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Although contemporary CR patients are now usually more stable from a cardiovascular perspective, needs have expanded for comprehensive approaches to exercise, lifestyle, care coordination, risk factor modification, and stress management. Furthermore, contemporary CR patients now typically include older adults who are contending with cardiovascular disease in the context of multimorbidity, frailty, sarcopenia, sensory limits, and cognitive impairment. The physiological mechanisms underlying exercise intolerance in cardiovascular disease include impairments in cardiac output, vascular function, and skeletal muscle metabolism and relate to elemental biological mechanisms that are common to all 3 as well as to noncardiovascular disease and aging. CR provides an important opportunity to address such aggregate risk. Nonetheless, CR remains underutilized, particularly by older adults, women, and those struggling with cognitive impairments, frailty, logistics, and social barriers to care. Emerging strategies, such as home-based and hybrid CR models, resistance training, and digital health technologies, are expanding the potential for access and effectiveness. Future research brings important opportunities to hone personalized CR strategies tailored to contemporary patient populations, including optimized exercise prescriptions as well as pharmacological, nutritional, and technological adjuncts. Related prospects to distinguish the biological mechanisms underlying patient-preferred clinical end points (eg, independence, quality of life) remain critical to augmenting CR\u2019s value in the contemporary therapeutic landscape.<\/jats:p>","DOI":"10.1161\/circresaha.125.325705","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T14:00:17Z","timestamp":1751551217000},"page":"255-272","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Benefits of Cardiac Rehabilitation: Mechanisms to Restore Function and Clinical Impact"],"prefix":"10.1161","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8774-6416","authenticated-orcid":true,"given":"Abdulla A.","family":"Damluji","sequence":"first","affiliation":[{"name":"Cardiovascular Center on Aging, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (A.A.D.)."},{"name":"Division of Cardiology, Department of Medicine (A.A.D)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-6466","authenticated-orcid":true,"given":"Corey R.","family":"Tomczak","sequence":"additional","affiliation":[{"name":"College of Kinesiology, University of Saskatchewan, Saskatoon, Canada (C.R.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8252-0517","authenticated-orcid":true,"given":"Stephanie","family":"Hiser","sequence":"additional","affiliation":[{"name":"Department of Health, Human Function, and Rehabilitation Sciences, George Washington University, Washington, DC (S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8480-461X","authenticated-orcid":true,"given":"Deirdre E.","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Mazankowski Heart Institute, University of Alberta Hospital, Edmonton, Canada (D.E.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7474-3737","authenticated-orcid":true,"given":"Parag","family":"Goyal","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, NY (P.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinn R.","family":"Pack","sequence":"additional","affiliation":[{"name":"UMass Chan Medical School-Baystate Health, Springfield, MA (Q.R.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7651-3740","authenticated-orcid":true,"given":"Stephen J.","family":"Foulkes","sequence":"additional","affiliation":[{"name":"Integrated Cardiovascular Exercise Physiology and Rehabilitation Lab, Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (S.J.F., M.J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Disease, University of Alabama at Birmingham Heersink School of Medicine (T.M.B.). 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