PURPOSE: We constructed incremental dose-response curves to acetylcholine infusion in the skin (ACh) in the presence and absence of nitric oxide(NO)-blockade in young, old untrained and old fit subjects. METHODS: Twelve young (6F/6M;27±1yrs,VO2max:49±3ml.kg-1.min1) subjects were recruited along with 16 older untrained(10F/6M;60±1yrs;29±1ml.kg-1.min-1) subjects and 12 masters athletes (59±1yrs;6F,6M;45±2ml.kg-1.min-1). Eight of the older (5F,3M) untrained group volunteered to undertake a 6 month exercise training program. Two microdialysis fibres were embedded into the skin of the ventral forearm and Doppler probes placed over these sites. A dose-response curve was constructed for 3 incremental doses of ACh for delivery through one probe, whilst the 2nd probe had a co-infusion of ACh+LNAME, a NO antagonist. At the end of the protocol, sodium nitroprusside (56mM) was infused through both probes in combination with localised heating at 42°C to assess maximal cutaneous vascular conductance (%CVCmax). RESULTS: The NO contribution of each ACh dose was impaired in the older untrained subjects (3±1, 11±2, 35±6%CVCmax), compared to younger (12±3, 22±4, 53±6%, P<0.05) and older fit subjects (7±1, 22±5, 53±8%, P<0.05) at the 2nd dose of ACh. Exercise training in the older unfit subjects enhanced the NO component of ACh-mediated vasodilator function at 12 and 24 weeks (12±4, 25±6, 53±5%CVCmax) and 24 weeks (8±3, 25±6, 54±6 %CVCmax, P<0.05 2-way ANOVA). CONCLUSIONS: This study characterised the contribution of NO to ACh-mediated skin blood flow responses in trained and untrained humans. Both chronic and shortterm exercise improves NO-vasodilator function in humans, a finding with potentially important clinical implications for patients with microvascular disease.