This chapter includes general recommendations regarding the eligibility for recreational and competitive sports participation. Although based on the latest knowledge in sports medicine and cardiology, these recommendations should be updated according to advances in the understanding of the athlete's heart. Physical exercise plays an important role in the leisure time of our society. Many patients with cardiac disease don't want to give up their physical or sport activity programs. Moreover, there is no doubt that many cardiovascular abnormalities may benefit from a controlled physical exercise program. Understanding the cardiac adaptations to exercise training, individualised evaluation of each cardiac pathology and adequate exercise prescription is essential in order to minimize the risks for every cardiac patient.