Obesity and Phase II Cardiac Rehabilitation: Tailored Management and Exercise Training

Obesity is highly prevalent among patients referred to cardiac rehabilitation and is associated with increased cardiometabolic risk, reduced functional capacity, and poorer long-term adherence. Phase II cardiac rehabilitation represents a unique opportunity to provide a structured, multidisciplinary intervention for these high-risk patients, targeting clinical stabilization, cardiovascular risk reduction, weight management, behavioral change, and improvement of psychosocial well-being and cardiorespiratory fitness. Core components include comprehensive baseline assessment, cardiovascular risk factor management, physical activity counselling and exercise training, nutritional counseling, weight management, psychological support, and patient education. Exercise prescription should be personalized based on clinical status and functional capacity rather than body mass index alone, with progressive adjustments to frequency, intensity, time, and type. Multicomponent programs combining aerobic and resistance training are particularly effective in improving cardiometabolic health, preserving lean mass, and enhancing physical performance, even when weight loss is modest. Furthermore, exercise training combined with dietary and behavioral strategies promotes clinically meaningful improvements in body composition and cardiovascular risk profile. Importantly, intentional weight loss is associated with better outcomes, whereas unintentional weight loss reflects a poorer prognosis. A tailored, patient-centered approach within phase II cardiac rehabilitation is essential to optimize outcomes for patients with obesity, emphasizing personalized assessment and management according to individual risk profile, limitations, functional capacity, comorbidities, and concomitant cardiovascular diseases, such as heart failure, coronary artery disease, atrial fibrillation, and valvular heart disease. Therefore, this manuscript aims to provide a comprehensive, up-to-date review of the personalized management of patients with obesity during phase II cardiac rehabilitation, with a particular focus on aerobic and resistance exercise training.