{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T18:06:42Z","timestamp":1779300402454,"version":"3.51.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Exercise-based cardiac rehabilitation (CR) has emerged as a promising strategy for promoting atherosclerotic plaque regression in patients with atherosclerotic cardiovascular disease (ASCVD). Although lipid-lowering drugs are firmly established for plaque regression, the impact of exercise-based CR on plaque regression remains underexplored, prompting synthesis of existing evidence. This review aims to characterize studies on exercise-based CR in ASCVD, summarize CR modalities, identify confounding factors, and evaluate evidence of plaque regression from imaging and clinical outcomes. A thorough literature search was conducted in May-June 2025 across PubMed, ScienceDirect, and EBSCO. Included studies were controlled trials on CR for ASCVD adults assessing plaque changes via imaging. Data extraction followed PRISMA-ScR guidelines focusing on study design, populations, interventions, and outcomes. Five trials encompassing 217 participants demonstrated that diverse CR programmes\u2014high-intensity interval training, aerobic exercise and resistance training\u2014combined with standard medical therapy significantly reduced plaque volume parameters, as measured by IVUS and carotid ultrasound. CR further improved key mechanistic markers, including inflammatory cytokines and endothelial function, underpinning plaque stabilization and regression. Exercise-based CR robustly promotes plaque regression and mitigates cardiovascular risk in ASCVD, complementing pharmacological approaches. These findings affirm CR\u2019s indispensable role in secondary prevention, though confounding from concurrent lipid-lowering therapies warrants consideration in future randomized trials.<\/jats:p>","DOI":"10.1371\/journal.pone.0347557","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:24:52Z","timestamp":1779297892000},"page":"e0347557","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise-based cardiac rehabilitation and atherosclerotic plaque regression in ASCVD: Is exercise really a game-changer? A scoping review of controlled trials"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4526-8513","authenticated-orcid":true,"given":"Dwita Rian","family":"Desandri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5325-5061","authenticated-orcid":true,"given":"Averina Octaxena","family":"Aslani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5320-358X","authenticated-orcid":true,"given":"Faqrizal Ria","family":"Qhabibi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8229-3190","authenticated-orcid":true,"given":"Dimitra","family":"Nikoletou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"pone.0347557.ref001","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ejim.2024.08.010","article-title":"The clinical relevance of the reversal of coronary atherosclerotic plaque","volume":"129","author":"A Cesaro","year":"2024","journal-title":"Eur J Intern Med"},{"issue":"1","key":"pone.0347557.ref002","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jacc.2021.10.035","article-title":"Coronary atherosclerotic plaque regression: JACC state-of-the-art review","volume":"79","author":"LP Dawson","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"21","key":"pone.0347557.ref003","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1016\/j.jacc.2014.08.045","article-title":"Effect of atorvastatin therapy on fibrous cap thickness in coronary atherosclerotic plaque as assessed by optical coherence tomography: the EASY-FIT study","volume":"64","author":"K Komukai","year":"2014","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"pone.0347557.ref004","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.jcmg.2018.04.015","article-title":"Effects of statins on coronary atherosclerotic plaques: The PARADIGM study","author":"SE Lee","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"issue":"6","key":"pone.0347557.ref005","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1185\/03007995.2011.570746","article-title":"Impact of statins on progression of atherosclerosis: rationale and design of SATURN (Study of Coronary Atheroma by InTravascular Ultrasound: effect of Rosuvastatin versus AtorvastatiN)","volume":"27","author":"SJ Nicholls","year":"2011","journal-title":"Curr Med Res Opin"},{"issue":"5","key":"pone.0347557.ref006","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.jacc.2015.05.065","article-title":"Impact of dual lipid-lowering strategy with ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention: The multicenter randomized controlled PRECISE-IVUS trial","volume":"66","author":"K Tsujita","year":"2015","journal-title":"J Am Coll Cardiol"},{"issue":"22","key":"pone.0347557.ref007","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1001\/jama.2016.16951","article-title":"Effect of evolocumab on progression of coronary disease in statin-treated patients: The GLAGOV Randomized Clinical Trial","volume":"316","author":"SJ Nicholls","year":"2016","journal-title":"JAMA"},{"issue":"7","key":"pone.0347557.ref008","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1016\/j.jcmg.2022.03.002","article-title":"Effect of evolocumab on coronary plaque phenotype and burden in statin-treated patients following myocardial infarction","volume":"15","author":"SJ Nicholls","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"issue":"6","key":"pone.0347557.ref009","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jjcc.2017.07.007","article-title":"A randomized controlled trial of eicosapentaenoic acid in patients with coronary heart disease on statins","volume":"70","author":"T Watanabe","year":"2017","journal-title":"J Cardiol"},{"issue":"2","key":"pone.0347557.ref010","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1253\/circj.CJ-15-0813","article-title":"Effects of the Addition of Eicosapentaenoic Acid to Strong Statin Therapy on Inflammatory Cytokines and Coronary Plaque Components Assessed by Integrated Backscatter Intravascular Ultrasound","volume":"80","author":"T Niki","year":"2016","journal-title":"Circ J"},{"key":"pone.0347557.ref011","doi-asserted-by":"crossref","unstructured":"Vaidya K, Arnott C, Mart\u00ednez GJ, Ng B, McCormack S, Sullivan DR, et al. 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