The science and practice of environmental flows - aimed at the protection of ecosystem values and functions in regulated rivers - has progressively recognized the relevance of incorporating socio-cultural demands of local communities in the calculation of water requirements of rivers' habitats and services. This review paper synthesizes the concept of cultural flows, and presents the main approaches explored or conducted up to this date to provide such flows in rivers of different regions and typology. This work highlights the necessity of integrating cultural demands in future attempts to protect and restore altered flow patterns, due to the multiple interactions between flow, ecology and people which typically characterize rivers and other aquatic systems.