Neurophysiological mechanisms underlying cardiovascular adaptations to exercise: A narrative review

The brain-heart connection, particularly during physical activity, plays a crucial role in health and disease management. This review examined the neurophysiological mechanisms driving cardiovascular adaptations to exercise, focusing on the bidirectional relationship between the brain and heart. Key mediators such as central autonomic networks, brain-derived neurotrophic factors (BDNF), and vascular endothelial growth factor (VEGF) enhance neural plasticity and vascular health. Regular structured exercise (e.g., high-intensity interval training, moderate and resistance exercise) moderates autonomic responses, increases BDNF, and supports neurovascular coupling, improving both cognitive and cardiovascular resilience through molecular pathways such as PGC-1α and TrkB signaling. Exercise enhances cerebral perfusion, reduces oxidative stress, and protects brain-heart health. It mitigates risks linked to neurodegenerative diseases, such as Alzheimer's and Parkinson's, by promoting neuroplasticity and vascular integrity. This review highlights the importance of incorporating exercise-based interventions in clinical practice and public health policies to optimize cognitive and cardiovascular health. Future studies should explore exercise-induced neurovascular coupling to further elucidate the mechanisms connecting brain and cardiovascular health.