Pre-participation medical screening is widely used to ensure against potential exercise-related risks. It is reported that the most common underlying cause of cardiac sudden death associated with exercise is coronary artery disease in the adult population. Therefore, the evaluation of coronary risk factors is essential in medical screening for the elderly. In the present study, more than 50% of elderly subjects had one or more coronary risk factors such as hypertension, hyperlipidemia and about 10% of elderly subjects had more than 2 risk factors. Some novel coronary risk factors, such as total plasma homocysteine, and high-sensitivity C-reactive protein, while proposed in the literature, has not had the risk potential significance in medical screening established. Risk stratification based on medical screening is needed to optimize the safety of exercise, and high risk subjects who have signs or symptoms suggestive of cardiovascular diseases, or any coronary risk factor, should undergo further evaluation. Since pre-participation medical screening cannot ensure safety of exercise completely, physical condition check on the day of exercise is effective to enhance safety of exercise. More efficient medical screening systems will be needed to cope with increasing numbers of participants in exercise.