Increasing physical activity is a potent strategy for reducing the risk of multiple chronic diseases, yet in the United States, most of the population is sedentary or near-sedentary. In many ways, this is a failure of our health care system. This system is really a “sick care” system that is organized around dealing with acute, short-term problems rather than issues that need continued attention over time. Physicians similarly want quick solutions and often don’t have the training needed to provide persuasive advice about lifestyle change. We live in environments that promote obesity and that make healthy choices difficult. Surrounded by advertising promises and hype, consumers themselves want an easy fix to their problems, rather than the hard work required to live a healthier lifestyle. In the end, however, the substantial benefits can make the hard work worth it.