We appreciate Dr. McDuffie's and Dr. Malkin's interest in our recent paper. Both have reiterated the importance of being a good role model for patients. We commend Dr. McDuffie on his own commitment to regular vigorous physical activity. He addresses the key point of tailoring and individualizing exercise prescriptions to meet the individual health needs of each patient. Our paper focused on how to help apparently healthy adults adopt a more active lifestyle. However, as Dr. McDuffie notes, patients with musculoskeletal limitations or other medical ailments can also get symptom relief through regular activity.

Dr. Malkin suggests that physicians offer seminars stressing the importance of exercise while dressed in athletic clothing. This may be an effective strategy for some physicians to encourage patients who wish to become more vigorously active. We caution, however, that many sedentary adults without a history of physical activity do not enjoy vigorous activity [1] and may find this intimidating [2]. Specialty seminars attract a biased group, probably those already predisposed to be physically active. Moreover, we think many sedentary people find that the need to change into athletic clothing and special footwear is a barrier to participation.

Although not optimal, a quick message delivered during a routine office visit that addresses the importance of increasing physical activity can elevate activity levels [3]. Furthermore, patients report being receptive to this type of brief counseling. We believe that routinely delivering such messages to all patients ensures that the maximum number of people will hear this from their care provider, thus offering the potential to spread the word to the largest possible audience. More research is clearly needed to specifically document the effectiveness of physician counseling to increase activity. Making physical activity counseling as much a part of each office visit as hypertension checks will also emphasize the reciprocal relation between health and physical activity.