Non-compaction cardiomyopathy (NCCM) is typified by deep invaginations of the myocardium and is caused by an arrest of normal myocardial morphogenesis. NCCM was once considered rare, but is now widely recognised owing to frequent use of advanced imaging techniques. NCCM can also be detected when competitive athletes undergo preparticipation screening for cardiac disease or when being evaluated for cardiac symptoms. It is not clear how athletes with NCCM should be managed. We searched PubMed and Google for articles addressing the issue of NCCM and athletic participation. We were able to identify only 18 cases of NCCM described in the context of sports, athletics or exercise. We conclude that there are insufficient data to develop firm recommendations on how to manage vigorous activity in patients with NCCM and future registries of sudden death in athletes should include a careful search for cases of NCCM among the victims so that clinicians can develop more definitive recommendations for athletes with this condition.