River management and restoration in Italy and France are increasingly considering physical processes and trends of channel adjustment as a basic knowledge for enhancing river conditions and promoting channel recovery. Italian and French rivers are characterized by a long history of human disturbances and land use changes. As a consequence, trends of channel adjustments and related management problems are similar, with a historical phase of aggradation followed by a period (last century) of intense channel incision and narrowing. A general overview on recent progress in using geomorphic approaches to river management in Italy and France is presented here by illustrating a series of examples of studies and management applications. A synthetic state of the art on the recent morphological changes of Italian and French rivers is first reported. Some examples of quantification of bed load are also illustrated, providing a necessary quantitative knowledge for possible interventions or strategies for promoting bed load recovery. Finally, examples are provided to illustrate how an understanding of geomorphic processes is used to define regional visions and associated tools for planning and targeting actions and to promote sustainable actions from local to catchment scale.