The awarding of the 2024 Nobel Prize in Physiology or Medicine emphasizes the important role of microRNA (miRNA) in gene regulation. Regular exercise serves as a “natural prescription” for cardiovascular protection and promotes cardiac repair by regulating the miRNA network. In this review, we initially introduce miRNA and summarize the close connection between miRNA and cardiovascular diseases. Finally, we have summarized the multi-dimensional regulatory mechanism and therapeutic potential of exercise-mediated miRNA in cardiac repair, providing a new model for non-drug intervention in cardiovascular diseases.