Health promotion related to physical activity and exercise is an integral part of the nurse practitioner (NP) role. Yet, studies suggest that only 30% of primary care clinicians provide counseling to their sedentary patients (Clinician's Handbook of Preventive Services, 1994). This percentage may be even less with clients who represent the oldest old or a minority population. Information about the extent to which NPs counsel patients about physical activity and exercise prescription has not been well documented. The purpose of this research study was to identify the NPs role in providing individualized exercise prescription and to determine what strategies NPs use in assisting older adults to initiate and maintain an exercise program. The study utilized a focus group design comprising two focus groups, ranging in size from 6 to 7. Purposive sampling was used to enlist NP focus group participants. Content analysis of each transcript revealed that NP participants in these two focus groups utilize health history taking and observation skills in determining an older adult's physical fitness, physical activity, and exercise. None of the NP participants used a formalized instrument, nor did they use specific guidelines in prescribing physical activity and exercise recommendations. Frailty and socioeconomic status were variables that NPs consider in their physical activity and exercise recommendations, whereas ethnicity, age, and gender were not. Overall, NPs reported using a very small percentage of their time to physical activity and exercise counseling in primary care visits. Given the well-documented benefits of physical activity and exercise (U.S. Department of Health and Human Services, 1996; American College of Sports Medicine, 1998), it remains a matter of serious concern that more than 60% of American adults are not regularly physically active (Office of the Surgeon General, 1996). It is imperative that policymakers include physical activity and exercise counseling as a condition for reimbursement in primary care visits.