Skip to main content
. 2026 Jul 13;17:1868998. doi: 10.3389/fphys.2026.1868998

Figure 2.

Flowchart illustration depicting how intense or prolonged exercise leads to hemodynamic and metabolic stress, resulting in the release of non-coding RNAs from cardiac and vascular cells, which are encapsulated in exosomes for stable circulation, with separate mechanisms described for exercise-responsive long non-coding RNAs and microRNAs.

NcRNAs, as cardiovascular biomarkers, are released during exercise. Exercise that is intense or prolonged causes metabolic and hemodynamic stress, thereby stimulating the release of ncRNAs from cardiac and vascular cells. Exercise-responsive lncRNAs (MALAT1, Mhrt, Chast) serve as transcriptional controllers, ceRNAs, and epigenetic regulators (Lee et al., 2003; Zeng and Cullen, 2003; Lee et al., 2004; Faller and Guo, 2008; Morlando et al., 2008). While chronic exercise modifies different sets of miRNAs (miR-139, miR-143, miR-223, miR-330), acute exercise quickly mobilizes miRNAs (miR-21, miR-146a, miR-221, miR-222) (Ultimo et al., 2018). EXOs and EVs encapsulate both miRNAs and lncRNAs to ensure their steady circulation. Early subclinical damage identification, left ventricular hypertrophy type differentiation, and hypertrophic cardiomyopathy screening are examples of clinical value that remain in the exploratory stage and require validation (de Gonzalo-Calvo et al., 2018; Barber et al., 2019; Ma and Liao, 2019; Hu et al., 2021, 2026).