Moreover, apart from gender, although the demographics of the included participants are characteristic of those who undertake cardiac rehabilitation, the study may have been subject to bias based on patterns of referral and intake into cardiac rehabilitation, further reducing generalizability. Although the study identifies a temporal relationship between VO2Peak and grey matter measures, followup MRI was not performed, precluding our ability to establish a direct causation. Finally, the present study does not elucidate relationships between perfusion at rest and perfusion during exercise, which remains an important area for further exploration. The association between putamen volume and VO2Peak in this study of older men with CAD concurs with that reported recently in adolescents, identifying a consistent correlate of fitness throughout the human lifespan. Moreover, in the present study, larger right putamen volumes were associated with larger changes in VO2Peak associated with the exercise intervention. The findings would be consistent with the involvement of the putamen in mediating changes to the dopaminergic reward system in response to exercise and with a role of the putamen in initiating physical activity behaviours based on a history of reward. These findings, taken together with the putamen’s pivotal position in the striatal circuitry controlling motor function, implicate the putamen as a critical node in the relationship between brain and behaviour. Sensorimotor CBF was associated with baseline VO2Peak and change in VO2Peak, which to our knowledge is a unique clinical finding to date and aligns with primate work showing exercise increases motor cortex vascular density. Thought to underlie the development of heart failure especially in patients with metabolic diseases, like diabetes. In analogy to ectopic lipid deposition in liver and skeletal muscle, myocardial lipid content can nowadays be non-invasively assessed by 1H magnetic resonance spectroscopy. MR imaging furthermore displays the method of choice for determining systolic cardiac function. Prior investigations applying cardiac MR-spectroscopy revealed myocardial lipid content to be increased in patients with type 2 diabetes and some authors also reported cardiac steatosis in prediabetic subjects. In addition, excessive lipid accumulation within the myocardium was found to be associated with elevated left ventricular mass and diastolic dysfunction, both key features of the diabetic cardiomyopathy. Interestingly, it has been recently reported that following the onset of overt diabetes women exhibit more pronounced cardiac steatosis compared to men with type 2 diabetes. We recently showed that cardiac steatosis is unrelated to insulin resistance in healthy women with normal glucose tolerance. On the other hand, we demonstrated that combined hyperglycemia and hyperinsulinemia increase myocardial lipid content in healthy subjects, suggesting that this environment typical for preand early type 2 diabetes might be responsible for the development of cardiac steatosis. Women with prior gestational diabetes display a relatively young population at high risk of developing diabetes.