Narrative review discusses exercise for cardiovascular disease without reported outcomes or safety data.

Low physical activity (PA) is an independent predictor of cardiovascular disease. Exercise, as a non-pharmacological intervention for prevention and treatment, has been widely proven to have direct cardiovascular protective effects, including improving cardiopulmonary function and regulating cardiac energy metabolism through key molecular pathways such as the PI3 K/Akt, AMPK, mTOR, PPAR, and SIRT3 signaling, which optimize mitochondrial function and reduce oxidative stress. Simultaneously, it can indirectly promote cardiovascular health by reshaping a healthy gut microbiota and enhancing the body's overall metabolic environment. Therefore, examining the interactions between the cardiovascular system and various metabolic systems from a holistic perspective is both important and necessary to fully understand the multiple mechanisms by which exercise benefits cardiovascular health. This review will systematically describe the direct regulatory effects of exercise on cardiopulmonary function and cardiac energy metabolism. Building on this, it will explore how exercise influences the diversity and abundance of gut microbiota, the function of the gut barrier, and the mediation of key gut microbiota metabolites such as short-chain fatty acids. It will also examine the links between gut microbiota dysbiosis and major adverse cardiovascular events, along with the potential intervention mechanisms of exercise. From an integrated metabolism perspective, the review will comprehensively detail the pathways through which exercise provides cardiovascular protection by regulating the cardiovascular system, gut microbiota, and interactions among multiple metabolic systems. Finally, it adopts an analytical framework based on multi-omics integration and systems biology network analysis, thereby overcoming the limitations of traditional single-dimensional research and facilitating a more comprehensive, holistic understanding of the complex, multi-scale metabolic changes induced by exercise and the underlying cardiovascular-protective regulatory networks.