This chapter considers the interaction of habitual physical activity and chronic disease expression in the older woman, with an aim to identify the intersection of these fields as they relate to optimization of aging processes, as well as both prevention and treatment of common disease and syndromes relevant to aging. There are many reasons to integrate exercise into the conceptual model of healthy aging, but clearly one of the most potent pathways from physical activity to health status involves the modulation of body composition by habitual exercise patterns. In the past, exercise has been generally considered inappropriate for frail or very aged individuals, due to both low expectations of benefit as well as exaggerated fears of exercise-related injury. Intolerance to many medication side effects in the very old makes the search for alternative non-pharmacologic therapies such as exercise very attractive in the cohort.