Contemporary Cardiac Rehabilitation: Evolution of Approaches and Remaining Challenges

Cardiovascular Diseases (CVDs) are the leading cause of death globally, with growing prevalence driven by modifiable risk factors including hypertension, dyslipidemia, poor diet, and sedentary lifestyles. A proven multidisciplinary strategy, Cardiac Rehabilitation (CR) enhances survival, functional capacity, and quality of life in patients with CVD. Phase 2, the traditional center-based program, delivers structured, supervised exercise and education immediately after cardiac events, significantly improving cardiovascular fitness. Phase 3 CR emphasizes long-term maintenance, fostering self-directed exercise and lifestyle modification; however, participation often declines without structured support. Exercise modalities, including aerobic, resistance, and high-intensity interval training, produce multi-system physiological adaptations. Beyond exercise, behavioral counseling, psychosocial support, nutritional guidance, smoking cessation, and medication adherence are essential to comprehensive CR. Emerging delivery model such as home-based CR, hybrid, telehealth, and app-supported programmes, address barriers such as accessibility, travel constraints, and adherence while maintaining clinical efficacy. Despite these innovations, challenges persist, including low referral rates, socioeconomic disparities, digital literacy gaps, and limited long-term data on outcomes. Future CR strategies aim to integrate precision medicine, digital monitoring, wearable technologies, and artificial intelligence to personalize interventions. This review synthesizes contemporary evidence on CR evolution, highlights persistent barriers, and explores strategies for maximizing accessibility, equity, and long-term effectiveness, offering a roadmap toward the next generation of patient-centered, technology-enabled CR.