The rapid growth of the global ageing population has intensified the burden of age-related diseases on public health systems. As physiological functions decline with increasing age, blood vessels and immune defences gradually weaken, impairing tissue repair, slowing metabolism, and leaving the body more vulnerable to chronic disorders such as cardiovascular disease, diabetes, and neurodegenerative conditions. These changes do not simply accompany ageing; they actively accelerate its progression, underscoring the urgent need for strategies that address the biological mechanisms driving physical decline rather than merely treating disease after it appears.
A recent review published on 20 October 2025 in Volume 138, Issue 20 of the Chinese Medical Journal offers new insight into how exercise may serve as a natural therapeutic tool against ageing. Authored by Professor Junjie Xiao and his team from the Cardiac Regeneration and Ageing Lab at Shanghai University’s Institute of Geriatrics, the review highlights the potential of exercise-induced angiogenesis (the formation of new blood vessels) and lymphangiogenesis (the growth of lymphatic vessels) to maintain health and slow age-related deterioration. Dr Xiao emphasises that exercise is more than a lifestyle habit; it is a potent biological stimulus that can trigger regenerative processes essential to vascular health and immune protection.
Angiogenesis ensures adequate oxygen and nutrient delivery to tissues, supports wound healing, and maintains metabolic efficiency. Lymphangiogenesis, by contrast, regulates immune activity, metabolic balance, and the removal of cellular waste. With age, both systems undergo marked decline, leading to insufficient tissue perfusion, accumulation of waste products, chronic inflammation, and impaired immune defence. By stimulating the growth and repair of these networks, exercise offers a means to counteract these fundamental causes of ageing.
The review details the molecular mechanisms behind these benefits. Physical activity upregulates vascular endothelial growth factor (VEGF) and its receptors, stimulates endothelial cell proliferation, and activates transcription factors such as hypoxia-inducible factor-1α (HIF-1α), as well as microRNAs associated with vascular growth. In lymphatic tissues, exercise activates receptors such as VEGFR-3, encouraging lymphatic remodelling. Through these pathways, exercise enhances circulation, boosts metabolic capacity, and supports immune resilience.
Organ-specific effects also make exercise a compelling anti-ageing intervention. In the heart, increased vascular regeneration improves myocardial perfusion and reduces cardiovascular risk. In skeletal muscles, denser vascular networks support strength, endurance, and delay muscle atrophy. In the brain, exercise strengthens neurovascular units, fosters cognitive vitality, and offers protection against diseases like Alzheimer’s. Exercise-induced improvements in vascular and lymphatic function have also been linked to reduced metabolic complications in obesity and diabetes.
Despite its promise, the review identifies ongoing challenges. Researchers still lack clarity regarding how different organs coordinate their vascular responses to exercise, and how factors such as exercise type, intensity, and individual variability influence outcomes. Overexertion may even cause harm, especially in elderly or clinically vulnerable individuals, making personalised exercise prescriptions essential. Integrating exercise with medical therapies remains another important frontier.
The review concludes that exercise should be viewed as a regenerative medical tool capable of stimulating vascular and lymphatic health. Future research must optimise exercise protocols for different populations and evaluate long-term safety. With further development, personalised exercise interventions may offer a safe, accessible, and effective strategy to enhance healthspan, combat disease, and support healthy ageing.
More information: Junjie Xiao et al, Exercise-induced angiogenesis and lymphangiogenesis: A potential therapeutic tool to fight aging and disease, Chinese Medical Journal. DOI: 10.1097/CM9.0000000000003831
Journal information: Chinese Medical Journal and Modeling Provided by Chinese Medical Journals Publishing House Co., Ltd.
