Moderate exercise is recommended for patients with thalamic vascular malformation, but strenuous exercise and excessive fatigue should be avoided. Thalamic vascular malformation is a type of cerebrovascular malformation that refers to congenital as well as non-neoplastic developmental abnormalities of the cerebral vasculature that produce localized problems with the number of blood vessels and structures, affecting the patient’s normal cerebral blood flow. Types of vascular malformations include congenital intracranial cystic aneurysms, venous hemangiomas, arteriovenous malformations, and cavernous hemangiomas. They can be asymptomatic for long periods of time or can manifest as hemorrhages, seizures, and throbbing headaches. Strenuous exercise, excessive fatigue, emotional excitement, drunkenness, and smoking may cause a transient and sudden increase in blood pressure, and the weak malformed blood vessel wall ruptures and bleeds because it cannot withstand the sudden increase in intravascular pressure. On the other hand, prolonged lack of exercise may cause health problems such as atherosclerosis, decline in cardiopulmonary function, muscle atrophy, etc. Therefore, moderate exercise is required for the purpose of maintaining good health. Patients with thalamic vascular malformations are advised to consult their doctors for specific exercise intensity and exercise regimen to avoid adverse consequences.