© 2014 S. Karger AG, Basel. The global prevalence of diabetes is rising, and is projected to exceed 380 million by 2025. Of concern is that the greatest changes in prevalence are expected in lower- and middle-income countries. Further, persons from low-income groups and ethnic minorities are often at increased risk for type 2 diabetes mellitus (T2DM). Physical activity has been unequivocally linked to primary prevention of T2DM, and nearly 1 in 3 adults are not meeting current recommendations for physical activity. Aim: The aim of this pragmatic review was to provide a summary of evidence concerning physical activity for primary prevention of T2DM, to inform policy and practice. Results: Results of longitudinal cohort studies suggest that persons meeting physical activity guidelines (150 min of moderate activity weekly) have a 30% reduction in risk of incident T2DM (RR: 0.71, 95% CI: 0.65-0.79). However, even a single bout of weekly vigorous activity has been shown to be protective. Sedentary behavior is also implicated, in a dose-dependent manner (RR for T2DM: 1.20, 95% CI: 1.14-1.27, for every 2-hour increment). Diabetes prevention programs, incorporating physical activity as part of lifestyle interventions, show even larger effects in high-risk persons (nearly 50% reduction). Barriers to physical activity include: access and affordability, low self-efficacy and cultural constraints. Conclusion: Current public health recommendations and strategies to promote physical activity are not only relevant, they are an imperative to prevent and manage the growing burden of T2DM. Care should be taken to ensure physical activity interventions are culturally coherent with communities and individuals for whom they are intended.