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Background: The 20th and 21st centuries are marked by an increase in life expectancy on one hand and on the other hand by the increase of so called civilization diseases. Their share one common trait: the energy metabolism imbalance, with low energy expenditure and high energy uptake. Our age can be viewed as the age of inactivity and wealth., Methods: The aim of the present review is to highlight the influence of habitual physical activity on energy metabolism and balance., Results: Energy balance is the difference between energy intake and energy expenditure, where energy expenditure further divides into resting metabolic rate, thermic effect of feeding and energy used by physical activity. In general population, resting metabolic rate remains constant and proportional to muscle body mass. Muscle mass increases with exercise, especially resistance exercise, concomitantly with increasing energy expenditure. The effect of exercise on appetite is very strong, proportional to exercise intensity. An acute bout of aerobic exercise suppresses appetite by decreasing ghrelin plasma levels, and increasing gut hormones. Different subgroups of patients respond differently to the same exercise or habitual activity and have thus distinct effects on energy balance. Different myokines plasma levels after exercise could explain these different reactions although most of their effect is still unclear., Conclusion: Physical activity plays an important role in the prevention and treatment of many disorders, like obesity, type 1 and type 2 diabetes, dyslipidaemia, hypertension, coronary heart disease, osteoporosis, psychiatric and neurologic disorders. It is evident, that physical activity has an effect not only on energy balance but also has a direct effect on other body organ via its own molecules - myokines. The pharmacological effect of myokines gives hope that one day we could have a "myokine drug" that could be used in patients who are unable to exercise. Until then we should use our "muscle-pharmacy" and try to convince also our patients to use theirs. Physical activity makes a huge impact on human health.