Moxibustion is a side-effect-free external therapy for relieving different clinical disorders. Its effects in eliminating sports fatigue, preventing myocardial injury in people undergeing exhausted exercise and its underlying mechanisms have been induced great concern by the sports medicine community. In the present paper, the authors make a review on the development of researches on the underlying mechanism of moxibustion in the prevention and treatment of sports myocardial injury in re- cent 10 years from 1) regulating myocardial endocrine function, 2) scavenging free radicals, 3) resisting oxidative damage, and 4) modulating blood rheology. On the basis of results mentioned above, the authors raise a new potential mechanism underlying protective effect of moxibustion on myocardial cells during exhaustive exercise from the cellular molecular level, i.e., mitochondrial telomerase-mediated anti-aging. This mitochondrial telomerase-mediated anti-aging may be a new target of moxibustion intervention for protecting cardiomyocytes from injury under exhaustive exercise condition.