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Background: Engaging in regular physical activity has a beneficial impact on both physical health and on subjective health indicators. The aims of this study were (i) to assess the association between physical activity levels and self- reported health status in European adolescents and (ii) to identify any differences in the distribution of adolescents reporting good health between active and inactive subjects across urban areas. Methods: The study sample comprised 13 783 15-year olds from 21 urban areas across Europe who participated in the European Urban Health Indicators System Part 2 youth survey in 2010/11. Data collected on physical activity levels, self-rated health status and covariates including gender, BMI, socioeconomic status and sedentary behaviour were analyzed in a multivariable logistic regression model. Results: High levels of physical activity (OR: 1.607, 95% CI: 1.245-2.074, P<0.001) were associated with self-rated 'good health' across the cohort as a whole. All cities except lasi showed a positive association between high levels of physical activity and good health. This was significant in four cases: Amsterdam, Cardiff, Greater Manchester and Merseyside (P=0.035, 0.016, 0.010 and 0.049, respectively). Only 13.3% of the cohort met the current WHO physical activity level recommendations. Conclusion: High levels of physical activity are positively associated with self-rated 'good health' status in European adolescents. Alarming levels of physical inactivity make it a priority to encourage greater engagement in physical activity. Promotion of physical activity should be specifically tailored to each urban area. [ABSTRACT FROM AUTHOR]