It remains unclear if the age-related decline in physical health mainly is related to ageing per se or to long term inactivity but both inactivity and ageing are associated with a decline in physical performance and reduced capillary supply to skeletal muscle. An optimized capillary network is an important variable for optimal diffusion conditions for oxygen and nutrients from the blood to the muscle, thus interventions that can enhance peripheral adaptation, such as capillary growth, are important in maintaining cardiovascular and metabolic health and functional independence of aged individuals.The process of capillary growth depends on the mechanical or chemical stimuli specific to the mode of exercise and the subsequent up-regulation of specific pro-angiogenic and angiostatic factors. When exercise is repeated for weeks or months, it is the balance of these angio-regulatory factors that determines if and when capillary growth occurs. Reports from studies on aged individuals have suggested that the angiogenic potential and acute response to exercise is reduced in aged compared to young. One important impairment in the aged is the much reduced exercise induced secretion of VEGF from skeletal muscle, which we propose is a central component in angiogenesis. The capacity of secreting VEGF from muscle appears to be improved by regular physical activity which may explain why capillary growth in response to a period of regular exercise appears to be similar in aged as in young individuals.