Clinical health care providers have been increasingly called on to respond to the physical inactivity epidemic in the United States. Given their high frequency of contact with sedentary patients, health care professionals, such as physicians, nurses, dietitians, nurse practitioners, exercise physiologists, and pharmacists, are in a unique position to facilitate physical activity via clinical counseling interventions. The literature on national, state, and local investigations that have assessed the frequency of physician-based physical activity counseling was reviewed. Despite the recent appeals and importance of physical activity in preventing and managing diabetes, results indicated that only about 40% of U.S. physicians regularly engage in physical activity counseling, with little improvement over the past few decades. In addition, three recent reviews on the efficacy of physician-based physical activity counseling have generated equivocal results. Strategies that may increase the frequency and improve the effectiveness of clinical counseling are discussed.