Introduction Physical activity is considered to be a tool for public health. Diseases resulting from a settled way of life should be prevented or solved by physical activity. This paper focuses on the role of national sport organisations in the socioeconomic context of health. Facts An in-depth analysis of the relation between physical activity and health, of the pressure of the economical environment and of social stakeholders is done. An historical approach of sports organisations is presented. The various organisational and managerial challenges they have to face within different national sport systems in Europe are underlined. Conclusion National sports organisations have to undergo a metamorphosis whether they want to become socioeconomic actors in the health sector. It is suggested that they should accept some social and behavioural missions included in the various national health plans. They should be granted in this context, in order to fulfil their mission of sport for all.