Exercise‑induced exosomal noncoding RNAs: Molecular signaling cascades in bone remodeling and translational...

Exercise has profound beneficial effects on bone health, yet the molecular mechanisms that mediate mechanical force transduction remain incompletely understood. Exosomal noncoding RNAs (ncRNAs) have emerged as critical intercellular messengers that translate mechanical stimuli into coordinated signaling cascades within the bone microenvironment. The present review systematically synthesizes evidence demonstrating that exercise dynamically modulates exosomal ncRNA expression in a modality‑dependent and temporally regulated manner. These exercise‑induced exosomal ncRNAs orchestrate bone remodeling by activating osteogenic pathways such as the Wnt/β‑catenin pathway, suppressing osteoclastogenesis via receptor activator of nuclear factor κB (RANK) ligand (RANKL)/RANK/osteoprotegerin axis modulation, and coordinating multicellular interactions. Translational applications for sports‑related bone injuries are critically evaluated, including noninvasive biomarkers, personalized exercise prescriptions, and engineered exosome‑based therapeutics, alongside current limitations. Collectively, these findings support exercise‑induced exosomal ncRNAs as a central paradigm linking physical activity to skeletal adaptation.