Mapping the evidence on exercise-related ventricular–arterial coupling adaptations in male adults: a scoping review

Background: Ventricular-arterial coupling (VAC) integrates cardiac and vascular function and has emerged as a relevant marker of cardiovascular efficiency and adaptability. Exercise and physical activity are believed to influence VAC through multiple physiological pathways, yet the scope, methods, and consistency of available evidence remain unclear. Objective: To map and characterize the existing evidence on the relationship between exercise, physical activity, and VAC across male adult populations, assessment methods, and study designs. Methods: A scoping review was conducted in accordance with JBI methodology and reported following PRISMA-ScR guidelines. Studies published between 1990 and 2025 were identified through PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible studies examined VAC in male adults in relation to exercise or physical activity using invasive or non-invasive methods. Consistent with scoping review methodology, diverse study designs were included, and no formal risk-of-bias assessment was performed. Results: Eleven studies involving 2,229 participants were included. Evidence encompassed interventional, observational, and methodological studies conducted in male healthy adults, athletes, older individuals, and populations with cardiovascular risk. VAC was assessed using multiple approaches, most commonly the arterial elastance/end-systolic elastance (Ea/Ees) ratio and pulse wave velocity/global longitudinal strain (PWV/GLS). Exercise exposure ranged from acute stress testing to structured training and lifelong physical activity. Substantial heterogeneity was observed in study designs, exercise contexts, and VAC measurement techniques. Across studies, physically active and endurance-trained individuals demonstrated preserved or optimised VAC, with aerobic exercise associated with improved ventricular efficiency and reduced arterial load, while VAC remained relatively stable during acute haemodynamic stress. Conclusions: The literature relating exercise and VAC is conceptually and methodologically heterogeneous. Available evidence suggests that aerobic exercise and sustained physical activity are associated with preserved or favourable VAC profiles across male adult populations; however, causal inferences remain limited. This scoping review highlights important methodological gaps and provides a framework to guide future mechanistic and longitudinal research.