Risk factors that are strongly associated with cardiovascular events in middle age are less predictive in the elderly. These reduced associations are most evident after about age 75 years. Exercise has been associated with survival in middle-aged men; data are sparse on its relation to survival in the very old. This association was tested in a community-dwelling cohort of 440 men and 457 women aged 75 years or older who were followed prospectively for an average of 5 years. In age-adjusted proportional hazards models, current regular exercise at least 3 times per week was strongly associated with survival in men (relative risk for death 0.54, P is less than.01) and women (relative risk 0.45, P is less than.01). Results were unchanged after adjustment for physical and emotional health status, or when persons with heart disease at baseline were excluded. Results were also unchanged after adjustment for change in exercise level compared with 10 years ago, and for conventional cardiovascular risk factors (blood pressure, lipid concentration, glucose levels, and smoking).