Two thousand years of human interventions has heavily modified the Dutch Rhine river. Situated in a densely populated and developed delta, the river and its infrastructure fulfil important societal functions: safety against flooding, inland waterways, nature, freshwater supply, and agriculture. Programs to improve individual functions increasingly lead to conflicts with other functions and therefore call for an integrated approach. This paper reviews the history of the Dutch Rhine and documents the sectoral improvement programs in recent decades, explaining adverse effects such as the large-scale bed degradation at rates of up to 4 cm per year. The lessons from the past are used to propose avenues for future integrated and sustainable river training and river management, arguing that mitigating adverse effects while maintaining societal functions requires a combination of recurrent sediment management measures and extensive structural measures that may change the layout of the river system.