Valvular heart disease (VHD) encompasses a spectrum of conditions that demand careful consideration when prescribing exercise. It is crucial to optimize patients’ health through evidence-based recommendations tailored to their specific VHD subtype, severity, and functional status. Valvular stenosis and regurgitation lead to hemodynamic alterations, resulting in pressure and volume overload on the heart. These adaptations necessitate cautious exercise program development to avoid exacerbating symptoms or compromising cardiac function. Before initiating any exercise regimen, a thorough evaluation is essential. Comprehensive clinical assessment, including echocardiography, exercise stress testing, and functional capacity assessment, helps determine the patient’s exercise tolerance and potential risks associated with physical activity. General exercise recommendations should emphasize the importance of adequate warm-up and cool-down routines to reduce the risk of arrhythmias and prevent hemodynamic stress. (1) Periodic reassessment and monitoring are essential to evaluate the patient’s response to exercise and make necessary adjustments to the regimen. Patient education about the signs and symptoms of worsening VHD is also very important, emphasizing the need for prompt medical evaluation. Individual risk stratification based on symptoms, ventricular function, and valve pathology guides the exercise prescription process.