Editorial: Fundamentals and Advances in Cardiopulmonary Rehabilitation

Chronic cardiovascular and respiratory diseases remain among the leading causes of morbidity and mortality worldwide, exerting a profound impact on functional capacity, quality of life, and healthcare systems (1). In this context, cardiopulmonary rehabilit ation has emerged as a cornerstone non-pharmacological intervention, consistently demonstrating its capacity to improve physiological function, reduce symptoms, and enhance long-term outcomes (2). However, despite its well-established efficacy, the field continues to face important challenges related to mechanistic understanding, intervention optimization, and real-world implementation.The contributions included in this Research Topic can be conceptually organized into three interconnected domains: strategies targeting central and autonomic regulation, functional outcomes and recovery trajectories, and implementation and adherence challenges. Together, these domains reflect a progressive trans formation in rehabilitation, moving beyond traditional exercise-based approaches toward integrative, multidimensional, and person-centered models that recognize the patient as an embodied and experiential subject (3,4).A first domain encompasses rehabilitation strategies targeting central and autonomic regulation, integrating both emerging technologies and structured exercise interventions through their shared effects on neural and autonomic processes. The narrative review by Xu X et al. on transcranial magnetic stimulation introduces a perspective in which respiratory dysfunction is not solely interpreted as a peripheral or mechanical impairment, but as a phenomenon rooted in cortical and subcortical processes. By modula ting corticospinal excitability, influencing neurotransmitter dynamics, and interacting with limbic circuits involved in emotional processing, transcranial magnetic stimulation provides emerging evidence that targeting central neural mechanisms may lead to clinically meaningful outcomes, including the attenuation of dyspnea through altered respiratory drive and perceptual processing. Taken together, the studies included in this Research Topic illustrate a field undergoing significant transformation. Cardiopulmonary rehabilitation is evolving from a predominantly exercise-based discipline into a complex, integrative science that incorporates neurophysiology, behavioral medicine, and health systems research. This evolution reflects a broader paradigm shift toward precision and integrative rehabilitation, where interventions are tailored not only to physiological impairments but also to in dividual, social, and contextual factors (6,7). Future research should focus on aligning mechanistic insight, individualized intervention, and real-world implementation, ensuring that advances in cardiopulmonary rehabilitation translate into meaningful and sustained patient benefit.