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

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.