The Role of Physical Activity in the Prevention of Atherosclerosis

Atherosclerosis remains a leading cause of death and disability worldwide. Despite advances in pharmacotherapy and revascularization, residual risk, adherence barriers, and adverse effects persist. Physical activity (PA) offers a scalable non-pharmacological strategy to reduce this burden. Regular physical activity mitigates atherogenesis by enhancing endothelial function and nitric oxide bioavailability, lowering blood pressure, improving insulin sensitivity and glycaemic control, optimizing lipid handling, and attenuating chronic low-grade inflammation. Evidence suggests that aerobic, resistance, and isometric exercise modalities are beneficial, and combined training programs show complementary advantages. Key gaps remain regarding the optimal intensity and dose, real-world long-term adherence, and potential risks from excessive training in susceptible individuals. This review systematically synthesizes contemporary epidemiological, mechanistic, and interventional evidence on the role of PA in preventing and managing atherosclerosis, compares aerobic, resistance, and isometric modalities in their effects on endothelial function, blood pressure, glycaemic control, lipid metabolism, and inflammation, and highlights individualized prescriptions and practical strategies for precise prevention and management.