Molecular mechanisms of exercise-induced cardiac rehabilitation

Cardiac rehabilitation (CR), centered on structured exercise training, improves exercise capacity, cardiac function, and quality of life in patients with cardiovascular disease (CVD). However, its benefits are still described mainly by functional outcomes, whereas the underlying molecular basis remains less clearly integrated. This review summarizes the major mechanisms of exercise-induced cardioprotection in CR, including modulation of inflammation and oxidative stress, enhancement of mitochondrial biogenesis and quality control, improvement of endothelial function, regulation of epigenetic pathways, and release of exercise-derived factors. These interconnected responses influence cardiac remodeling, metabolic homeostasis, endothelial repair, and cell survival. We further integrate these mechanisms into a conceptual framework and discuss how different exercise stimuli may preferentially engage distinct biological pathways, supporting a mechanism-informed approach to individualized exercise prescription. A better understanding of these molecular networks may help advance CR from functional rehabilitation toward a more precise and biology-guided strategy.