jumping, solo sailing, surfing and windsurfing.
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What the ILAE suggests, with your neurologist's advice:
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England Boxing doesn't allow boxing with epilepsy, and the British Sub-Aqua Club recommends being free of seizures while awake, and off epilepsy medicine, for 5 years before scuba diving. Epilepsy Action suggests some people use the driving rules as a guide to how safe they feel doing an activity.
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Ask what your seizures are like and how often they happen, what would happen if one struck during the activity, and what would make it safer, such as a buddy, a helmet or a different setting. Epilepsy Action says any risk assessment should be done "with you, not for you".
The risk of drowning is 15 to 19 times higher in people with epilepsy, and higher still with a learning disability. The Royal Life Saving Society UK notes that going into hot or cold water is one of the most common triggers for seizures.
"You don't need to take more safety precautions than anyone else", says Epilepsy Action.
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Open water is more dangerous because of tides, currents, cold and the chance of not being seen. Swim England warns that someone having a seizure in open water may breathe out the air in their lungs and sink, quickly disappearing from view, so have a helper on or in the water, and take extra care.
The NHS advises having showers instead of baths if you can. In one Canadian study, 44% of drownings in people with epilepsy happened in the bath.
Never go alone, make sure the person with you knows about your epilepsy and how to help, and wear a life jacket if you could fall in. Scuba diving isn't safe while you still have seizures.
Wear a well-fitting helmet and high-visibility clothing. If you still have seizures, avoid busy roads, rivers and canals, and try to avoid public roads. Cycling is in the ILAE's moderate-risk group. If a medicine makes you tired or dizzy, don't ride until it passes; an indoor exercise bike avoids traffic altogether (our suggestion).
Climbing is in the ILAE's high-risk group, and NICE lists avoiding working at heights among safety topics, and for children "not climbing above their height without supervision". Epilepsy Action says heights could be dangerous, but "This does not mean that you shouldn't go climbing": talk to your epilepsy nurse first. Our suggestion: indoor climbing on a rope or auto-belay with a belayer who knows your epilepsy, or low bouldering over good mats, are the lower-risk options.
Use well-lit, traffic-free routes away from rivers and canals, plan your route and tell someone where you're going. If you still have seizures, go with someone and wear a medical ID.
"If you have been seizure free for 12 months you should be able to use any piece of gym equipment", says Epilepsy Action. If you still have seizures, some equipment may not be safe: talk to the staff and ask for a safety assessment. Weightlifting is in the ILAE's moderate-risk group.
If your seizures aren't controlled, choose machines with safety stops, bodyweight moves and light dumbbells over heavy barbells held over your face or on your back, use a spotter, and clip the treadmill's safety key to your clothing.
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Contact sports such as football, hockey, basketball and rugby "have not been shown to increase the chance of someone having a seizure", but carry a risk of head injury, so wear the recommended head protection. If your epilepsy was caused by a head injury, ask your doctor about contact sports.
The Epilepsy Society says boxing or martial arts "that involve blows to the head are not recommended", and England Boxing doesn't allow boxing with epilepsy. Before starting any martial art, ask your doctor and make sure the instructor knows what to do if you have a seizure.
If you can, avoid exercising when you know seizures are more likely, for example soon after waking if that's your pattern, or after a poor night's sleep.
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Take your medicine on time, keep regular sleep, manage stress and keep alcohol moderate.
Drink during exercise, and the Epilepsy Society advises not exercising straight after a meal. There's little evidence that missing meals triggers seizures.
The leaflets for topiramate and zonisamide warn that they can reduce sweating and cause overheating, mainly in children in hot weather; the zonisamide leaflet also tells adults in warm weather to drink enough water and keep cool. Our reading for adults who exercise: drink well, take care exercising hard in the heat, and ask your epilepsy team if you're unsure. Very hot skin with little or no sweating, confusion, cramps or a fast heartbeat needs urgent help.
Deliberate fast, deep over-breathing can bring on absence seizures in some children, and the Epilepsy Society says extreme breathing techniques in yoga may need extra care. Slow, gentle breathing is different.
If you have photosensitive epilepsy, avoid strobe lighting in classes. Swim England mentions sunlight shimmering on water.
You don't have to tell anyone if your epilepsy is unlikely to affect your safety, but telling a coach or class leader what your seizures look like and how to help can make you feel more confident. Equality law protects your access to sport and leisure.
Stay calm, and:
Stay with them and keep them safe, gently guide them away from danger, stay calm and reassuring, and time it. Don't restrain them.
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From behind, support their head so their face stays out of the water, move them to shallow water if you can, and shout for the lifeguard. Get them out once the seizure is over, put them in the recovery position and keep them warm.
Many people with epilepsy have a care plan, which may include rescue medicine, and don't need an ambulance every time. If you exercise with someone regularly, show them your plan.
"Do not change your dose or stop taking your medicine without talking to your specialist." The ILAE says changes to medicine should always be made under close medical supervision. Missing doses is one of the most common triggers.
Long-term use of carbamazepine, phenytoin, primidone and sodium valproate is linked with lower bone density and more fractures, especially with little sun, little calcium in the diet or not moving much. NICE asks clinicians to consider vitamin D and calcium supplements for people at risk. Weight-bearing, impact and strength exercise is the usual way to support bone (see our osteoporosis guide), and stronger bones matter more if seizures cause falls (our reading).
Some medicines cause dizziness or tiredness: the NHS says if topiramate makes you feel tired or dizzy, don't drive, ride a bike or use machinery until it passes. Topiramate and zonisamide can reduce sweating (see heat, above). Ask your epilepsy team or pharmacist if a side effect is getting in the way.
SUDEP is rare, affecting about 1 in 1,000 people with epilepsy a year. Tonic-clonic seizures, seizures that aren't controlled, not taking medicine as prescribed, and sleeping alone without supervision raise the risk, which is one more reason to take your medicine on time. Nothing in the sources we read links exercise with SUDEP.
Indoor options avoid traffic and water while seizures aren't controlled; clip the treadmill's safety key to your clothing. Build towards 150 minutes a week.
2 days a week, 2 to 3 sets of 8 to 12 (our editorial starting point). If you still have seizures, machines, bodyweight moves and light dumbbells are safer than heavy barbells.
3D demoLeg pressBeginner · Strength machine
3D demoChest press machineBeginner · Strength machine
3D demoSeated cable rowBeginner · A cable machine
3D demoLat pulldownBeginner · A cable machine
3D demoSit to stand from a chairBeginner · A bench or box
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoGlute bridgeBeginner · No equipment
3D demoKnee push-upBeginner · No equipment
3D demoBand rowBeginner · A band + An anchor point
3D demoDead bugBeginner · No equipment
3D demoBird dogBeginner · No equipmentIf you take a medicine linked to bone loss: impact and strength on 2 or more days a week, building up gradually (our editorial starting point). Our osteoporosis guide has the detail.
Slow, gentle breathing is fine; avoid deliberate fast, deep over-breathing.
Floor and standing workouts need no special set-up. In the gym workouts, swap free weights for machines if your seizures aren't controlled.
A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 20-minute full-body dumbbell workout: two supersets of squats, rows, Romanian deadlifts and push-ups. Twice a week covers the minimum dose.
20 minBeginner8 movesA dumbbell, A bench or boxImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.
25 minBeginner14 movesNo equipmentFor runs and walks, plan routes away from rivers and canals and tell someone where you're going.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerIt's the first, it lasts over 5 minutes or longer than usual, one follows another, there's a serious injury or trouble breathing, or it happened in water (see first aid above).
For a collapse during exercise with chest pain, palpitations or breathlessness, or if someone faints while exercising. A collapse during exertion isn't always epilepsy, and NICE says it needs an urgent heart check.
If you think you've had a seizure for the first time and didn't go to hospital, or you've had a seizure after a long time without one.
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Very hot skin with little or no sweating, confusion, muscle cramps, or a fast heartbeat or breathing: move to a cool, shaded place, sponge the skin with cool (not cold) water, drink cold water and get urgent medical help.
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Epilepsy Action's helpline is 0808 800 5050, and the Epilepsy Society also runs a helpline: check its website for the current number.
The ILAE says this advice came from "fear, overprotection, and ignorance", and that people seizure-free for 12 months can take part in all sports. Most people can find activities with a good balance of risk, and schools must support pupils to take part.
For most people it doesn't: only 2% of 204 adults with active epilepsy had seizures in more than half of their exercise sessions, and the ILAE calls a direct link in reported cases speculative. Missing medicine, tiredness and stress are far more common triggers.
Exercise programmes improved quality of life, but in a review of small trials the fall in seizures wasn't statistically clear. Some charity pages go further than this evidence. Never change or stop a medicine without your specialist.
You can, with precautions if your seizures aren't fully controlled: never alone, someone in the water who knows what to do, the lifeguard told, and a buoyancy aid if you need one. The precautions matter because the drowning risk is 15 to 19 times higher.
Don't. "They will not swallow their tongue", says the Epilepsy Society, and you shouldn't put anything in their mouth, including your fingers.
Don't hold them down. Move dangers away, cushion their head, time it, and roll them onto their side once the jerking stops.
Brief jerking can happen in an ordinary faint, and a collapse during exertion can come from the heart, which NICE treats as a reason for an urgent heart check. Call 999 if someone faints while exercising.
Yes, and most people with epilepsy should. An international task force says people with epilepsy have often been advised against sport out of fear and overprotection, and that after 12 months without seizures they can take part in any sport. If you still have seizures, you can still be active: it's about choosing activities and set-ups that keep you safe.
For most people, no. In a survey of 204 adults with active epilepsy, only 2% had seizures in more than half of their exercise sessions, mostly during hard effort, and experts call a direct link in reported cases speculative. Missing medicine, lack of sleep and stress are much more common triggers.
It's not proven. In a review of small trials, seizures fell a little with exercise, but the authors judged the result not statistically clear, though quality of life did improve. In most studies exercise didn't increase seizures. Keep taking your medicine as prescribed: exercise is an addition, not a replacement.
That depends on how well controlled your seizures are. Sports where a seizure could be fatal, such as climbing, scuba diving, motor sports, parachuting and surfing, are in the experts' high-risk group and are generally for people who have been seizure-free. Some UK bodies have their own rules: England Boxing doesn't allow boxing with epilepsy, and the British Sub-Aqua Club recommends 5 years off medicine and free of seizures while awake before scuba diving.
Yes. If your seizures are fully controlled, you need no more precautions than anyone else. If you still have seizures, never swim alone: have someone in the water who knows what to do, tell the lifeguard, consider a buoyancy aid, avoid crowded sessions and take extra care in open water. These steps matter because people with epilepsy are 15 to 19 times more likely to drown.
Yes. Epilepsy Action says that after 12 months seizure-free you should be able to use any equipment; if you still have seizures, some equipment may not be safe, so talk to the staff and ask for a safety assessment. Machines, a spotter and the treadmill's safety key are sensible if your seizures aren't controlled.
Often yes, with care. For cycling, wear a helmet and high-visibility clothing, and if you still have seizures, avoid busy roads, rivers and canals. Climbing is in the high-risk group: talk to your epilepsy nurse first, and choose roped indoor climbing or low bouldering with someone who knows your epilepsy. NICE advises that children don't climb above their own height without supervision.
Team sports such as football, rugby and hockey haven't been shown to increase seizures, but carry a risk of head injury, so wear the recommended protection. Boxing and martial arts with blows to the head aren't recommended, and England Boxing doesn't allow boxing with epilepsy. Ask your doctor before starting a martial art, and tell the instructor.
Rest until you feel fully back to normal, which can take hours or days after a tonic-clonic seizure. After a first seizure, get an urgent GP appointment or call NHS 111 if you didn't go to hospital, and wait until you've been checked before going back to sport. After a single seizure, the international task force suggests low-risk sports after a medical check and higher-risk sports after 12 months without seizures, unless your neurologist advises otherwise.
Stay calm, move anything harmful away, cushion their head and time the seizure. Don't hold them down or put anything in their mouth. When the jerking stops, roll them onto their side and stay until they've recovered. Call 999 if it's their first seizure, it lasts more than 5 minutes, another follows, or they're injured or struggling to breathe.
From behind, support their head to keep their face out of the water, shout for the lifeguard, and move them to shallow water if you can. Get them out once the seizure stops, put them in the recovery position and keep them warm. Call 999 if they may have swallowed or breathed in water, even if they seem fully recovered.
Some can. A few older medicines, including carbamazepine, phenytoin, primidone and sodium valproate, can thin the bones over time, so strength and impact exercise matter, and NICE says to consider vitamin D and calcium for people at risk. Topiramate and zonisamide can reduce sweating, so drink well and take care in the heat. Never change or stop a medicine without your specialist.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
