Many physicians are spending significantly more of their energies combating the growing health problems caused by chronic illnesses. Being physically active is one of the most important steps people can take to improve their overall health and to lower their risk for chronic diseases.

With the 2005 Los Angeles County Health Survey showing that more than 1.3 million (20.9 percent) adults were obese and 600,000 were diagnosed with diabetes, and with both numbers continuing to rise, ensuring that your patients are achieving recommended levels of activity is critical. Taking a few minutes to discuss the importance of physical activity and to create a realistic action plan will help patients start taking small steps to greatly improve their health.

Regular physical activity can reduce a person's risk for cardiovascular disease, diabetes, hypertension, osteoporosis, arthritis and some types of cancer. In addition, research has demonstrated that physical activity also promotes mental well-being, decreases symptoms of anxiety and depression, and helps older adults maintain physical function. Despite the multiple benefits of physical activity, many people are still not active enough. In Los Angeles County, physical activity levels are improving, but according to the 2005 survey, 48 percent of adults were not participating in physical activity at levels recommended to provide health benefits.

Here are the levels of physical activity recommended to provide health benefits:

*Adults should participate in 30 minutes of moderate-intensity physical activity (e.g., walking briskly, mowing the lawn, swimming recreationally or bicycling) on five or more days a week; or participate in 20 minutes of vigorous-intensity physical activity (e.g., jogging, doing heavy yard work, dancing or swimming laps) on three or more days a week.

* Children and adolescents should participate in at least 60 minutes of moderate-intensity physical activity most days of the week.

Patients should realize that starting a regular exercise routine does not have to be intimidating. Simple measures, such as taking the stairs instead of the elevator or playing actively with their kids will increase their daily physical activity level. Patients can still achieve their recommended levels of activity in the midst of busy schedules--research has shown that brisk walking for as little as 10 minutes at a time, three times a day, can produce major health benefits.

How to Promote Physical Activity
Exams and checkups are the ideal time to talk with your patient about creating a physical activity action plan. An effective plan can be developed within a brief 5-10 minute counseling session. Remember to keep your message straightforward and focused on a realistic plan. Below are five steps you can take when counseling patients.

ADDRESS the issue: Show your patient where he falls in a body mass index chart or growth chart to demonstrate why he should act now to increase his level of physical activity. Using objective parameters, such as BMI, allows you to raise the issue in a nonjudgmental manner.

ASSESS the patient's beliefs, concerns and feelings: Does the patient (or patient's parent) think that that he is overweight and/or needs to increase his physical activity?

ADVISE by providing personalized information: The instructions and advice that you offer each patient will vary depending on the patient's readiness to change.

ASSIST your patient with a realistic physical activity action plan: Identify personal barriers as well as resources as you work with your patient to create a plan.  Remind the patient of his overall objective and offer suggestions for incremental changes he can make in his daily patterns.

ARRANGE to follow up: Check your patient's progress in adhering to the action plan on future office visits.

You can get help in discussing physical activity with patients from the federally funded PACE+ Project. PACE+ (Patient-Centered Assessment for Exercise and Nutrition) is a tool supporting initial and sustained improvements in physical activity, diet and other lifestyle behaviors. For more information about PACE+, visit the Web site at www.paceproject.org/home.html.

The authors work for the Los Angeles County Department of Public Health. Elan Shultz, MPH, is a staff analyst in the director's office. Eloisa Gonzalez, MD, MPH, is the director of the Physical Activity and Cardiovascular Health Program. Margaret Shih, MD, PhD, is the chief of the epidemiology unit in the Office of Health Assessment and Epidemiology.