OBJECTIVE -To determine the impact of chronic exercise training initiated later in life upon development of metabolic markers of cardiovascular disease risk.RESEARCH DESIGN AND METHODS -Two inception cohorts of previously sedentary healthy adults aged 55-75 years at baseline (1989), one initiating regular supervised physical exercise training and the other a geographical similar sedentary control, were assessed for anthropometric, biochemical, and clinical markers of the metabolic syndrome and comorbidity over 10 years.RESULTS -At baseline, active individuals aged 68 years compared with sedentary individuals aged 67 years had similar fitness levels (5.7 vs. 5.8 metabolic equivalents). At follow-up, complete data were obtained for 161 active and 136 sedentary subjects. Drop out occurred primarily because of failure to adhere to the exercise regimen and poor physical health for active and sedentary individuals, respectively. More metabolic abnormalities were seen in the sedentary group than in the active group for one or two (64 vs. 36%, P Ͻ 0.001) and three or more (35 vs. 22%, P Ͻ 0.003) abnormalities, respectively. In those assessed at follow-up, the sedentary group compared with the active group had lower fitness levels (5.0 [13.8% decrease] vs. 5.9 [3.5% increase] metabolic equivalents), had a greater likelihood of a positive exercise electrocardiogram or symptom (32 vs. 10%, P Ͻ 0.001), and had more comorbid conditions (Charlson Comorbidity Index score 0.9 vs. 0.4, P Ͻ 0.01).CONCLUSIONS -Higher fitness achieved over 10 years of regular exercise training in older adults was associated with reduced development of metabolic risk factors for cardiovascular disease, fewer exercise-induced cardiac abnormalities, and reduced comorbidity. Diabetes Care 28:694 -701, 2005D espite an overall reduction in cardiovascular mortality over the past decade, an aging population has seen a shift in risk for cardiovascular disease to the older adult (1). However, few longitudinal studies of predictors and modifiers of this risk in the older population are available. This gap in evidence is critical as an aging population becomes increasingly sedentary, whereas the importance of physical activity as a modifier of cardiovascular risk remains unequivocal (2-6).Coincident with an older more sedentary population at risk for type 2 diabetes, hypertension, and cardiovascular disease (7-9) is an increased prevalence of the clustering of metabolic risk factors (10 -13). The importance of metabolic risk factors from both a clinical and public health perspective is that their prevention, detection, and reversal can occur before the development of overt cardiovascular disease (14). Coupled with particularly poor treatment and control rates for type 2 diabetes, hypertension, and cardiovascular disease (15), prevention and screening strategies early in the cardiovascular disease continuum are essential.Recent evidence from both the Finnish Diabetes Prevention Study (16) and the U.S. Diabetes Prevention Program (17) showed that even modest lif...

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