Counselling can induce women to increase their physical activity, but for some reason men don't seem to respond, a study has found.

"We have shown that counselling about physical activity can improve fitness in women," says Dr Denise Simons-Morton, deputy director of the National Heart, Lung and Blood Institute program which sponsored the two-year Activity Counselling Trial. Why men did not show the same improvement is not known, she says.

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"Maybe women are just more amenable to improving their lifestyles," she says.

A report in the August 8 issue of the Journal of the American Medical Association says that medical research centres in California, Texas, and Tennessee recruited 874 physically inactive men and women. They did not follow the standard recommendation of at least 30 minutes of moderately intense physical activity five days a week. And while they had many risk factors for coronary disease - more than 70 percent were overweight, a third had high blood pressure, and 20 percent had high blood cholesterol - none had active cardiovascular disease.

A third of the participants got the kind of advice any doctor would give an inactive patient, a pep talk lasting two to four minutes and referral to a health educator for more information. Another third got the same treatment, plus behavioural counselling by a health educator, one telephone call, an electronic device to measure activity and a monthly newsletter. The third group got all that, plus regular telephone counselling and weekly classes about exercise and its benefits.

After two years, the results for men were nil - no more physical activity, no improvement in oxygen intake in the two active intervention groups compared with the group that got just advice. But women in the two active groups reported more physical activity and had a 5 percent improvement in oxygen intake.

The fact that both moderate and more intensive intervention produced the same benefits was a surprise, Simons-Morton says. Looking on the bright side, she says, "This study provides evidence that if you sit down with patients and do counselling on a one-to-one basis, if you do that with women you can help them become more physically fit."

Dr Christina Wee, an instructor in medicine at Harvard Medical School and author of an accompanying editorial, was less optimistic.

"The results are somewhat mixed," she says. "They are encouraging in the sense that this is the first study that is well done and shows that counselling that is this intensive can make a difference. But the differences are quite small, and even in women the improvement is small. There is a lot of effort for a small improvement."

The counselling needed to show that improvement was "fairly aggressive and intensive," and "perhaps more than any primary care physician can offer patients," Wee says.

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