Cardiac Rehabilitation in Transition: Integrating Behavior, Context, and Innovation for Improved Outcomes

Abstract

Cardiac rehabilitation (CR) is one of the most effective evidence-based interventions in cardiovascular medicine, consistently demonstrating benefits in mortality reduction, functional capacity, and quality of life. Yet, despite its well-established efficacy, CR remains underutilized and unevenly implemented worldwide. Traditional models often anchored in standardized exercise prescriptions and biomedical risk factor control have struggled to address the growing complexity of contemporary cardiovascular populations. Patients increasingly present with multimorbidity, psychological distress, cognitive impairment, persistent post-viral symptoms, and environmental risk exposure, all of which influence rehabilitation engagement and outcomes. The studies included in this Research Topic collectively demonstrate that cardiac rehabilitation must evolve into a multidimensional, person-centered, and adaptive system of care, capable of addressing the complex and interrelated determinants of cardiovascular health. Taken together, the contributions of this Research Topic support a redefinition of cardiac rehabilitation as an integrated system of care rather than a standardized intervention. Future research should prioritize longitudinal and interventional studies that test multilevel, theoryinformed rehabilitation models, while incorporating psychological, cognitive, and environmental outcomes as core endpoints of cardiac rehabilitation. In parallel, there is a need to evaluate hybrid and personalized delivery models that balance adherence, equity, and scalability, alongside mechanistic research linking biological markers such as BDNF to functional and behavioral outcomes and implementation studies exploring how communitybased and culturally adapted rehabilitation models can be sustainably embedded within diverse health systems. In conclusion, this Research Topic demonstrates that advancing cardiac rehabilitation requires expanding both its scope to include psychosocial, cognitive, environmental, and biological dimensions and its depth, through personalization, contextual sensitivity, and mechanistic insight. By aligning clinical practice with the realities of modern cardiovascular health, the work presented here provides a strong foundation for the next generation of rehabilitation research and practice, aimed not only at prolonging life, but at enhancing resilience, participation, and long-term quality of life across the cardiovascular continuum.