Objectives In recent years, issues related to physical health took on a major role in the care of youth who experienced a first episode psychosis (FEP). Compared to the general population, people with a psychotic disorder have a reduced life expectancy of 15 years, with physical health problems accounting for 60 to 70% of that part. With the increased awareness about these issues, physical activity is considered as a new prevention and intervention strategy in the recovery process for youth with a FEP. The objective of the present article is to summarize the different physical health issues in FEP and the impacts of physical activity. Methods Narrative review addressing physical health issues, the role of antipsychotics, the need for metabolic monitoring, and for improvement of lifestyle habits (e.g., smoking, sedentary lifestyle, physical inactivity, poor diet) in youth with a FEP. The impact of physical activity on physical and mental health, on smoking cessation as well as the interest of adventure therapy in the recovery process will be discussed. Finally, we will propose motivational strategies and tools to promote physical activity. In the different sections, we will support our arguments with the highest levels of evidence available (e.g., meta-analyses, systematic reviews, randomized controlled trials, cohort studies, N-of-1) and highlight implications for clinical practice. Results Metabolic health problems progress rapidly after the initiation of antipsychotic treatment, and inadequate lifestyle habits contribute to the development of these problems. In an early intervention context, several types of physical activity have shown benefits on physical health, psychotic symptoms, functioning and more generally in the recovery process. Nevertheless, few patients spontaneously engaged in regular physical activity because of low motivation. Physical activity interventions should be adapted to the FEP population and several factors taken into consideration such as the type of physical activity, its context, intensity, frequency, motivational parameters, and support/supervision from health professionals. Conclusion From a physical and a psychiatric perspective, the years following treatment initiation for FEP are critical. Considering its positive impacts on different dimensions of recovery physical activity interventions should be integrated into the range of services offered in early intervention services.