Regular physical activity has been one of the cornerstones of type 1 diabetes mellitus (T1DM) therapy for decades. The benefits attributed to regular physical activity include increased sense of well being, quality of life, improved body composition, improved blood pressure and more. The beneficial effect in individuals with T1DM includes decreased risk of diabetes-related complications and mortality. In view of the recent recommendations for physical activity in healthy youth, advocating daily participation in 60 minutes of moderate to vigorous physical activity, we review the recent literature regarding physical activity in the context of youth with T1DM. We discuss its physiological and metabolic effects in youth with T1DM, its health promoting benefits and challenges that exercise poses in these individuals.