• chronic disease
• health promotion
• physical activity

“It is tragically ironic that major legislative actions have been implemented to protect society against all other forms of preventable deaths except those resulting from physical inactivity.” Booth, 2000

It is very likely that the reader of the British Journal of Sports Medicine will agree that “exercise has preventive and therapeutic health benefits”. Yet the vast majority of people in the developed world choose to remain inactive. The prevalence of chronic diseases contributed to by physical inactivity is escalating so rapidly that their costs will exceed $1 trillion in the United States in the next decade!¹ More alarming, there are 250 000 deaths annually in the United States directly attributable to physical inactivity.¹ Despite these distressing data, most physicians and health providers miss many opportunities to prescribe exercise when treating chronic diseases such as obesity, diabetes, and cardiovascular disease. What lies behind this striking paradox, this dissonance between knowledge and practice? How do we create, implement, and sustain programmes of physical activity in a culture that actively encourages overeating and sedentary behaviour?² This leader suggests strategies for bringing practice (physically active behaviour) into line with the evidence that treatment of physical inactivity provides enormous health benefits.¹