Coronary risk factors such as obesity, dyslipoproteinaemia and low physical fitness are often prevalent in childhood. In contrast, regular physical activity and healthy nutrition have been shown to be effective in primary and secondary prevention of coronary artery disease. An increment in physical activity with concomitant weight loss has a profound influence on peripheral lipoprotein metabolism and has shown to improve the atherogenic lipoprotein profile. As risk factors often track from childhood into adulthood it seems inevitable to prevent or diminish risk factors as early as possible. Therefore, intervention programmes for prevention of coronary artery disease have to be conducted in childhood. Experience from an own intervention programme of obese children has shown that the combination of intensive dietary and physical education improves physical fitness, body composition as well as lipid metabolism. Whether short-term benefits will continue into adulthood and reduce coronary artery disease in midlife will have to be shown. Nonetheless, it seems out of question that children showing risk factors such as obesity or hypercholesterolaemia will benefit from early intervention programmes when changing dietary and exercise behaviours.