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Further to the Trisha Greenhalgh posting... I am a lay writer (with a beginners interest in the evidence-base for health care) and recently wrote a piece for the consumer magazine Health Which? on exercise and exercise promotion. Apologies if this is obvious but the US Surgeon General's report (downloadable from http://www.cdc.gov/nccdphp/sgr/sgr.htm) is an excellent reference material for the evidence-base for the "moderate message". The NIH Consensus Conference document (JAMA, July 17, 1996 Vol 276. No3) is in the same vein with "Activity that reduces CVD risk factors and confers many other health benefits does not require a structured or vigorous exercise programme. The majority of benefits of physical activity can be gained by performing moderate-intensity activities." Have you also seen Erikssen and colleagues "Changes in physical fitness and changes in mortality" Lancet 1998; 352:759-62? "even small improvements in physical fitness are associated with a significantly lowered risk of death..." Finally, you have concentrated on energy expenditure as the primary outcome measure but also mention other biomedical variables and walking. Health-related quality of life and mental health are also factors you might want to consider for a broad based evaluation of the impact of changes in physical activity. Regards Philip Taylor Senior Researcher Health Which? Direct: 0171 830 6390 Fax: 0171 830 7664 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%