A 12-month structured exercise reduces epicardial adipose volume in a frequency-dependent manner and lowers serum M-CSF in community-dwelling older adults: a randomized controlled trial

Objective Exercise is a well-established strategy for promoting healthy aging and reducing cardiometabolic risk; however, its effects on epicardial adipose volume (EAV) and associated inflammatory pathways in older adults remain insufficiently understood. This randomized controlled trial examined whether a 12-month structured exercise program reduces EAV in community-dwelling older adults, and secondarily explored changes in serum pro-inflammatory cytokines. Methods This single-center pragmatic randomized controlled trial incorporated a Zelen design. A total of 156 older adults (≥60 years) were evenly allocated to a structured exercise (STE) group or a control group. The control group received health education only; the STE group performed one supervised center-based session plus at least two home-based sessions per week, with matched intensity and duration. EAV, body fat parameters, and circulating pro-inflammatory factors were measured at baseline and after 12 months. Results Among the randomized participants, 57 individuals in the control group and 61 individuals in the STE group completed the 12-month follow-up (55 men, 46.6%; mean age 69.17 ± 4.41 years). The absolute EAV change differed significantly between groups (STE vs. control: −15.15 mL, 95% CI –22.61 to −7.69, p < 0.0001). After adjusting for baseline values, only serum macrophage colony-stimulating factor (M-CSF) showed a significant between-group difference (−1.75 pg/mL, 95% CI –3.34 to −0.16, p = 0.032). Univariate linear regression indicated that each additional weekly exercise session was associated with a 3.156 mL greater EAV reduction ( R 2 = 0.084). Conclusion A 12-month structured exercise intervention was associated with reduced EAV and lower circulating M-CSF levels in community-dwelling older adults, with greater reductions observed among participants engaging in more frequent weekly exercise sessions. These findings support regular supervised exercise as a non-pharmacological strategy to reduce cardiac adiposity and modulate inflammation in aging populations. Clinical trial registration https://www.chictr.org.cn/indexEN.html , ChiCTR2400081824.