Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic heart disease, characterized by left ventricular hypertrophy not explained by hemodynamic overload. For decades, individuals with HCM were advised to avoid high-intensity physical activity due to the fear of sudden cardiac death during exercise. However, recent evidence has challenged this paradigm, demonstrating that supervised exercise programs, including those of moderate to high intensity, can improve functional capacity, cardiovascular profile, and quality of life without significantly increasing the risk of arrhythmias or adverse events. Recent randomized clinical trials have shown that structured physical training reduces ventricular filling pressure, enhances maximal oxygen consumption (VO₂), and provides measurable psychological benefits, including among patients without left ventricular outflow tract obstruction. Recent meta-analyses further support the safety and efficacy of these interventions when implemented through individualized prescription and specialized supervision. This chapter reviews the main contemporary evidence on exercise in patients with HCM, emphasizing the shift from a restrictive model to a personalized and safe approach to cardiovascular rehabilitation.

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