Role of Exercise in Modulating the Brain–Heart Axis in Cardiovascular Diseases

Regular exercise is a cornerstone of the primary and secondary prevention of cardiovascular diseases (CVDs), yet the mechanisms underlying its cardioprotective effects remain incompletely understood. Emerging evidence indicates that dysfunction of the brain-heart axis is closely involved in the onset and progression of CVDs, whereas exercise may exert cardiovascular protection, at least in part, by modulating this bidirectional regulatory network. This review summarizes the pathophysiological significance of brain-heart axis dysregulation in CVDs and systematically discusses the potential mechanisms through which exercise regulates this axis to alleviate CVDs. We further examine how exercise prescription-related variables may differentially influence brain-heart axis regulation and address the potential risks associated with excessive exercise. Finally, we highlight future directions for translating these mechanistic insights into precision exercise medicine. Overall, this review provides an updated framework for understanding how exercise modulates the brain-heart axis in CVDs and offers new perspectives for their prevention and treatment.