Exercise training elicits a metabolic and cardiovascular response that underlies fitness. The molecular mechanisms that orchestrate this adaptive response and secure the wide-ranging gains of a regimented exercise program are poorly understood. Formed through association of the Kir6.2 pore and the sulfonylurea receptor, the stress-responsive ATP-sensitive K ؉ channels (K ATP channels), with their metabolic-sensing capability and broad tissue expression, are potential candidates for integrating the systemic adaptive response to repetitive exercise. Here, the responses of mice lacking functional Kir6.2-containing K ATP channels (Kir6.2-KO) were compared with wild-type controls following a 28-day endurance swimming protocol. While chronic aquatic training resulted in lighter, leaner, and fitter wild-type animals, the Kir6.2-KO manifested less augmentation in exercise capacity and lacked metabolic improvement in body fat composition and glycemic handling with myocellular defects. Moreover, the repetitive stress of swimming unmasked a survival disadvantage in the Kir6.2-KO, associated with pathologic calcium-dependent structural damage in the heart and impaired cardiac performance. Thus, Kir6.2-containing K ATP channel activity is required for attainment of the physiologic benefits of exercise training without injury. Diabetes 53 (Suppl. 3): S169 -S175, 2004 P hysical exertion elicits an array of metabolic and cardiovascular responses that allow the body to adapt to the demands of exercise, thereby achieving fitness, a state of enhanced aerobic capacity, and generalized well-being (1-4). Reinforced by frequent repetition of the exercise regimen, the specific systemic benefits of regular activity range from reductions in body weight and adiposity to improved glucose and insulin homeostasis (1-7). Moreover, the inverse relation of physical exercise with both cardiovascular disease and mortality has long been recognized (1,4,8,9). Yet, the molecular determinants that orchestrate the adaptive response to exercise and that assure the wide-ranging gains of a regimented training program are poorly understood.Unique metabolic-sensing capabilities and broad tissue expression point to the ATP-sensitive K ϩ channel (K ATP channel) as a potential candidate for integrating the systemic adaptive response and thereby securing the benefits of exercise training. K ATP channels are evolutionarily conserved plasma-membrane protein complexes, widely represented in tissue beds with high metabolic activity (10 -14). There, they are formed through the physical association of the inwardly rectifying potassium channel pore, most typically Kir6.2, and the regulatory sulfonylurea receptor subunit, an ATP-binding cassette protein (15)(16)(17). Energetic signals, received via tight integration with cellular metabolic pathways, are processed by the sulfonylurea receptor subunit that in turn gates the nucleotide sensitivity of the channel pore, thereby controlling membrane potential-dependent cellular functions (18 -21). Recent findings, elicited ...