Even for the most disabled, there's hope, said author and fitness expert Charlotte Hayes, but health professionals must do more.

Hayes, who wrote "The I Hate to Exercise Book For People With Diabetes," said telling patients to exercise is different from telling them how.

Every step of exercise is important, she said. For those who can walk, a few steps a day helps. For those who can't, there are alternatives.

"We take a small-steps approach," she said.

The American Diabetes Association recommends people get at least 30 minutes of aerobic exercise, such as brisk walking, five times a week. But the association says for those who can't, there are benefits from even five minutes a day, along with everyday activities such as gardening or walking to work.

Morrato said she doesn't know the answer, only that the results of her study are disappointing.

"It is difficult to be optimistic about addressing the twin epidemics of obesity and diabetes without success in increasing physical activity in the population," her study concludes. "The results of this study provide very pessimistic data."

Deeb, who specializes in pediatrics, said the next generation is off to a better start. Children, he said, are taught nutrition and the benefits of physical activity. Now, families, local governments and school boards need to take action, while doctors need to follow up and find out if at-risk patients know where to get help.

"When you ask a family what they're doing, the answer is all about time. They know what's good for their families, but both parents are working, and sometimes the only time they have is to pick up fast food," he said. "They have to understand, your health depends on it.

"We will not give up," he said. "We can't give up."

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