BACKGROUND: Research has established that built environments, including street networks, bicycle and pedestrian infrastructure, and land uses, can positively affect the frequency and duration of daily physical activity. Attention is now being given to policy frameworks such as zoning codes that set the standards and expectations for this built environment. METHODS: We examined the adoption and implementation of mixed-use and related zoning provisions with specific attention to the role that physical activity serves as a motivation for such policies and to what extent public health agencies influence the adoption process. A sample of planning directors from 53 communities with outstanding examples of mixed-use developments and 145 randomly selected midsized communities were surveyed. RESULTS: Physical activity is not a dominant motivator in master plans and/or zoning codes and public health agencies played minor roles in policy adoption. However, physical activity as a motivation appears to be increasing in recent years and is associated with higher levels of policy innovation. CONCLUSIONS: Recommendations include framing the importance of physical activity in terms of other dominant concerns such as livability, dynamic centers, and economic development. Health agencies are encouraged to work in coalitions to focus arguments on behalf of physical activity.