Roll up a sleeve for the blood pressure cuff. Stick out a wrist for the pulse-taking. Lift your tongue for the thermometer. Report how many minutes you are active or getting exercise. 

Wait, what?

If the last item isn't part of the usual drill at your doctor's office, a movement is afoot to change that. One recent national survey indicated only a third of Americans said their doctors asked about or prescribed physical activity.

Kaiser Permanente, one of the nation's largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit, and some other medical systems are doing it, too.

Here's how it works: During any routine check of vital signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it's among the first things the doctor sees.

"All we ask our physicians to do is to make a comment on it, like, 'Hey, good job,' or 'I noticed today that your blood pressure is too high and you're not doing any exercise. There's a connection there. We really need to start you walking 30 minutes a day,'" said Dr. Robert Sallis, a Kaiser family doctor. He hatched the vital sign idea as part of a larger initiative by doctors groups.

He said Kaiser doctors generally prescribe exercise first, instead of medication, and for many patients who follow through that's often all it takes.

It's a challenge to make progress. A study looking at the first year of Kaiser's effort showed more than a third of patients said they never exercise.

Sallis said some patients may not be aware that research shows physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. As recently as November a government-led study concluded that people who routinely exercise live longer than others, even if they're overweight.

Zendi Solano, who works for Kaiser as a research assistant in Pasadena, Calif., says she always knew exercise was a good thing. But until about a year ago, when her Kaiser doctor started routinely measuring it, she "really didn't take it seriously."

She was obese, and in a family of diabetics, had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

Solano, 34, decided to take up running and after a couple of months she was doing three miles. Then she began training for a half marathon — and ran that 13-mile race in May in less than three hours. She formed a running club with co-workers and now runs several miles a week. She also started eating smaller portions and buying more fruits and vegetables.

She is still overweight but has lost 30 pounds and her blood sugar is normal.

Her doctor praised the improvement at her last physical in June and Solano says the routine exercise checks are "a great reminder."

Kaiser began the program about three years ago after 2008 government guidelines recommended at least 2 1/2 hours of moderately vigorous exercise each week. That includes brisk walking, cycling, lawn-mowing — anything that gets you breathing a little harder than normal for at least 10 minutes at a time.

A recently published study of nearly 2 million people in Kaiser's southern California network found that less than a third met physical activity guidelines during the program's first year ending in March 2011. That's worse than results from national studies. But promoters of the vital signs effort think Kaiser's numbers are more realistic because people are more likely to tell their own doctors the truth.

Dr. Elizabeth Joy of Salt Lake City has created a nearly identical program and she expects 300 physicians in her Intermountain Healthcare network to be involved early this year.

"There are some real opportunities there to kind of shift patients' expectations about the value of physical activity on health," Joy said.

NorthShore University HealthSystem in Chicago's northern suburbs plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

Dr. Carrie Jaworski, a NorthShore family and sports medicine specialist, already asks patients about exercise. She said some of her diabetic patients have been able to cut back on their medicines after getting active.

Dr. William Dietz, an obesity expert who retired last year from the Centers for Disease Control and Prevention, said measuring a patient's exercise regardless of method is essential, but that "naming it as a vital sign kind of elevates it."

Figuring out how to get people to be more active is the important next step, he said, and could have a big effect in reducing medical costs.

Related stories: 

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• Best DIY diet? MyFitnessPal app, Consumer Reports says
• 'Our plates are killing us': Black women battle obesity

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What's he writing anyway?

Have you ever been tempted to sneak a peek at those notes your doctor is scribbling about you? If you have, you’re like most patients, new Harvard research shows. 

But chances are, your doctor would rather you keep your nose out of his notes. A poll of 100 primary care doctors nationwide conducted by Truth On Call for msnbc.com found that 68 percent of physicians have written something in a patient's chart they wouldn't want that person to see.

Wendie Howland took a look at her chart while she waited alone in an exam room. The notes revealed that years earlier a doctor had stitched her up in the wrong place during surgery, and that’s why she developed an infection that was so bad it landed her back in the hospital for 10 days.

“The nurse left it, and I picked it up and started reading it,” says the 60-year-old nurse from Cape Cod, Mass. “I went through it because I didn’t have anything better to do. It angered me because I was pretty uncomfortable for a couple months. God knows I was.”

Deciding it was time to allow patients access to written notes in their charts, researchers at the Harvard University Medical School and the Beth Israel Deaconess Medical Center in Boston created a new system called Open Notes, and invited patients to take a look.

 “You’re allowed legally to get ahold of those notes, but we make it as difficult as possible,” says Dr. Tom Delbanco, a professor of medicine at the Harvard University Medical School and senior author of the report published Monday in the Annals of Internal Medicine.

“Legally to do that, you may have to pay for it; you’ve got to see it with a nurse sitting next to you. There are all kinds of impediments. We say that’s a lot of nonsense. We want to open the black box. It’s your body; therefore we invite you to read what we wrote.”

When they asked nearly 40,000 patients in Boston, Seattle and rural Pennsylvania what they thought about seeing their charts, the team of researchers led by Jan Walker, a nurse at Harvard and Beth Israel Deaconess, found that 90 percent wanted to see their primary doctor’s written notes.

More than half thought they would take their medications better if they were taking any, and 90 percent felt they would be in more control of their care. At least 80 percent of patients also felt they would take better care of themselves if given the opportunity to read their notes and gain greater understanding about their medical situations, and half thought they would share their notes with others.

Doctors, however, didn’t like the idea at all.  

What are they hiding in there anyway? In a famous “Seinfeld” episode, Elaine peeked at her chart and discovered her doctor called her a “difficult” patient. When she asked about his note, he pretended to erase it, and failed to treat her rash. The “difficult patient” note followed her to a second doctor, so she hatched a plan for Kramer steal her chart.

Weigh in on Facebook: Why do you think doctors don't want you to see what they're writing?

In this study, doctors were divided into two groups: 114 doctors who participated in the study and 140 who were surveyed, but didn’t participate. Across the three study sites, about 84 percent of doctors who didn’t participate in the study said they were concerned that if patients saw their notes, they would bombard them with questions between visits, researchers said.

“We tend to sell patients short, and we don’t realize how resourceful patients are; we are still learning about that,” Delbanco says. “As far as confusing or worrying you, we are going to scare some patients. But if something is going to scare you, we should be talking to you about it anyway.”

Next year, the researchers will report back on what happens when doctors and patients get on the same page.

The health care practitioner polling firm Truth On Call contributed to this report.