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Patients desire to have information about health-related behaviors (e.g., exercise) provided to them by their health care provider. Outcomes of clinical trials in physical activity counseling are modest at best and therefore, the degree of effectiveness of physical activity counseling in the primary care setting remains unclear. We describe what may be considered a “real-world” example of behavior change counseling aimed at primary or secondary risk factor identification and modification for CHD in women. We examined rates of baseline and follow-up physical activity in our sample of midlife Caucasian and African American women (N = 227) participating in a hospital-based CHD-risk screening. Baseline physical activity levels and rates of return for follow-up appointments were quite low with only negligible achievement of behavior change recommendations. In light of these findings, the potential role of behavioral medicine in training and collaboration with health care providers in primary care behavior counseling is discussed.