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Regular physical activity offers numerous benefits to children's health and well-being and is essential for reducing cardiovascular risk in children with cardiovascular disease. Despite increasing evidence supporting its benefits, many young patients remain insufficiently active because of concerns regarding exercise related risks, limited expertise. This clinical consensus statement provides practical guidance for the prescription of exercise and physical activity in children and adolescents aged 6 to 17 years with cardiovascular disease. The document aims to bridge the gap between evidence supporting the benefits of physical activity and its implementation in daily clinical practice, promoting safe participation in sport and exercise across a broad spectrum of cardiovascular conditions. This consensus statement outlines an individualised, patient-centred approach to exercise prescription based on clinical assessment, cardiovascular risk stratification, and the FITT principle: frequency, intensity, time, and type. Specific recommendations are provided for congenital and acquired heart disease, cardiomyopathies, arrhythmias, pulmonary hypertension, cardio-oncology patients, and children with physical disabilities or syndromes. The document emphasises the importance of multidisciplinary care, periodic follow up, exercise testing when indicated, and tailored programs adapted to the child's clinical condition, developmental stage, and personal preferences. The overarching goal is to encourage safe and enjoyable participation in physical activity, improve quality of life and functional capacity, and foster lifelong healthy behaviours in children with cardiovascular disease.