Cardiac rehabilitation in patients with heart failure: clinical recommendation based on a review of the evidence.

Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary approach that combines exercise training, risk factor management, and psychosocial support, contributing to managing heart failure (HF). Despite its proven benefits, CR remains underutilized due to challenges such as limited accessibility and patient adherence. This reviews the beneficial effects of exercise on HF, including improvements in peak oxygen consumption. It outlines the key steps on the patient's journey toward a CR program, such as referral processes, risk stratification, and exercise prescription. It also explores the different types of CR programs and delivery models designed to enhance patient engagement and improve long-term adherence. Furthermore, it outlines clinical scenarios needing customized exercise prescriptions, including atrial fibrillation, pacemakers, implantable cardioverter-defibrillators, ventricular assist devices, and heart transplantation.