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Reduced health-related fitness and decreased functional status occur concomitantly with reduced physical activity levels. Statistical reports estimate that 70% of women over age 65 are not participating in enough regular exercise for healthful living. This problem is compounded by the increased health risks women encounter due to declining estrogen levels. This review briefly summarizes the impact of physical activity and exercise on the aging female including cardiorespiratory, neurologic, behavioral, musculoskeletal, and thermoregulation functions, as well as body composition. Impact on sarcopenia, osteoporosis, breast cancer, and diabetes also is addressed. Practical guidelines for safe but effective exercise participation are given.