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Lowered baroreflex sensitivity (BRS) predicts mortality and occurs with increasing age and diabetes. We examined whether aerobic exercise could restore arterial BRS in adults at high cardiovascular risk (diabetes, geriatric age group, hypercholesterolemia, and hypertension).Randomized, controlled, single-blind study.VITALiTY (Vancouver Initiative to Add Life to Years) Research Laboratory.Thirty-nine older adults (mean age, 71.5 ± 0.7 years) with diet-controlled or oral hypoglycemic-controlled type 2 diabetes, hypertension, and hypercholesterolemia.Subjects were recruited to each of 2 groups: an aerobic group (3 months of vigorous aerobic exercise as defined by 80% to 85% of maximal heart rate), and a nonaerobic (no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer 3 times per week.Baroreflex function was assessed using the spontaneous baroreflex method. Main outcome measures included BRS, BRSup, BRSdown, and o2max.The aerobic group demonstrated an increase in BRS that was not demonstrated in the nonaerobic group (+60.9 ± 23.5 vs +2.2 ± 7.9%; P = 0.010).Our findings indicate that a relatively short aerobic exercise intervention can reverse functional impairments of the arterial baroreflex function in older adults at high cardiovascular risk.