THE EXERCISE PILLAR OF LIFESTYLE MEDICINE: EMERGING EVIDENCE, NOVEL MODALITIES, MOLECULAR MECHANISMS, AND PHARMACOLOGICAL SYNERGIES A NARRATIVE REVIEW

Background: Physical activity, one of the six foundational pillars of lifestyle medicine, is arguably the most potent non-pharmacological intervention available for the prevention and management of non-communicable diseases (NCDs). Recent years have witnessed transformative evidence from landmark randomized controlled trials demonstrating exercise-driven cancer survival benefits to the discovery of novel ultra short activity paradigms and exercise derived molecular mediators-that collectively redefine the scope and practice of exercise prescription within lifestyle medicine. Objective: This narrative review synthesizes emerging and paradigm-shifting evidence on the exercise pillar of lifestyle medicine, focusing on four interconnected frontiers: (1) Exercise is Medicine and exercise prescription for NCDs, (2) novel exercise modalities including vigorous intermittent lifestyle physical activity (VILPA) and exercise snacking, (3)the gut-brain axis, exerkines, and molecular mechanisms of exercise, and (4) exercise as an adjunct to pharmacotherapy, particularly with GLP-1 receptor agonists and antidepressants.