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Some literature shows a positive relationship between physicians' personal physical activity (PA) levels and physicians' encouraging patients' PA, though it remains unclear how this evolves during medical training. In this paper, we describe U.S. medical students' PA levels and factors predicting relevance and frequency of their PA counseling of patients.This is a prospective survey of a representative sample of U.S. medical students from 16 schools (N = 2316) designed to determine health-related attitudes and practices. Student's PA levels were assessed using a Godin exercise questionnaire. An 80.3% (N = 1658) response rate was achieved during 4 yr.More than half (61%) of U.S. medical students adhered to CDC PA recommendations. This rate was relatively stable during the 4 yr of medical training. Of those who reported a lot of stress in the last 12 months or 2 wk, fewer than 60% complied with the CDC exercise recommendations, compared with at least 80% who reported almost no stress. Frequency of PA counseling of patients was consistently related to personal PA practices. The percent of students perceiving that PA counseling would be highly relevant to their practices decreased during the 4 yr of medical school, from 69 to 53% (P < 0.01).Among U.S. medical students, personal PA levels are higher than those of age-matched peers in the general population, are maintained throughout medical school, and are correlated with frequency of PA counseling of their patients. Promotion of adequate PA habits during medical education may be an important step to improve the PA preventive counseling that future clinicians provide.