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Figure 2. Exercise stimulates molecular and cellular changes in the aged heart. Exercise benefits cardiac cells and molecular processes. Exercise enhances endothelial cell function by increasing nitric oxide (NO) production and reducing reactive oxygen species (ROS), while also elevating vascular endothelial growth factor (VEGF) to support angiogenesis. In fibroblasts, exercise decreases myofibroblast activation, reducing fibrosis and improving cardiac function. It also impacts leukocytes by lowering hematopoietic stem and progenitor cell (HSPC) proliferation, reducing leukocytosis and increasing myeloid-derived suppressor cells (MDSCs) to diminish inflammation. Additionally, exercise promotes physiological cardiac growth through cardiomyocyte proliferation and hypertrophy, improving cardiac function.