Aerobic exercise and cardiovascular health: insights into perivascular and epicardial adipose tissues

Physical exercise is a cornerstone lifestyle intervention for the prevention and management of cardiovascular and metabolic diseases, eliciting systemic adaptations that extend beyond skeletal muscle to include vascular, cardiac, and metabolic tissues. In recent years, increasing attention has been directed toward the role of ectopic adipose depots, particularly perivascular adipose tissue (PVAT) and epicardial adipose tissue (EAT), as active modulators of cardiovascular homeostasis through paracrine and endocrine signaling. Both PVAT and EAT are increasingly recognized as dynamic tissues that influence vascular tone, endothelial function, inflammation, and myocardial metabolism. Emerging evidence from animal studies indicates that exercise training favorably modulates the phenotype and function of these adipose depots by attenuating pro-inflammatory signaling, improving redox balance, and restoring vasoprotective and cardioprotective properties. Among exercise modalities, aerobic exercise is the most widely studied and prescribed intervention for cardiovascular health, given its well-established effects. This review synthesizes current findings from experimental animal models on the effects of aerobic exercise on PVAT and EAT, with particular emphasis on obesity-related cardiovascular dysfunction. Collectively, current evidence indicates that exercise modulates ectopic adipose depots and their crosstalk with the cardiovascular system, serving as an additional mechanistic pathway alongside established systemic adaptations. Moreover, important knowledge gaps remain, underscoring the need for future studies aimed at optimizing exercise-based strategies for cardiovascular health, especially in females.