{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:41:12Z","timestamp":1787586072739,"version":"build-2736575974"},"reference-count":75,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"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>Background\/Objectives: Frailty is a multifactorial clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. It is increasingly recognized as a predictor of poor outcomes in cardiac rehabilitation (CR). However, how frailty is defined, assessed, and addressed across outpatient CR programmes remains unclear. This scoping review aimed to map the extent, range, and nature of research examining frailty in the context of outpatient CR, including how frailty is measured, its impact on CR participation and outcomes, and whether sex and gender considerations or participation barriers are reported. Methods: Following the PRISMA-ScR guidelines, we conducted a comprehensive search across six electronic databases (from inception to 15 May 2025). Eligible peer-reviewed studies included adult participants assessed for frailty using validated tools and enrolled in outpatient CR programmes. Two reviewers independently screened citations and extracted data. Results were synthesized descriptively and narratively across three domains: frailty assessment, sex and gender considerations, and barriers to CR participation. The protocol was registered with the Open Science Framework. Results: Thirty-nine studies met inclusion criteria, all conducted in the Americas, Western Pacific, or Europe. Frailty was assessed using 26 distinct tools, most commonly the Kihon Checklist, Fried\u2019s Frailty Criteria, and Frailty Index. The median pre-CR frailty prevalence was 33.5%. Few studies (n = 15; 38.5%) re-assessed frailty post-CR. Sixteen studies reported sex or gender data, but none applied sex- or gender-based analysis (SGBA) frameworks. Only eight studies examined barriers to CR participation, identifying physical limitations, emotional distress, cognitive concerns, healthcare system-related factors, personal and social factors, and transportation as key barriers. Conclusions: The literature on frailty in CR remains fragmented, with heterogeneous assessment methods, limited global representation, and inconsistent attention to sex, gender, and participation barriers. Standardized frailty assessments and individualized CR programme adaptations are urgently needed to improve accessibility, adherence, and outcomes for frail individuals.<\/jats:p>","DOI":"10.3390\/jcm14155354","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T12:39:29Z","timestamp":1753792769000},"page":"5354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Understanding Frailty in Cardiac Rehabilitation: A Scoping Review of Prevalence, Measurement, Sex and Gender Considerations, and Barriers to Completion"],"prefix":"10.3390","volume":"14","author":[{"given":"Rachael P.","family":"Carson","sequence":"first","affiliation":[{"name":"Faculty of Health, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Voldiana L\u00facia Pozzebon","family":"Schneider","sequence":"additional","affiliation":[{"name":"Ci\u00eancias da Sa\u00fade e do Esporte (CEFID), State University of Santa Catarina, Florianopolis 88080-350, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Main","sequence":"additional","affiliation":[{"name":"Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8444-1222","authenticated-orcid":false,"given":"Carolina Gonzaga","family":"Carvalho","sequence":"additional","affiliation":[{"name":"KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7946-3718","authenticated-orcid":false,"given":"Gabriela L. Melo","family":"Ghisi","sequence":"additional","affiliation":[{"name":"Faculty of Health, York University, Toronto, ON M3J 1P3, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada"},{"name":"Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.cger.2019.07.002","article-title":"Evaluating and Treating Frailty in Cardiac Rehabilitation","volume":"35","author":"Afilalo","year":"2019","journal-title":"Clin. Geriatr. 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