Molecules in motion: A narrative review on exercise, exosomes and eating disorders

Exercise plays a dual role in eating disorders: maladaptive exercise contributes to their development and maintenance, while supervised and adapted exercise can support recovery. The mechanisms underlying these opposing effects remain unclear. Exosomes, i.e., key mediators of organ crosstalk, may help explain both harmful and therapeutic exercise responses. This narrative review examines how exosomes and their cargo may serve as biomarkers of exercise effects in the context of eating disorders. We synthesized current evidence on exosome biology, exercise-induced exosomal signaling, and insights from related clinical conditions. Current knowledgebase shows that exercise alters exosome release and cargo, including myomiRs involved in muscle regeneration, neuroplasticity, and metabolic regulation. Findings from populations with depression or neurodegenerative disorders suggest that exercise-responsive exosomes can influence various factors of brain health, though these mechanisms have not yet been studied in eating disorders. The exosomal cargo sensitivity to stressors such as exercise and low energy availability, indicate that exosomes may offer a promising pathway for diagnostic and therapeutic biomarker development. Future research must replicate research from other clinical conditions on exercise-induced release and alteration of exosome and their cargo to populations with eating disorders to clearly establish this mechanism in eating disorders treatment.