Exercise is an important aspect of the care of both children and adults with type 1 diabetes, promoting improved cardiovascular health, glycemic control, and participation in normal life. However, exercise presents several important challenges related to exogenous insulin delivery and risk of potentially dangerous glycemic excursions. In these and other respects, considerations for management of exercise in type 1 diabetes are quite different from type 2 diabetes. In this chapter, general recommendations for exercise will be reviewed, along with an update on the understanding of differential physiologic mechanisms that contribute to glycemic excursions in type 1 diabetes. We will emphasize a practical approach based on underlying physiology to facilitate safe exercise in type 1 diabetes, with a specific discussion pertinent to new technology including the artificial pancreas.