Background Alzheimer’s Disease (AD) is characterised by proteasome activity impairment and oxidative stress, resulting in β-amyloid (Aβ) production/degradation imbalance. Apolipoprotein E (ApoE) is implicated in Aβ clearance, and ApoE ε4 isoform predisposes to AD development. Regular physical activity is known to reduce AD progression. However, the impact of ApoE polymorphism and physical exercise on Aβ production and proteasome system activity has never been investigated in human peripheral blood cells.Methods Healthy subjects were enrolled and classified based on the ApoE polymorphism (by the restriction fragment length polymorphism technique) and physical activity level (Borg Scale), dividing them in ApoE ε4/non-ε4 carriers and active/non-active subjects. The plasma antioxidant capability (AOC), the erythrocyte Aβ production/accumulation, and the nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated proteasome functionality were evaluated in all groups by chromatographic and immunoenzymatic assay, respectively. Moreover, epigenetic mechanisms were investigated considering the expression of the histone deacetylase 6, employing a competitive ELISA, and the modulation of two keys miRNAs (miR-153-3p and miR-195-5p), through miRNeasy Serum/Plasma Mini Kit.Results ApoE ε4 subjects showed a reduction in plasma AOC and an increase of the Nrf2 blocker, miR-153-3p, contributing to an enhancement of the erythrocyte concentration of Aβ. Physical exercise increased plasma AOC and reduced the amount of Aβ and its precursor, involving a reduced miR-153-3p expression and a miR-195-5p enhancement.Conclusions Our data highlight the impact of ApoE genotype on the amyloidogenic pathway and the proteasome system, and suggest the positive impact of physical exercise, also through epigenetic mechanisms.