REHABILITATION STRATEGIES FOR ADULTS WITH CARDIOVASCULAR DISEASES: A COMPREHENSIVE REVIEW
DOI:
https://doi.org/10.67034/2786-8354.2026.20.2.06Keywords:
сardiovascular diseases, сardiac rehabilitation, аerobic exercise, health, patients, modification, nutritionAbstract
Introduction. To conduct a comparative analysis of clinical practices in the United States, China, leading European countries, Scandinavia, Canada, Japan, Australia, and Brazil, and to synthesize the evidence published between 2000 and 2026, focusing on both non-pharmacological (exercise, nutrition, psychosocial, behavioral) and pharmacological rehabilitation strategies for adult populations with IHD, MI, or HF
Materials and Methods. The research material includes recent academic publications, international and national clinical guidelines, randomized controlled trials (RCTs), systematic reviews, meta-analyses, and observational cohort studies published between January 2000 and March 2026. The investigation was structured around an exhaustive database search in PubMed, Scopus, and Web of Science, utilizing precise targeted medical subject headings (MeSH) and key terms related to secondary cardiovascular prevention. The methodological approach relied on structural synthesis, cross-national evaluation, taxonomy building, and cross-sectional descriptive mapping of regional rehabilitation infrastructures, clinical protocols, and adherence tracking systems.
Results. The result is a detailed cross-national analysis and descriptive mapping of secondary prevention systems across the US, China, Europe, Scandinavia, Canada, Japan, Australia, and Brazil, identifying key socioeconomic and structural barriers while outlining strategies to improve long-term patient rehabilitation. Clinical evidence from 2000–2026 confirms that multidisciplinary interventions – specifically HIIT and Mediterranean/DASH diets – reduce cardiovascular mortality by up to 20% while maintaining an excellent safety profile. Cross-national analysis reveals critical disparities in global cardiac rehabilitation, ranging from highly effective systematic referral models in Scandinavia (>60% enrollment) to severe underutilization due to structural barriers in the US and developing nations. To overcome socioeconomic challenges and enhance long-term patient adherence, the study substantiates the transition toward integrated care models driven by digital health tools and culturally tailored frameworks. Furthermore, behavioral interventions and smartphone-based digital platforms demonstrate significant efficacy in improving lifestyle modification and guideline-directed medical therapy (GDMT) compliance, addressing the critical challenge where up to 40% of patients otherwise discontinue their preventive medications within a year post-myocardial infarction.
Conclusions. Integrated cardiac rehabilitation reduces cardiovascular mortality by 20%, yet its global utilization is heavily restricted by structural barriers – ranging from under 30% in the US to over 60% in Scandinavia – necessitates a shift toward systematic models for the automated referral of patients and the implementation of digital tools to monitor adherence to rehabilitation.
References
1. Ades, P. A., Keteyian, S. J., Wright, J. S., Hamm, L. F., Lui, K., Newlin, K., Shepard, D. S., & Thomas, R. J. (2017). Increasing cardiac rehabilitation participation from 20% to 70%: A road map from the Million Hearts Cardiac Rehabilitation Collaborative. Journal of Cardiopulmonary Rehabilitation and Prevention, 37(5), 306–311. https://doi.org/10.1016/j.mayocp.2016.10.014
2. Anderson, L., Oldridge, N., Thompson, D. R., Zwisler, A. D., Rees, K., Martin, N., & Taylor, R. S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology, 67(1), 1–12. https://doi.org/10.1016/j.jacc.2015.10.044
3. Bafail, D. A., & Alhalees, N. H. (2026). Effect of SGLT2 inhibitors on heart failure outcomes in patients with and without diabetes: A systematic review and meta-analysis of randomized controlled trials. Experimental and Therapeutic Medicine, 31(3), 84. https://doi.org/10.3892/etm.2026.13079
4. Blumenthal, J. A., Babyak, M. A., Carney, R. M., Keefe, F. J., Davis, R. D., LaCaille, R. A., ... & Sherwood, A. (2016). Telephone-based coping skills training for patients awaiting lung transplantation: A randomized clinical trial. JAMA Internal Medicine, 176(6), 859–867. https://doi.org/10.1037/0022-006X.74.3.535
5. Choudhry, N. K., Avorn, J., Glynn, R. J., Antman, E. M., Schneeweiss, S., Toscano, M., ... & Shrank, W. H. (2011). Full coverage for preventive medications after myocardial infarction. New England Journal of Medicine, 365(22), 2088–2097. https://doi.org/10.1056/NEJMsa1107913
6. Cornelissen, V. A., & Smart, N. A. (2013). Exercise training for blood pressure: A systematic review and meta-analysis. Journal of the American Heart Association, 2(1), e004473. https://doi.org/10.1161/JAHA.112.004473
7. Critchley, J. A., & Capewell, S. (2003). Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: A systematic review. JAMA, 290(1), 86–97. https://doi.org/10.1001/jama.290.1.86
8. Dalal, H. M., Doherty, P., & Taylor, R. S. (2015). Cardiac rehabilitation. BMJ, 351, h5000. https://doi.org/10.1001/jama.290.1.86
9. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F., ... & Martínez-González, M. A. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 368(14), 1279–1290. https://doi.org/10.1056/NEJMoa1200303
10. Grace, S. L., Turk-Adawi, K. I., Contractor, A., Atrey, A., Campbell, N., Derman, W., ... & Sarrafzadegan, N. (2016). Cardiac rehabilitation delivery model for low-resource settings. Heart, 102(18), 1449–1455. https://doi.org/10.1136/heartjnl-2015-309209 .
11. Hambrecht, R., Gielen, S., Linke, A., Fiehn, E., Yu, J., Walther, C., ... & Schuler, G. (2000). Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial. JAMA, 283(23), 3095–3101. https://doi.org/10.1001/jama.283.23.3095
12. Iglesies-Grau, J., Dionne, V., Latour, É., Gayda, M., Besnier, F., Gagnon, D., Debray, A., Gagnon, C., Tessier, A. J., Paradis, A., Klai, C., Martin, N., Pelletier, V., Simard, F., Nigam, A., L'Allier, P. L., Juneau, M., Bouabdallaoui, N., & Bherer, L. (2024). Cardiac rehabilitation for prediabetes and metabolic syndrome remission: Impact of ultraprocessed food-intake reduction and time-restricted eating in the DIABEPIC-1 study. CJC Open, 6(11), 1411–1421. https://doi.org/10.1016/j.cjco.2024.07.018
13. Laukkanen, J. A., Kunutsor, S. K., Ozemek, C., Mäkikallio, T., Lee, D. C., Wisloff, U., & Lavie, C. J. (2019). Cross-country skiing and running's association with cardiovascular events and all-cause mortality: A review of the evidence. Progress in Cardiovascular Diseases, 62(6), 505–514. https://doi.org/10.1016/j.pcad.2019.09.001
14. Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., ... & Wulsin, L. R. (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: Systematic review and recommendations. Circulation, 129(12), 1350–1369. https://doi.org/10.1161/CIR.0000000000000019
15. McDonagh, S. T., Dalal, H., Moore, S., Clark, C. E., Dean, S. G., Jolly, K., ... & Taylor, R. S. (2023). Home-based versus centre-based cardiac rehabilitation. Cochrane Database of Systematic Reviews, 10(10), CD007130. https://doi.org/10.1002/14651858.CD007130.pub5
16. McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., ... & Chioncel, O. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599–3726. https://doi.org/10.1093/eurheartj/ehab368
17. O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., ... & Piña, I. L. (2009). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 301(14), 1439–1450. https://doi.org/10.1001/jama.2009.454
18. Piepoli, M. F., Corrà, U., Adamopoulos, S., Benzer, W., Bjarnason-Wehrens, B., Cupples, M., ... & Schmid, J. P. (2016). Secondary prevention through cardiac rehabilitation: Physical activity counselling and exercise training. European Heart Journal, 37(29), 2315–2338. https://doi.org/10.1093/eurheartj/ehw106
19. Rognmo, Ø., Moholdt, T., Bakken, H., Hole, T., Mølstad, P., Myhr, N. E., ... & Slørdahl, S. A. (2012). Cardiovascular risk of high‐versus moderate‐intensity aerobic exercise in coronary heart disease patients. Circulation, 126(12), 1436–1440. https://doi.org/10.1161/CIRCULATIONAHA.112.123117
20. Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., ... & Lin, P. H. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine, 344(1), 3–10. https://doi.org/10.1056/NEJM200101043440101
21. Santiago de Araújo Pio, C., Marzolini, S., Pakosh, M., & Grace, S. L. (2017). Effect of cardiac rehabilitation dose on mortality and morbidity: A systematic review and meta-regression analysis. Mayo Clinic Proceedings, 92(11), 1644–1659. https://doi.org/10.1016/j.mayocp.2017.07.019
22. Santo, K., Singleton, A., Rogers, K., Thiagalingam, A., Chalmers, J., Chow, C. K., & Redfern, J. (2019). Medication reminder applications to improve adherence in coronary heart disease: A randomised clinical trial. Heart, 105(4), 323–329. https://doi.org/10.1136/heartjnl-2018-313479
23. Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., ... & Whooley, M. A. (2019). Home-based cardiac rehabilitation: A scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69–e89. https://doi.org/10.1161/CIR.0000000000000663
24. Turk-Adawi, K., Sarrafzadegan, N., & Grace, S. L. (2014). Global availability of cardiac rehabilitation. Nature Reviews Cardiology, 11(10), 586–596. https://doi.org/10.1038/nrcardio.2014.98
25. Vanegas, P., Zazpe, I., Santiago, S., Fernandez-Lazaro, C. I., de la O, V., & Martínez-González, M. Á. (2022). Macronutrient quality index and cardiovascular disease risk in the Seguimiento Universidad de Navarra (SUN) cohort. European Journal of Nutrition, 61(7), 3517–3530. https://doi.org/10.1007/s00394-022-02901-3
26. Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., ... & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2021). Heart disease and stroke statistics-2021 update. Circulation, 143(8), e254–e743. https://doi.org/10.1161/CIR.0000000000000950
