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We investigated the effect of CR on circulating levels of myostatin, follistatin, apelin, and follistatin-related protein 1 (FSTL1) in post-ACS patients. A total of 110 patients underwent a 2-week CR programme (group S) and were compared with 110 non-CR patients (group K). In group S, blood pressure, heart rate, anthropometrics, body composition, and serum myokine levels were measured at baseline and post-CR; in group K, these were assessed once. After CR, apelin, myostatin, and FSTL1 increased in group S. Apelin and myostatin were higher in group S post-CR compared with group K, while follistatin remained higher in group K at both time points. FSTL1 was initially higher in group K but increased post-CR in STEMI patients only; myostatin increased in NSTEMI patients. Apelin increased in STEMI patients. Apelin and myostatin levels were independent of cardiovascular risk factors. Post-CR, follistatin correlated inversely with diastolic pressure; FSTL1 was related to fat tissue, muscle mass and body mass index. CR modulates key myokines and differential myokine responses in STEMI vs. NSTEMI patients support the need for personalised rehabilitation strategies. ClinicalTrials.gov registration number: NCT03935438.<\/jats:p>","DOI":"10.1038\/s41598-025-22897-0","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:55:58Z","timestamp":1762437358000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cardiac rehabilitation influences serum myokine levels in patients after acute coronary syndrome: the randomised CARDIO-REH study"],"prefix":"10.1038","volume":"15","author":[{"given":"Damian","family":"Skrypnik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Skrypnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Casa\u00f1a","family":"Granell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2759-4625","authenticated-orcid":false,"given":"Dawid","family":"Woszczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Suliburska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"22897_CR1","doi-asserted-by":"publisher","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","volume":"80","author":"M Vaduganathan","year":"2022","unstructured":"Vaduganathan, M., Mensah, G. 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