{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:42:06Z","timestamp":1791477726965,"version":"4.3.4"},"reference-count":64,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union-NextGenerationEU through the Italian Ministry of University and Research under PNRR-M4C2\u2014I1.3 Project","award":["PE_00000019"],"award-info":[{"award-number":["PE_00000019"]}]},{"name":"National Institute for Cardiovascular Research"},{"name":"FAR CHIMOMO 2023"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Adherence to exercise-based cardiac rehabilitation (CR) is essential for preventing and managing cardiovascular disease (CVD). Participation in CR reduces all-cause mortality by 27% and cardiac deaths by 31% and lowers rehospitalization rates while also improving functional capacity and quality of life. However, many patients do not start, complete, or maintain CR, resulting in reduced functional abilities, a higher risk of recurring events, and poorer long-term outcomes. This narrative review summarizes patterns of adherence to exercise and CR in CVD, with a specific focus on sex- and gender-related differences in referral, participation, and completion. We synthesize evidence on biological, psychological, and social barriers that limit engagement and describe emerging strategies, such as technology-enabled and home-based programs, multidisciplinary care, and family-centered models, to enhance adherence. Finally, we propose a practical, gender-aware framework for CR design and delivery that can be adjusted and evaluated across diverse healthcare settings to guide clinical practice and future research.<\/jats:p>","DOI":"10.3390\/jcdd13010008","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T14:27:51Z","timestamp":1766586471000},"page":"8","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Adherence to Exercise and Functional Rehabilitation Programs in Patients with Cardiovascular Diseases: Barriers and Strategies"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7067-279X","authenticated-orcid":false,"given":"Gianluca","family":"Pagnoni","sequence":"first","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"},{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5441-218X","authenticated-orcid":false,"given":"Aurora","family":"Vicenzi","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Darroudi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4929-4678","authenticated-orcid":false,"given":"Arianna","family":"Maini","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sbarra","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Marangi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Loffi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azienda Socio-Sanitaria Territoriale di Cremona, 26100 Cremona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3079-8001","authenticated-orcid":false,"given":"Milena","family":"Nasi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9118-1262","authenticated-orcid":false,"given":"Marcello","family":"Pinti","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9603-2396","authenticated-orcid":false,"given":"Valentina","family":"Selleri","sequence":"additional","affiliation":[{"name":"Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Baccarani","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, Modena Policlinico Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5348-5991","authenticated-orcid":false,"given":"Gianluca","family":"Carnevale","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8040-0324","authenticated-orcid":false,"given":"Carlo Mario","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cremona Hospital, 26100 Cremona, Italy"},{"name":"Cardiology, ASST Ospedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1577-5402","authenticated-orcid":false,"given":"Daniela","family":"Aschieri","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1487-9530","authenticated-orcid":false,"given":"Anna Vittoria","family":"Mattioli","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Department of Quality of Life, Alma Mater Studiorum\u2014University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fedele","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-6941","authenticated-orcid":false,"given":"Francesca","family":"Coppi","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/ijtr.2023.0132","article-title":"Impact of Lifestyle Interventions in Cardiac Rehabilitation for Individuals with Ischaemic Heart Disease: A Prospective Cohort Study","volume":"31","author":"Stendal","year":"2024","journal-title":"Int. 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