The Beneficial Role of Exercise and Whole-Food Plant-Based Diet in Coronary Artery Disease Prevention and Management

Coronary Artery Disease (CAD) remains a critical global health issue, substantially contributing to morbidity and mortality worldwide. The strategic combination of Regular Physical Exercise (RPE) and a Whole-Food Plant-Based Diet (WFPBD) offers an innovative and powerful solution to mitigate cardiovascular disease risk. Under the visionary leadership of Prof. Dasaad Mulijono, Bethsaida Hospital in Tangerang has successfully pioneered this integrative approach, achieving exceptional clinical results. This comprehensive review examines the multifaceted cardiovascular benefits of RPE and plant-based nutritional therapy, highlighting improvements in lipid profiles, insulin sensitivity, blood pressure regulation, cardiac and vascular remodelling, sleep quality, mitochondrial function, and cellular longevity. Highlighting the ground-breaking clinical outcomes at Bethsaida Cardiac Centre, this integrative model addresses traditional cardiovascular risk factors, enhances overall vitality, and promotes longevity, representing a transformative framework for modern cardiovascular healthcare.

CAD is the leading cause of death globally, imposing a heavy burden on healthcare systems worldwide [1-3]. Lifestyle-related factors, particularly sedentary behaviours and unhealthy dietary practices, significantly contribute to the incidence and progression of CAD [3-8]. Growing evidence has demonstrated the decisive role of lifestyle modification, notably RPE combined with nutritional interventions, in preventing and managing CAD [9-22]. Specifically, a WFPBD, characterized by high consumption of fruits, vegetables, legumes, whole grains, nuts, and seeds, has emerged as a promising nutritional strategy. This diet, when combined with consistent physical activity, has demonstrated remarkable efficacy in addressing key cardiovascular risk factors, including hypertension, dyslipidaemia, insulin resistance, and obesity.

RPE, defined as planned, structured, and repetitive physical activity to improve physical fitness, has long been established as crucial for maintaining cardiovascular health. Exercise enhances endothelial function, optimizes lipid profiles, improves insulin sensitivity, lowers blood pressure, induces favourable cardiac remodelling, improves sleep quality, and promotes longevity [16-22]. Despite these well-documented benefits, the precise mechanisms underlying these protective effects remain partially understood. Ongoing research aims to optimize exercise regimens for maximal cardiovascular benefit.

This review provides an extensive synthesis of the current evidence regarding the physiological and clinical impacts of integrating regular exercise and a WFPBD approach in the prevention and management of CAD. Additionally, we present significant clinical outcomes from the Bethsaida Cardiac Centre in Indonesia, demonstrating the real-world effectiveness of these combined lifestyle interventions. The aim is to encourage further adoption of these strategies in clinical practice and highlight areas for future research.

Exercise prompts numerous beneficial adaptations within the cardiovascular system, including improved lipid profiles, enhanced insulin sensitivity, reduced blood pressure, and favourable cardiac remodelling.

Plasma lipids and atherogenesis

RPE positively influences plasma lipid levels by elevating High-Density Lipoprotein (HDL) and lowering triglycerides [23-27]. Exercise also directly enhances endothelial function and reduces arterial stiffness, which is essential to preventing atherosclerosis. Physical activity increases the availability of Nitric Oxide (NO), a crucial vasodilator that promotes arterial health [28-33].

Insulin sensitivity

Exercise significantly enhances insulin sensitivity, a crucial factor for maintaining cardiovascular health. It reduces triglyceride production, promotes favourable lipoprotein profiles, and enhances NO-mediated vasodilation. Regular physical activity mitigates the harmful vascular effects of insulin resistance, including endothelial dysfunction and arterial stiffness, thereby decreasing CAD risk [34-36].

Blood pressure regulation

RPE results in significant long-term reductions in resting blood pressure. This effect is primarily mediated by decreased systemic vascular resistance, resulting from enhanced endothelial NO production and increased vasodilatory capacity, which significantly lowers the incidence of cardiovascular events [37-41].

Cardiac remodelling and function

RPE induces physiological cardiac hypertrophy, characterized by improved ventricular function and enhanced contractility. Exercise promotes myocardial metabolism, mitochondrial biogenesis, and cardiac ion channel function, enhancing cardiac efficiency and reducing the risk of arrhythmia [42-46].

Vascular adaptations

Exercise stimulates increased micro vascular density, enhanced endothelial function, and improved responsiveness to vasodilatory stimuli. These adaptations enhance tissue perfusion and mitigate ischemic risks, thereby promoting cardiovascular resilience [47-50].

RPE significantly enhances sleep quality, contributing to overall cardiovascular health. Adequate sleep is crucial for cardiovascular recovery, as it helps reduce stress hormones, inflammation, and blood pressure levels. Exercise promotes deeper, more restorative sleep patterns, which indirectly support cardiovascular health and reduce the risk of CAD [51-55].

RPE plays a significant role in maintaining a youthful appearance and promoting longevity. Exercise enhances mitochondrial function, which is vital for energy production and reducing cellular oxidative stress. Improved mitochondrial efficiency prevents premature cellular aging and promotes overall vitality [56-59]. Additionally, exercise has been shown to slow telomere attrition - the progressive shortening of telomeres associated with aging and age-related diseases. Thus, RPE can extend lifespan and enhance quality of life by protecting against cellular aging mechanisms [60-67] (Figure 1).

Figure 1: Lifestyle Intervention for Cardiac Health — A patient undergoing treadmill exercise under professional supervision at Bethsaida Cardiac Center. The healthcare specialist demonstrates a heart-healthy diet consisting of fresh vegetables, fruits, and whole foods, emphasizing the combined role of regular physical activity and balanced nutrition in cardiovascular disease prevention and rehabilitation.

Under the leadership of Prof. Dasaad Mulijono, Bethsaida Hospital in Tangerang has pioneered integrating WFPBD with RPE (minimum 30 minutes daily of moderate to heavy intensity) as a standard cardiac care practice for nearly seven years, resulting in remarkable outcomes:

Hypertension reversal

Achieving normotensive status without the use of antihypertensive medications.

Diabetes management

Significant reductions in insulin dependency, improved glycaemic control, and increased energy.

LDL reduction

Significant LDL-C reductions without PCSK9 inhibitors.

Sustainable weight loss

Achieved optimal body mass indices (BMI 20-22) without caloric restrictions.

Renal function restoration

Improved kidney function, avoiding dialysis for many.

Improved heart failure outcomes

Enhanced left ventricular function in heart failure patients.

CAD regression

Demonstrated plaque regression and exceptionally low restenosis rates (2%) Post-Drug-Coated Balloon (DCB)- angioplasty.

Inflammation reduction

Stabilized or reversed chronic inflammatory and autoimmune conditions.

COVID-19 outcomes

Remarkable success in managing high-risk elderly COVID-19 patients, achieving zero mortality and no hospitalizations through early WFPBD and RPE interventions.

Integrating RPE and a WFPBD offers comprehensive and synergistic cardiovascular benefits. The evidence summarized in this review highlights the capacity of exercise to significantly improve lipid profiles, insulin sensitivity, blood pressure, cardiac function, and vascular health, as well as mitochondrial function and telomere length, which are fundamental to the prevention and management of CAD. Similarly, a WFPBD complements these benefits by reducing dietary intake of harmful substances such as saturated fats, sodium, and animal proteins, and enhancing intake of antioxidants, fibre, and phytochemicals. The clinical outcomes from Bethsaida Cardiac Centre underscore the practical efficacy and sustainability of these combined interventions, demonstrating impressive clinical results, including the reversal of hypertension, improved glycaemic control, LDL reduction, and CAD regression.

However, uncertainties persist regarding optimal exercise intensity, duration, frequency, and specific dietary components of a WFPBD. Further research should investigate precise molecular mechanisms, potential synergies between diet, exercise, and pharmacological treatments, and strategies for maintaining long-term adherence to lifestyle modifications. Clarifying these uncertainties will enable healthcare providers to develop individualized interventions tailored to patient-specific cardiovascular risks and lifestyles, thereby maximizing the preventive and therapeutic potential of lifestyle modifications.

Integrating RPE and a WFPBD represents a robust and comprehensive strategy for significantly reducing CAD risk and enhancing cardiovascular health. The physiological mechanisms underlying these benefits encompass improved lipid profiles, enhanced insulin sensitivity, optimized blood pressure regulation, beneficial cardiac remodelling, significant vascular adaptations, restorative sleep quality, enhanced mitochondrial function, and the prevention of telomere shortening. The impressive clinical outcomes achieved at Bethsaida Cardiac Centre provide compelling evidence in support of the widespread adoption of this combined approach in cardiovascular care. Ongoing research and personalized intervention strategies are crucial for fully harnessing the preventive and therapeutic potential of lifestyle modifications in cardiovascular disease management.

D.M, Conceptualization, writing, review, and editing.

This research received no external funding.

Not applicable.

Not applicable.

Data are contained within the article.

The authors declare no conflict of interest.

1. Di Cesare M, Perel P, Taylor S, Kabudula C, Bixby H, Gaziano TA, McGhie DV, Mwangi J, Pervan B, Narula J, Pineiro D, Pinto FJ. The Heart of the World. Glob Heart. 2024 Jan 25;19(1):11. doi: 10.5334/gh.1288. PMID: 38273998; PMCID: PMC10809869.
2. Shahjehan RD, Sharma S, Bhutta BS. Coronary artery disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
3. Brown JC, Gerhardt TE, Kwon E. Risk Factors for Coronary Artery Disease. 2023 Jan 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32119297.
4. Hu FB. Diet and lifestyle influences on risk of coronary heart disease. Curr Atheroscler Rep. 2009 Jul;11(4):257-63. doi: 10.1007/s11883-009-0040-8. PMID: 19500488.
5. Gaudel P, Kaunonen M, Neupane S, Joronen K, Koivisto AM, Rantanen A. Lifestyle-related risk factors among patients with coronary artery disease in Nepal. Scand J Caring Sci. 2020 Sep;34(3):782-791. doi: 10.1111/scs.12784. Epub 2019 Oct 30. PMID: 31667878.
6. Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006 Jul 11;114(2):160-7. doi: 10.1161/CIRCULATIONAHA.106.621417. Epub 2006 Jul 3. PMID: 16818808.
7. Rippe JM. Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease. Am J Lifestyle Med. 2018 Dec 2;13(2):204-212. doi: 10.1177/1559827618812395. PMID: 30800027; PMCID: PMC6378495.
8. Hajar R. Risk Factors for Coronary Artery Disease: Historical Perspectives. Heart Views. 2017 Jul-Sep;18(3):109-114. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_106_17. PMID: 29184622; PMCID: PMC5686931.
9. Tuso P, Stoll SR, Li WW. A plant-based diet, atherogenesis, and coronary artery disease prevention. Perm J. 2015 Winter;19(1):62-7. doi: 10.7812/TPP/14-036. Epub 2014 Nov 24. PMID: 25431999; PMCID: PMC4315380.
10. Mehta P, Tawfeeq S, Padte S, Sunasra R, Desai H, Surani S, Kashyap R. Plant-based diet and its effect on coronary artery disease: A narrative review. World J Clin Cases. 2023 Jul 16;11(20):4752-4762. doi: 10.12998/wjcc.v11.i20.4752. PMID: 37583985; PMCID: PMC10424050.
11. Salehin S, Rasmussen P, Mai S, Mushtaq M, Agarwal M, Hasan SM, Salehin S, Raja M, Gilani S, Khalife WI. Plant Based Diet and Its Effect on Cardiovascular Disease. Int J Environ Res Public Health. 2023 Feb 14;20(4):3337. doi: 10.3390/ijerph20043337. PMID: 36834032; PMCID: PMC9963093.
12. Diab A, Dastmalchi LN, Gulati M, Michos ED. A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now? Vasc Health Risk Manag. 2023 Apr 21;19:237-253. doi: 10.2147/VHRM.S379874. PMID: 37113563; PMCID: PMC10128075.
13. Peña-Jorquera H, Cid-Jofré V, Landaeta-Díaz L, Petermann-Rocha F, Martorell M, Zbinden-Foncea H, Ferrari G, Jorquera-Aguilera C, Cristi-Montero C. Plant-Based Nutrition: Exploring Health Benefits for Atherosclerosis, Chronic Diseases, and Metabolic Syndrome-A Comprehensive Review. Nutrients. 2023 Jul 21;15(14):3244. doi: 10.3390/nu15143244. PMID: 37513660; PMCID: PMC10386413.
14. Elliott PS, Kharaty SS, Phillips CM. Plant-Based Diets and Lipid, Lipoprotein, and Inflammatory Biomarkers of Cardiovascular Disease: A Review of Observational and Interventional Studies. Nutrients. 2022 Dec 17;14(24):5371. doi: 10.3390/nu14245371. PMID: 36558530; PMCID: PMC9787709.
15. Najjar RS, Moore CE, Montgomery BD. Consumption of a defined, plant-based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeks. Clin Cardiol. 2018 Aug;41(8):1062-1068. doi: 10.1002/clc.23027. Epub 2018 Aug 17. PMID: 30014498; PMCID: PMC6489854.
16. Al-Mamari A. Atherosclerosis and physical activity. Oman Med J. 2009 Jul;24(3):173-8. doi: 10.5001/omj.2009.34. PMID: 22224180; PMCID: PMC3251175.
17. Bowles DK, Laughlin MH. Mechanism of beneficial effects of physical activity on atherosclerosis and coronary heart disease. J Appl Physiol (1985). 2011 Jul;111(1):308-10. doi: 10.1152/japplphysiol.00634.2011. Epub 2011 May 26. PMID: 21617083; PMCID: PMC3137539.
18. Mehanna E, Hamik A, Josephson RA. Cardiorespiratory Fitness and Atherosclerosis: Recent Data and Future Directions. Curr Atheroscler Rep. 2016 May;18(5):26. doi: 10.1007/s11883-016-0580-7. PMID: 27005804; PMCID: PMC5593139.
19. Chacon D, Fiani B. A Review of Mechanisms on the Beneficial Effect of Exercise on Atherosclerosis. Cureus. 2020 Nov 23;12(11):e11641. doi: 10.7759/cureus.11641. PMID: 33376653; PMCID: PMC7755721.
20. Nystoriak MA, Bhatnagar A. Cardiovascular Effects and Benefits of Exercise. Front Cardiovasc Med. 2018 Sep 28;5:135. doi: 10.3389/fcvm.2018.00135. PMID: 30324108; PMCID: PMC6172294.
21. Aengevaeren VL, Mosterd A, Sharma S, Prakken NHJ, Möhlenkamp S, Thompson PD, Velthuis BK, Eijsvogels TMH. Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management. Circulation. 2020 Apr 21;141(16):1338-1350. doi: 10.1161/CIRCULATIONAHA.119.044467. Epub 2020 Apr 20. PMID: 32310695; PMCID: PMC7176353.
22. Ruderman NB, Schneider SH. Diabetes, exercise, and atherosclerosis. Diabetes Care. 1992 Nov;15(11):1787-93. doi: 10.2337/diacare.15.11.1787. PMID: 1468316.
23. Escalante Y, Saavedra JM, García-Hermoso A, Domínguez AM. Improvement of the lipid profile with exercise in obese children: a systematic review. Prev Med. 2012 May;54(5):293-301. doi: 10.1016/j.ypmed.2012.02.006. Epub 2012 Feb 23. PMID: 22387009.
24. Muscella A, Stefàno E, Marsigliante S. The effects of exercise training on lipid metabolism and coronary heart disease. Am J Physiol Heart Circ Physiol. 2020 Jul 1;319(1):H76-H88. doi: 10.1152/ajpheart.00708.2019. Epub 2020 May 22. PMID: 32442027.
25. Yun H, Su W, Zhao H, Li H, Wang Z, Cui X, Xi C, Gao R, Sun Y, Liu C. Effects of different exercise modalities on lipid profile in the elderly population: A meta-analysis. Medicine (Baltimore). 2023 Jul 21;102(29):e33854. doi: 10.1097/MD.0000000000033854. PMID: 37478257; PMCID: PMC10662825.
26. Heath GW, Ehsani AA, Hagberg JM, Hinderliter JM, Goldberg AP. Exercise training improves lipoprotein lipid profiles in patients with coronary artery disease. Am Heart J. 1983 Jun;105(6):889-95. doi: 10.1016/0002-8703(83)90385-x. PMID: 6858834.
27. Stanton KM, Kienzle V, Dinnes DLM, Kotchetkov I, Jessup W, Kritharides L, Celermajer DS, Rye KA. Moderate- and High-Intensity Exercise Improves Lipoprotein Profile and Cholesterol Efflux Capacity in Healthy Young Men. J Am Heart Assoc. 2022 Jun 21;11(12):e023386. doi: 10.1161/JAHA.121.023386. Epub 2022 Jun 14. PMID: 35699182; PMCID: PMC9238648.
28. Arefirad T, Seif E, Sepidarkish M, Mohammadian Khonsari N, Mousavifar SA, Yazdani S, Rahimi F, Einollahi F, Heshmati J, Qorbani M. Effect of exercise training on nitric oxide and nitrate/nitrite (NOx) production: A systematic review and meta-analysis. Front Physiol. 2022 Oct 4;13:953912. doi: 10.3389/fphys.2022.953912. PMID: 36267589; PMCID: PMC9576949.
29. Tsukiyama Y, Ito T, Nagaoka K, Eguchi E, Ogino K. Effects of exercise training on nitric oxide, blood pressure and antioxidant enzymes. J Clin Biochem Nutr. 2017 May;60(3):180-186. doi: 10.3164/jcbn.16-108. Epub 2017 Apr 7. PMID: 28603344; PMCID: PMC5463976.
30. Oral O. Nitric oxide and its role in exercise physiology. J Sports Med Phys Fitness. 2021 Sep;61(9):1208-1211. doi: 10.23736/S0022-4707.21.11640-8. Epub 2021 Jan 20. PMID: 33472351.
31. Maeda S, Tanabe T, Otsuki T, Sugawara J, Iemitsu M, Miyauchi T, Kuno S, Ajisaka R, Matsuda M. Moderate regular exercise increases basal production of nitric oxide in elderly women. Hypertens Res. 2004 Dec;27(12):947-53. doi: 10.1291/hypres.27.947. PMID: 15894835.
32. Lewis TV, Dart AM, Chin-Dusting JP, Kingwell BA. Exercise training increases basal nitric oxide production from the forearm in hypercholesterolemic patients. Arterioscler Thromb Vasc Biol. 1999 Nov;19(11):2782-7. doi: 10.1161/01.atv.19.11.2782. PMID: 10559026.
33. Goto C, Nishioka K, Umemura T, Jitsuiki D, Sakagutchi A, Kawamura M, Chayama K, Yoshizumi M, Higashi Y. Acute moderate-intensity exercise induces vasodilation through an increase in nitric oxide bioavailiability in humans. Am J Hypertens. 2007 Aug;20(8):825-30. doi: 10.1016/j.amjhyper.2007.02.014. PMID: 17679027.
34. Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med. 2000 Jan;21(1):1-12. doi: 10.1055/s-2000-8847. PMID: 10683091.
35. Holloszy JO. Exercise-induced increase in muscle insulin sensitivity. J Appl Physiol (1985). 2005 Jul;99(1):338-43. doi: 10.1152/japplphysiol.00123.2005. PMID: 16036907.36.
36. Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med. 2017 Mar 1;2(1):e000143.doi: 10.1136/bmjsem-2016-000143. PMID: 28879026; PMCID: PMC5569266.
37. Alpsoy Ş. Exercise and Hypertension. Adv Exp Med Biol. 2020;1228:153-167. doi: 10.1007/978-981-15-1792-1_10.PMID:32342456.
38. Lopes S, Mesquita-Bastos J, Alves AJ, Ribeiro F. Exercise as a tool for hypertension and resistant hypertension management: current insights. Integr Blood Press Control. 2018 Sep 20;11:65-71. doi: 10.2147/IBPC.S136028. PMID: 30288097; PMCID: PMC6159802.
39. Halbert JA, Silagy CA, Finucane P, Withers RT, Hamdorf PA, Andrews GR. The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer. J Hum Hypertens. 1997 Oct;11(10):641-9. doi: 10.1038/sj.jhh.1000509. PMID: 9400906.
40. Saco-Ledo G, Valenzuela PL, Ruiz-Hurtado G, Ruilope LM, Lucia A. Exercise Reduces Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2020 Dec 15;9(24):e018487. doi: 10.1161/JAHA.120.018487. Epub 2020 Dec 5. PMID: 33280503; PMCID: PMC7955398.
41. Ishikawa-Takata K, Ohta T, Tanaka H. How much exercise is required to reduce blood pressure in essential hypertensives: a dose-response study. Am J Hypertens. 2003 Aug;16(8):629-33.doi:10.1016/s0895-7061(03)00895-1.PMID:12878367.
42. Weiner RB, Baggish AL. Exercise-induced cardiac remodeling. Prog Cardiovasc Dis. 2012 Mar-Apr;54(5):380-6. doi: 10.1016/j.pcad.2012.01.006. PMID: 22386288.
43. Duncker DJ, van Deel ED, de Waard MC, de Boer M, Merkus D, van der Velden J. Exercise training in adverse cardiac remodeling. Pflugers Arch. 2014 Jun;466(6):1079-91. doi: 10.1007/s00424-014-1464-8. Epub 2014 Feb 27. Erratum in: Pflugers Arch. 2016 Feb;468(2):367.doi:10.1007/s00424-015-1761-x.PMID:24573174.
44. Weiner RB, DeLuca JR, Wang F, Lin J, Wasfy MM, Berkstresser B, Stöhr E, Shave R, Lewis GD, Hutter AM Jr, Picard MH, Baggish AL. Exercise-Induced Left Ventricular Remodeling Among Competitive Athletes: A Phasic Phenomenon. Circ Cardiovasc Imaging. 2015Dec;8(12):e003651.doi:10.1161/CIRCIMAGING.115.003651.PMID:26666381.
45. Bernardo BC, McMullen JR. Molecular Aspects of Exercise-induced Cardiac Remodeling. Cardiol Clin. 2016 Nov;34(4):515-530. doi: 10.1016/j.ccl.2016.06.002. Epub 2016 Aug 25. PMID: 27692221.
46. Fulghum K, Hill BG. Metabolic Mechanisms of Exercise-Induced Cardiac Remodeling. Front Cardiovasc Med. 2018 Sep 11;5:127. doi: 10.3389/fcvm.2018.00127. PMID: 30255026; PMCID: PMC6141631.
47. Thompson SL, Brade CJ, Henley-Martin SR, Naylor LH, Spence AL. Vascular adaptation to exercise: a systematic review and audit of female representation. Am J Physiol Heart Circ Physiol. 2024 Apr 1;326(4):H971-H985. doi: 10.1152/ajpheart.00788.2023. Epub 2024 Feb 23. PMID: 38391316.
48. Green DJ, Hopman MT, Padilla J, Laughlin MH, Thijssen DH. Vascular Adaptation to Exercise in Humans: Role of Hemodynamic Stimuli. Physiol Rev. 2017 Apr;97(2):495-528. doi:10.1152/physrev.00014.2016.PMID:28151424;PMCID:PMC5539408.
49. Sun H, Zhang Y, Shi L. Advances in exercise-induced vascular adaptation: mechanisms, models, and methods. Front Bioeng Biotechnol. 2024 Feb 22;12:1370234. doi: 10.3389/fbioe.2024.1370234. PMID: 38456010; PMCID: PMC10917942.
50. Sakellariou XM, Papafaklis MI, Domouzoglou EM, Katsouras CS, Michalis LK, Naka KK. Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease. World J Cardiol. 2021 Sep 26;13(9):399-415. doi: 10.4330/wjc.v13.i9.399.PMID:34621486;PMCID:PMC8462042.
51. Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018 Jul 11;6:e5172. doi: 10.7717/peerj.5172. PMID: 30018855; PMCID: PMC6045928.
52. Alnawwar MA, Alraddadi MI, Algethmi RA, Salem GA, Salem MA, Alharbi AA. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. 2023Aug16;15(8):e43595.doi:10.7759/cureus.43595.PMID:37719583;PMCID:PMC1050395
53. Jurado-Fasoli L, De-la-O A, Molina-Hidalgo C, Migueles JH, Castillo MJ, Amaro-Gahete FJ. Exercise training improves sleep quality: A randomized controlled trial. Eur J Clin Invest. 2020Mar;50(3):e13202.doi:10.1111/eci.13202.Epub2020Feb12.PMID:31989592.
54. Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2021 Jun 7;12:664499. doi: 10.3389/fpsyt.2021.664499. PMID: 34163383; PMCID: PMC8215288.
55. Xie W, Lu D, Liu S, Li J, Li R. The optimal exercise intervention for sleep quality in adults: A systematic review and network meta-analysis. Prev Med. 2024 Jun;183:107955. doi: 10.1016/j.ypmed.2024.107955. Epub 2024 Apr 18. PMID: 38641082.
56. Memme JM, Erlich AT, Phukan G, Hood DA. Exercise and mitochondrial health. J Physiol. 2021 Feb;599(3):803-817. doi: 10.1113/JP278853. Epub 2019 Dec 9. PMID: 31674658.
57. Porter C, Reidy PT, Bhattarai N, Sidossis LS, Rasmussen BB. Resistance Exercise Training Alters Mitochondrial Function in Human Skeletal Muscle. Med Sci Sports Exerc. 2015 Sep;47(9):1922-31. doi: 10.1249/MSS.0000000000000605. PMID: 25539479; PMCID: PMC4478283.
58. Zhang H, Zhang Y, Zhang J, Jia D. Exercise Alleviates Cardiovascular Diseases by Improving Mitochondrial Homeostasis. J Am Heart Assoc. 2024 Oct;13(19):e036555. doi: 10.1161/JAHA.124.036555. Epub 2024 Sep 18. PMID: 39291488; PMCID: PMC11681480.
59. Mølmen KS, Almquist NW, Skattebo Ø. Effects of Exercise Training on Mitochondrial and Capillary Growth in Human Skeletal Muscle: A Systematic Review and Meta-Regression. Sports Med. 2025 Jan;55(1):115-144. doi: 10.1007/s40279-024-02120-2. Epub 2024 Oct 10. PMID: 39390310; PMCID: PMC11787188.
60. Song S, Lee E, Kim H. Does Exercise Affect Telomere Length? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas). 2022 Feb 5;58(2):242. doi: 10.3390/medicina58020242. PMID: 35208566; PMCID: PMC8879766.
61. Sánchez-González JL, Sánchez-Rodríguez JL, Varela-Rodríguez S, González-Sarmiento R, Rivera-Picón C, Juárez-Vela R, Tejada-Garrido CI, Martín-Vallejo J, Navarro-López V. Effects of Physical Exercise on Telomere Length in Healthy Adults: Systematic Review, Meta-Analysis, and Meta-Regression. JMIR Public Health Surveill. 2024 Jan 9;10:e46019. doi: 10.2196/46019. PMID: 38194261; PMCID: PMC10806448.
62. Puterman E, Weiss J, Lin J, Schilf S, Slusher AL, Johansen KL, Epel ES. Aerobic exercise lengthens telomeres and reduces stress in family caregivers: A randomized controlled trial - Curt Richter Award Paper 2018. Psychoneuroendocrinology. 2018 Dec;98:245-252. doi: 10.1016/j.psyneuen.2018.08.002. Epub 2018 Aug 2. PMID: 30266522.
63. Arsenis NC, You T, Ogawa EF, Tinsley GM, Zuo L. Physical activity and telomere length: Impact of aging and potential mechanisms of action. Oncotarget. 2017 Jul 4;8(27):45008-45019. doi: 10.18632/oncotarget.16726. PMID: 28410238; PMCID: PMC5546536.
64. Oizumi R, Sugimoto Y, Aibara H. The Potential of Exercise on Lifestyle and Skin Function: Narrative Review. JMIR Dermatol. 2024 Mar 14;7:e51962. doi: 10.2196/51962. PMID: 38483460; PMCID: PMC10979338.
65. Alam M, Walter AJ, Geisler A, Roongpisuthipong W, Sikorski G, Tung R, Poon E. Association of Facial Exercise With the Appearance of Aging. JAMA Dermatol. 2018 Mar 1;154(3):365-367. doi: 10.1001/jamadermatol.2017.5142. PMID: 29299598; PMCID: PMC5885810.
66. Nishikori S, Yasuda J, Murata K, Takegaki J, Harada Y, Shirai Y, Fujita S. Resistance training rejuvenates aging skin by reducing circulating inflammatory factors and enhancing dermal extracellular matrices. Sci Rep. 2023 Jun 23;13(1):10214. doi: 10.1038/s41598-023-37207-9. PMID: 37353523; PMCID: PMC10290068.
67. Castillo-Garzón MJ, Ruiz JR, Ortega FB, Gutiérrez A. Anti-aging therapy through fitness enhancement. Clin Interv Aging. 2006;1(3):213-20. doi: 10.2147/ciia.2006.1.3.213. PMID: 18046873; PMCID: PMC2695180.