The objectives of this study were (1) to evaluate the long-term effects of a lifestyle physical activity intervention (n = 60) and a structured exercise intervention (n = 60) on physical self-perceptions and self-esteem in older adults compared with a control group (n = 66), and (2) to test the longitudinal fit of the exercise and self-esteem model (EXSEM). Immediately after the 11-month interventions, the lifestyle group showed significant improvements in self-perceived physical condition, sport competence, body attractiveness, and physical self-worth. In the structured group, significant effects were found on physical condition and sport competence. One year later, the lifestyle program had significant effects on body attractiveness and global self-esteem, while the structured group showed significant improvements in physical condition, sport competence, and body attractiveness. Path analyses revealed a good fit for the EXSEM across the 2-year period.