Physical activity as a regulator of myocardial remodeling: from cellular mechanisms to clinical recommendations

Cardiac rehabilitation is an effective method for restoring and improving cardiovascular function in patients with cardiovascular diseases. Rehabilitation exercises not only enhance physical endurance and improve patients’ psycho-emotional state but also play a key role in myocardial remodeling. This article explores the molecular and cellular mechanisms through which physical activity influences cardiac tissue repair, including the regulation of cardiomyocyte apoptosis, angiogenesis, fibrosis, and inflammatory processes. The review analyzes current research data confirming the positive impact of exercise on the morphological and functional state of the heart, as well as the prospects for using rehabilitation training as an adjunctive strategy to optimize myocardial remodeling. Particular attention is given to the role of non-coding RNAs, signaling pathways, and intercellular interactions in these processes. The study also identifies gaps in our understanding of the mechanisms underlying exercise-induced improvements in pathological cardiac remodeling, highlighting the need for further research. The use of modern methods, such as high-throughput sequencing and analysis of individual cells, may open up new perspectives in studying the mechanisms responsible for the beneficial effects of rehabilitation exercises. These technologies make it possible to detail the mechanisms of adaptation of the cardiovascular system to physical activity and identify potential therapeutic targets for the development of new drugs and non-medicinal interventions.