This paper reviews some key issues regarding the cyclic loading response of offshore piled foundations. Starting with axial loading it considers: the cyclic loading that can be expected; the fundamental responses of piles driven in clays and sands; frameworks for understanding axial cyclic response and specifying cyclic soil testing; and approaches for practical application in design. The review then moves to consider pile responses to moment and lateral loading, distinguishing between flexible and relatively rigid piles and anchors. A range of possible design approaches is considered and it is argued that current routine practice needs to be reconsidered. Practical methods now exist to address the potentially highly significant effects on axial capacity of piles that experience high ratios of cyclic to average loads. New research and calculation procedures are emerging that offer significant improvements in a broad spread of topics.