Exercise and physical therapies are increasingly being considered as a lifestyle intervention in people with Huntington’s disease (HD). In addition to possible effects on motor function, there may be benefits in mood, behaviour and cognition from early in the disease. Certainly exercise may also infer general health benefits and there are recent suggestions that exercise may indeed potentiate disease modification. This review provides an overview of a strategic approach to the development and evaluation of complex exercise interventions in this neurodegenerative disease with a view to informing future clinical trials