Physical inactivity constitutes the fourth leading cause of death globally. Health systems are being called to respond to the epidemic of non-communicable diseases (NCDs) and help deliver on the promise of prevention approaches. Substantial evidence exists in support of multi-prong physical activity counseling, prescription and referral strategies, in particular those linking clinical and community-based resources, to help increase physical activity (PA) levels. In late 2007, the “Exercise is Medicine” (EIM) initiative was established by the American College of Sports Medicine to institutionalize PA promotion into the US healthcare system.