Exercise is underutilized in the battle against cardiovascular disease (CVD) for both the nondisabled and spinal cord-injured (SCI) populations. The American College of Sports Medicine and American Heart Association have launched the Exercise is Medicine™ initiative to facilitate widespread adoption of exercise as a practical treatment option by increasing awareness and providing structured guidance. We review the initiative, current exercise recommendations for the nondisabled, supporting evidence in the SCI population, and appropriate SCI-related alterations to exercise prescription. Finally, we provide resources supporting the prescription process for persons with SCI. © 2009 Thomas Land Publishers, Inc.