This article outlines the evolving evidence and guidelines surrounding exercise in hypertrophic cardiomyopathy (HCM), challenging the traditional paradigm of universal restriction. It highlights that most patients with HCM can safely engage in physical activity (PA) and improve cardiovascular outcomes. Recent evidence demonstrates that vigorous PA improves functional capacity and does not increase adverse events in most low-risk HCM patients. Contemporary guidelines advocate for individualized exercise recommendations based on comprehensive risk stratification and shared decision-making. A clinical framework is proposed to support tailored exercise prescriptions and shared decision-making.