Beyond phase II cardiac rehabilitation: strategies for long-term exercise adherence and cardiovascular health maintenance

Cardiac rehabilitation is a comprehensive, evidence-based intervention designed to improve functional capacity, reduce cardiovascular risk, support psychological recovery, and enhance quality of life in individuals with cardiovascular disease. Although Phase II cardiac rehabilitation provides structured, supervised exercise and education following an acute cardiac event or cardiovascular intervention, its benefits may diminish when patients transition to independent exercise and long-term self-management. Maintaining regular physical activity after completion of supervised rehabilitation is therefore a major challenge in secondary cardiovascular prevention. Barriers such as low motivation, fear of exercise, comorbidities, limited access to facilities, socioeconomic constraints, inadequate social support, and difficulty integrating exercise into daily routines can contribute to declining adherence. This review examines strategies that extend beyond Phase II cardiac rehabilitation to promote sustained exercise participation and cardiovascular health maintenance. It discusses the transition from supervised rehabilitation to community-based and home-based exercise, individualized exercise prescription, behavioural counselling, goal setting, self-monitoring, wearable technology, tele-rehabilitation, family involvement, and multidisciplinary follow-up. Particular attention is given to the role of physiotherapists and cardiac rehabilitation professionals in developing long-term exercise habits, monitoring cardiovascular risk factors, and adapting physical activity to changing clinical needs. The review also considers outcome measures, including exercise adherence, cardiorespiratory fitness, functional capacity, blood pressure, lipid profile, glycaemic control, body composition, quality of life, and cardiovascular events. A practical maintenance framework is proposed to connect supervised rehabilitation with lifelong physical activity through individualized planning, progressive exercise, behavioural support, and periodic reassessment. Long-term cardiovascular health should not be viewed as the final stage of a time-limited rehabilitation programme, but as an ongoing process requiring patient engagement, accessible services, and coordinated healthcare support.