The important role of obesity and inactivity in the pathogenesis of cardiovascular diseases is generally accepted. In Germany, 75% of men and 59% of women at the age of 25-69 years are overweight or obese. The prevalence of inactivity in Germany is 30% for all age groups, and only 13% of the population achieves a level of physical activity known to have cardioprotective effects. Overweight and inactivity have shown to be associated with several cardiovascular risk factors such as hypertension, diabetes mellitus type 2 and dyslipoproteinemia. It has been demonstrated that obesity (body mass index > 30 kg/m2) considerably increases the risk for cardiovascular diseases (by up to 50%). Comparable findings have been observed in a meta-analysis when the effects of inactivity on cardiovascular morbidity or mortality have been investigated. Compared to regular physical activity, inactivity increased the relative risk for myocardial infarction or death by 60% and 90%, respectively. Therapeutic lifestyle changes (TLC) by increased physical activity and dietary intervention have shown to reduce cardiovascular risk factors and the incidence and prevalence of cardiovascular disease. Therefore, TLC should be the primary intervention in inactive overweight or obese subjects. This recommendation is specifically important for patients with the metabolic syndrome.