The clinical approach to hypertrophic cardiomyopathy (HCM) and its treatment have rapidly changed over the last 3–5 years. For the first time, treatments exist specifically for HCM, and data now exist to support exercise prescriptions and high-intensity activities. Lifestyle counseling and adjustments, though, remain an important part of the approach to a patient with HCM. As HCM physiology can vary widely amongst patients, an individualized approach is essential while also ensuring the patient has a voice in their own care through shared decision making (SDM). Hydration should be emphasized for HCM patients, especially those with left ventricular outflow tract (LVOT) obstruction and those exercising at moderate to high intensities. Diuretics and strict regulation of fluid balance may be needed, though, when congestion is present. It is important to remind patients that the phenotype of HCM and its manifestations may change over time, and therefore, ongoing HCM expert input should be ongoing. So, too, will our data regarding lifestyle in our patients, along with the emergence of new therapeutics which target HCM itself. It is incumbent upon those who treat these patients to continue to engage our patients with education, risk stratification, treatment, and SDM to ensure the best outcomes possible.