Although white adipocytes are best known as the cell type that sequesters large quantities of neutral lipid, most eukaryotic cells, including skeletal myocytes, form lipid droplets. Current interests in intramyocellular triacylglycerol (IMTG) stem largely from their infamous association with metabolic disease (reviewed in Refs. 1, 2 ). Thus, in the context of obesity and type 2 diabetes, IMTG content Abstract Intramuscular accumulation of triacylglycerol, in the form of lipid droplets (LD), has gained widespread attention as a hallmark of metabolic disease and insulin resistance. Paradoxically, LDs also amass in muscles of highly trained endurance athletes who are exquisitely insulin sensitive. Understanding the molecular mechanisms that mediate the expansion and appropriate metabolic control of LDs in the context of habitual physical activity could lead to new therapeutic opportunities. Herein, we show that acute exercise elicits robust upregulation of a broad program of genes involved in regulating LD assembly, morphology, localization, and mobilization. Prominent among these was perilipin-5, a scaffolding protein that affects the spatial and metabolic interactions between LD and their surrounding mitochondrial reticulum. Studies in transgenic mice and primary human skeletal myocytes established a key role for the exercise-responsive transcriptional coactivator PGC-1 ␣ in coordinating intramuscular LD programming with mitochondrial remodeling. Moreover, translational studies comparing physically active versus inactive humans identifi ed a remarkably strong association between expression of intramuscular LD genes and enhanced insulin action in exercisetrained subjects.These results reveal an intimate molecular connection between intramuscular LD biology and mitochondrial metabolism that could prove relevant to the etiology and treatment of insulin resistance and other disorders of lipid imbalance. Abbreviations: ATGL, adipose triglyceride lipase ; BMI, body mass index; DAG, diacylglycerol; EDL, extensor digitorum longus; EE, energy expenditure; G0S2, G0/G1 switch 2; HF, high fat; HSkMC, human skeletal myotube; IMCL, intramyocellular lipid; IMTG, intramyocellular triacylglycerol; NT, nontransgenic; LD, lipid droplet; PGC-1 ␣ , PPAR ␥ coactivator-1 ␣ ; PLIN5, perilipin family protein 5; PPAR, peroxisome proliferator-activated receptor; Rd, whole-body glucose disposal; ⌬ Rd, change in whole-body glucose disposal (insulin sensitivity); RQ, respiratory quotient; ⌬ RQ, change in respiratory quotient (metabolic fl exibility); SC, standard chow; SCD1, stearoyl-CoA desaturase 1; TA, tibialis anterior; TAG, triacylglycerol; VO 2 max, maximal oxygen consumption per kilogram of body weight as measured during maximal exercise test; Wmax, maximum watts achieved per kilogram of body weight as measured during a maximal exercise test.