In Andersen and colleagues' paper on the physician's role in encouraging patients to be more physically active [1], I found three gems of statements. None was referenced, and I assume that each was the authors' common sense opinion.

1. "Writing the recommendation [for exercise] on a prescription pad may increase the likelihood that the recommendation will be followed."

2. "A physician's active interest and encouragement in how the patient is succeeding in becoming more physically active can be very helpful in increasing adherence."

3. "Physicians who set a good example themselves further enhance the importance of the message they wish to send to patients."

The third statement is arguably the most important of the three [2], but it can be made even more potent with a change in format. Physicians usually counsel their patients one at a time in a consultation room. It is more effective and efficient to invite all the patients to a seminar on exercise as preventive medicine. The physician should dress not in a white coat but in sneakers and athletic clothes. The seminar would be held not at a medical facility but in a YMCA facility or public park. The physician would discuss choice of exercise and frequency, distance, and intensity [3], with special attention to the importance of technique to increase aerobic effectiveness [4]. A follow-up weekly program in aerobic walking, preferably physician-instructed, would improve compliance. The weekly program should be graduated in distance and intensity to prevent musculoskeletal injury. After a few weeks, when metabolic and brain chemistry changes occur, motivation will become self-sustaining.