Our lifestyle is comprised of several different factors. The lifestyle pattern is set during childhood with a lasting effect upon adult lifestyle and later health. Several lifestyle factors may be modified including food, nutrition, physical activity and smoking. These are important for later health both in healthy children and in children with respiratory illness. The present editorial reflects upon the article by Roy J. Sheppard in the present issue of American Journal of Lifestyle in Medicine, taking up the influence of lifestyle factors on respiratory health in children. Physical activity is the primary factor in this context, relating both to healthy children and to children with chronic lung diseases. Physical activity is important for mastering of illness, and for some diseases even lifetime prognosis. Physical activity may increase the susceptibility to environmental exposures, such as environmental pollution and chlorine exposure in swimming pools. Limitations to physical activity may be set by chronic respiratory illness due to reduced baseline lung function, limiting increased ventilation levels during physical activity, and by exercise induced bronchoconstricion in asthma. Both aspects are important for treatment, habilitation and mastering of illness. Other aspects are fitness levels, overweight and impact upon quality of life and respiratory health. Regular physical training may be an important part of treatment strategies for respiratory diseases in children, and on the other hand, very heavy physical activity in adolescent top endurance athletes may lead to bronchial hyperresponsiveness and exercise induced asthma. The problem is complex deserving careful consideration.