Benefits of Cardiac Rehabilitation: Mechanisms to Restore Function and Clinical Impact

Abdulla A. Damluji, Cardiovascular Center on Aging, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (A.A.D.).
Corey R. Tomczak, College of Kinesiology, University of Saskatchewan, Saskatoon, Canada (C.R.T.).
Stephanie Hiser, Department of Health, Human Function, and Rehabilitation Sciences, George Washington University, Washington, DC (S.H.).
Deirdre E. O'Neill, Division of Cardiology, Department of Medicine and Mazankowski Heart Institute, University of Alberta Hospital, Edmonton, Canada (D.E.O.).
Parag Goyal, Weill Cornell Medicine, New York, NY (P.G.).
Quinn R. Pack, UMass Chan Medical School-Baystate Health, Springfield, MA (Q.R.P.).
Stephen J. Foulkes, Integrated Cardiovascular Exercise Physiology and Rehabilitation Lab, Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (S.J.F., M.J.H.).
Todd M. Brown, Division of Cardiovascular Disease, University of Alabama at Birmingham Heersink School of Medicine (T.M.B.). Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh, PA.
Mark J. Haykowsky, Integrated Cardiovascular Exercise Physiology and Rehabilitation Lab, Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (S.J.F., M.J.H.).
Dale M. Needham, Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD (D.M.N).
Daniel E. Forman, Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, PA (D.E.F.).

Document Type

Journal Article

Publication Date

7-7-2025

Journal

Circulation research

Volume

137

Issue

2

DOI

10.1161/CIRCRESAHA.125.325705

Keywords

aging; cardiovascular diseases; digital health; quality of life; sarcopenia

Abstract

Cardiac rehabilitation (CR) has evolved from foundations as a postmyocardial infarction mobilization strategy for patients who were typically unstable, into a comprehensive, multidisciplinary program for most patients with cardiovascular disease aimed at optimizing cardiovascular health, reducing morbidity, and enhancing functional recovery. Although contemporary CR patients are now usually more stable from a cardiovascular perspective, needs have expanded for comprehensive approaches to exercise, lifestyle, care coordination, risk factor modification, and stress management. Furthermore, contemporary CR patients now typically include older adults who are contending with cardiovascular disease in the context of multimorbidity, frailty, sarcopenia, sensory limits, and cognitive impairment. The physiological mechanisms underlying exercise intolerance in cardiovascular disease include impairments in cardiac output, vascular function, and skeletal muscle metabolism and relate to elemental biological mechanisms that are common to all 3 as well as to noncardiovascular disease and aging. CR provides an important opportunity to address such aggregate risk. Nonetheless, CR remains underutilized, particularly by older adults, women, and those struggling with cognitive impairments, frailty, logistics, and social barriers to care. Emerging strategies, such as home-based and hybrid CR models, resistance training, and digital health technologies, are expanding the potential for access and effectiveness. Future research brings important opportunities to hone personalized CR strategies tailored to contemporary patient populations, including optimized exercise prescriptions as well as pharmacological, nutritional, and technological adjuncts. Related prospects to distinguish the biological mechanisms underlying patient-preferred clinical end points (eg, independence, quality of life) remain critical to augmenting CR's value in the contemporary therapeutic landscape.

Department

Health, Human Function, and Rehabilitation Sciences

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