This is study was to identify the cardiovascular risk level and self-care activities according to stage of change for exercise in diabetic elders with metabolic syndrome. Method: A descriptive correlational design a convenient sampling method was used and eighty-one type 2 diabetic elderly people with metabolic syndrome were recruited from a university hospita1. The Arizona Heart Institute Cardiovascular Risk Factor Analysis (1982) for cardiovascular disease (CVD) risk level and the Toobert, Hampson and Glasgow’s Revised Summary of Diabetes Self-Care Activities Measure Scale (2000) were used. The data were analyzed using descriptive statistics, Pearson correlation coefficient, and one-way ANOVA with SPSS/WIN 12.0. Results: The CVD risk of diabetic elders with metabolic syndrome indicated a significantly negative correlation to self-care activities (r=-.277, p=.012) and stage of change for exercise (r=-.257, p=.021) and a positive correlation to waist circumference (r=.254, p=.032) and diastolic blood pressure (r=.253, p=.024). The mean score of CVD risk for maintenance stage for exercise, 15.13, was lower than for contemplation stage (M=19.35) and action stage (M=19.91). The mean of relative risk of CVD for diabetic elders with metabolic syndrome was found to be approximately 2.15 times that of elders who are the same age without any risk profiles. Conclusion: These results indicate that diabetic elders with metabolic syndrome with low adherence to exercise and self-care activities for diabetic control are likely to have an increased waist circumference and diastolic blood pressure, and be at high risk for CVD.