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Epilepsy is a common disease found in 2% of the population, affecting both young and old. Unfortunately, epileptics have previously been discouraged from participation in physical activity and sports for fear of inducing seizures or increasing seizure frequency. Despite a shift in medical recommendations toward encouraging rather than restricting participation, the stigma remains and epileptics continue to be less active than the general population. This results in increased body mass index, decreased aerobic endurance, poorer self-esteem, and higher levels of anxiety and depression. Although there are rare cases of exercise-induced seizures, studies have shown that physical activity can decrease seizure frequency, as well as lead to improved cardiovascular and psychologic health. The majority of sports are safe for epileptics to participate in with special attention to adequate seizure control, close monitoring of medications, and preparation of family, coaches, or trainers. Contact sports including football, hockey, and soccer have not been shown to induce seizures, and epileptics should not be precluded from participation. Water sports and swimming are felt to be safe if seizures are well controlled and direct supervision is present. Additional care must be taken in sports involving heights such as gymnastics, harnessed rock climbing, or horseback riding. Sports such as hang-gliding, scuba diving, or free climbing are not recommended, given the risk of severe injury or death, if a seizure were to occur during the activity. This article reviews the risks and benefits of physical activity in epileptics, discusses sports in which epileptics may participate, and addresses how to decrease possible risks for injury.