{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:55:09Z","timestamp":1792090509395,"version":"4.4.0"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,9]],"date-time":"2025-02-09T00:00:00Z","timestamp":1739059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cardiac rehabilitation is a well-established multidisciplinary interventional protocol that plays a pivotal role in the management and prevention of future cardiovascular events in patients with cardiovascular diseases. This patient-tailored approach includes educating patients about their cardiovascular condition and how to control the associated risk factors, an expert-designed lifestyle modification plan that may include exercise, proper nutrition, pharmacological treatment, and psychological support at each step. Exercise training represents a fundamental component of cardiac rehabilitation. It facilitates an enhancement of cardiovascular fitness, a reduction in heart rate, blood pressure and cardiac remodeling, an increase in the left ventricular ejection fraction, the optimization of endothelial function, and a reduction in inflammation and oxidative stress. Moreover, the beneficial physiological changes resulting from cardiac rehabilitation contribute to a reduction in morbidity and mortality in survivors of myocardial infarction (MI). Furthermore, the European Society of Cardiology Guidelines advocate for the initiation of cardiac rehabilitation as early as possible, while the patient who survived MI is still in hospital. This two-part comprehensive review commences with a historical overview of cardiac rehabilitation, followed by a detailed exploration of the four phases of the cardiac rehabilitation programme and its impact on cardiovascular health. In Part 2, the study aims to provide a detailed account of the optimal timing for starting cardiac rehabilitation programs and to examine the factors affecting low engagement in such programs, as well as gender-based differences in adherence.<\/jats:p>","DOI":"10.3390\/jcm14041117","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T03:39:47Z","timestamp":1739158787000},"page":"1117","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Part 1\u2014Cardiac Rehabilitation After an Acute Myocardial Infarction: Four Phases of the Programme\u2014Where Do We Stand?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7711-9905","authenticated-orcid":false,"given":"Aneta","family":"Aleksova","sequence":"first","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34100 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Sciences, University of Trieste, 34125 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6427-8093","authenticated-orcid":false,"given":"Alessandra Lucia","family":"Fluca","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34100 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Sciences, University of Trieste, 34125 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0679-2710","authenticated-orcid":false,"given":"Antonio Paolo","family":"Beltrami","sequence":"additional","affiliation":[{"name":"Dipartimento di Area Medica (DAME), Istituto di Patologia Clinica, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5833-0780","authenticated-orcid":false,"given":"Elena","family":"Dozio","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-8478","authenticated-orcid":false,"given":"Gianfranco","family":"Sinagra","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34100 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Sciences, University of Trieste, 34125 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1888-3430","authenticated-orcid":false,"given":"Maria","family":"Marketou","sequence":"additional","affiliation":[{"name":"Cardiology Department Crete, School of Medicine, Heraklion University General Hospital, University of Crete, 700 13 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9579-1439","authenticated-orcid":false,"given":"Milijana","family":"Janjusevic","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34100 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Sciences, University of Trieste, 34125 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/ehjacc\/zuad107","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"13","author":"Byrne","year":"2024","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Schon, C., Felismino, A., de Sa, J., Corte, R., Ribeiro, T., and Bruno, S. (2024). Efficacy of early cardiac rehabilitation after acute myocardial infarction: Randomized clinical trial protocol. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0300855"},{"key":"ref_3","first-page":"e9349","article-title":"Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study","volume":"12","author":"Khan","year":"2020","journal-title":"Cureus"},{"key":"ref_4","unstructured":"WHO (2024, June 19). The top 10 Causes of Death. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e328","DOI":"10.1161\/CIR.0000000000001289","article-title":"Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation","volume":"150","author":"Brown","year":"2024","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100564","DOI":"10.1016\/j.ijcchd.2024.100564","article-title":"Cardiac rehabilitation in ACHD: Further investment is now due","volume":"19","author":"Kasouridis","year":"2025","journal-title":"Int. J. Cardiol. Congenit. Heart Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/00005792-192909000-00001","article-title":"Coronary thrombosis: Its various clinical features","volume":"8","author":"Levine","year":"1929","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/jama.1952.02930160001001","article-title":"\u201cArmchair\u201d treatment of acute coronary thrombosis","volume":"148","author":"Levine","year":"1952","journal-title":"J. Am. Med. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Munir, H., Fromowitz, J., and Goldfarb, M. (2020). Early mobilization post-myocardial infarction: A scoping review. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0237866"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ccc.2006.11.002","article-title":"Inactivity and inflammation in the critically ill patient","volume":"23","author":"Winkelman","year":"2007","journal-title":"Crit. Care Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"776","DOI":"10.2340\/16501977-0254","article-title":"Effects of 6 months exercise training on ventricular remodelling and autonomic tone in patients with acute myocardial infarction and percutaneous coronary intervention","volume":"40","author":"Zheng","year":"2008","journal-title":"J. Rehabil. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7823","DOI":"10.21037\/apm-21-1478","article-title":"Effect analysis of kinetic energy progressive exercise in patients with acute myocardial infarction after percutaneous coronary intervention: A randomized trial","volume":"10","author":"Jiang","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.jjcc.2021.06.004","article-title":"Early rehabilitation after acute myocardial infarction: A nationwide inpatient database study","volume":"78","author":"Nakamura","year":"2021","journal-title":"J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1001\/jama.1988.03410070073031","article-title":"Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials","volume":"260","author":"Oldridge","year":"1988","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1185\/03007991003604216","article-title":"Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality","volume":"26","author":"Junger","year":"2010","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1177\/0193945907303061","article-title":"Older adults\u2019 early disability following a cardiac event","volume":"30","author":"Dolansky","year":"2008","journal-title":"West. J. Nurs. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/MAJ.0b013e31820ab4f6","article-title":"Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure","volume":"341","author":"Morris","year":"2011","journal-title":"Am. J. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1097\/CCM.0b013e3181a38937","article-title":"Early exercise in critically ill patients enhances short-term functional recovery","volume":"37","author":"Burtin","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/nicc.12455","article-title":"The effect of early mobilization in critically ill patients: A meta-analysis","volume":"25","author":"Zang","year":"2020","journal-title":"Nurs. Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/s41569-021-00611-7","article-title":"The role of cardiac rehabilitation in improving cardiovascular outcomes","volume":"19","author":"Taylor","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1177\/2047487320905719","article-title":"Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II)","volume":"27","author":"Salzwedel","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dibben, G., Faulkner, J., Oldridge, N., Rees, K., Thompson, D.R., Zwisler, A.D., and Taylor, R.S. (2021). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD001800.pub4"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1056\/NEJMra2302291","article-title":"Cardiac Rehabilitation\u2014Challenges, Advances, and the Road Ahead","volume":"390","author":"Thomas","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/216507998403200210","article-title":"Cardiac rehabilitation: An overview","volume":"32","author":"Nelson","year":"1984","journal-title":"Occup. Health Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology","volume":"28","author":"Ambrosetti","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e039096","DOI":"10.1136\/bmjopen-2020-039096","article-title":"In-hospital cardiac rehabilitation and clinical outcomes in patients with acute myocardial infarction after percutaneous coronary intervention: A retrospective cohort study","volume":"10","author":"Kanazawa","year":"2020","journal-title":"BMJ Open"},{"key":"ref_27","first-page":"e197103","article-title":"Community-Based Physical Rehabilitation After Percutaneous Coronary Intervention for Acute Myocardial Infarction","volume":"48","author":"Xiao","year":"2021","journal-title":"Tex. Heart Inst. J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Darsin Singh, S.K., Ahmedy, F.B., Noor, A., Abdullah, K.L., Abidin, I.Z., and Suhaimi, A.B. (2023). Changes in Perception of Illness during Cardiac Rehabilitation Programme among Patients with Acute Coronary Syndrome: A Longitudinal Study. Healthcare, 11.","DOI":"10.3390\/healthcare11030311"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1001\/archinte.168.20.2194","article-title":"Global secondary prevention strategies to limit event recurrence after myocardial infarction: Results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network","volume":"168","author":"Giannuzzi","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/HCR.0000000000000201","article-title":"Association between phase 3 cardiac rehabilitation and clinical events","volume":"37","author":"Brawner","year":"2017","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1002\/clc.24130","article-title":"Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: A systematic review and meta-analysis","volume":"46","author":"Wang","year":"2023","journal-title":"Clin. Cardiol."},{"key":"ref_32","unstructured":"Stephenson, B. (2024, May 17). The Four Cardiac Rehab Phases. Available online: https:\/\/blog.rehabselect.net\/the-four-cardiac-rehab-phases."},{"key":"ref_33","first-page":"e46469","article-title":"Revolutionizing Cardiac Care: A Comprehensive Narrative Review of Cardiac Rehabilitation and the Evolution of Cardiovascular Medicine","volume":"15","author":"Ullah","year":"2023","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1161\/CIRCULATIONAHA.112.121996","article-title":"An early appointment to outpatient cardiac rehabilitation at hospital discharge improves attendance at orientation: A randomized, single-blind, controlled trial","volume":"127","author":"Pack","year":"2013","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4330\/wjc.v9.i2.134","article-title":"Aerobic vs anaerobic exercise training effects on the cardiovascular system","volume":"9","author":"Patel","year":"2017","journal-title":"World J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s40798-020-00271-w","article-title":"Muscle-strengthening Exercise Epidemiology: A New Frontier in Chronic Disease Prevention","volume":"6","author":"Bennie","year":"2020","journal-title":"Sports Med. Open"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/HCR.0000000000000337","article-title":"Progression of Exercise Training in Early Outpatient Cardiac Rehabilitation: An Official Statement from the American Association of Cardiovascular and Pulmonary Rehabilitation","volume":"38","author":"Squires","year":"2018","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/j.hlc.2023.06.854","article-title":"A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement","volume":"32","author":"Verdicchio","year":"2023","journal-title":"Heart Lung Circ."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Thagizadeh, A., Ghahramanian, A., Zamanzadeh, V., Aslanabadi, N., Onyeka, T.C., and Ramazanzadeh, N. (2022). Illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention in Iran. BMC Cardiovasc. Disord., 22.","DOI":"10.1186\/s12872-022-02684-9"},{"key":"ref_40","unstructured":"(2025, February 04). MCNAIR study: Comparative Effectiveness of In-Person and Telehealth Cardiac Rehabilitation, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05933083."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e2453499","DOI":"10.1001\/jamanetworkopen.2024.53499","article-title":"Rehabilitation at Home Using Mobile Health for Older Adults Hospitalized for Ischemic Heart Disease: The RESILIENT Randomized Clinical Trial","volume":"8","author":"Dodson","year":"2025","journal-title":"JAMA Netw. Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1117\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:30:03Z","timestamp":1760027403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,9]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041117"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041117","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,9]]}}}