Two groups of sedentary older adults, participating in either a lifestyle physical activity intervention (LIFE, n = 60) or a structured exercise intervention (STRU, n = 60), were compared with a control group (CO, n = 66) in terms of physical fitness and cardiovascular risk factors. Participants in LIFE were stimulated to integrate physical activity into their daily routines and received an individualized home-based program. Participants in STRU completed 5 supervised training sessions every 2 wk in a fitness center. Both interventions lasted 11 months and focused on endurance, strength, flexibility, and postural/balance exercises. The results revealed that the interventions were equally effective in improving functional performance. STRU was more effective than LIFE in improving cardiorespiratory and muscular fitness. Limited effects emerged on cardiovascular risk, with STRU improving in total cholesterol and HDL. Consequently, interventions aiming at reducing cardiovascular risks among sedentary elderly should focus on long-term changes in physical activity behavior.