IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204123
Open Access Review
Exercise-based cardiac rehabilitation programs in the era of COVID-19: a critical review
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1 Physiotherapy Department, University of West Attica, 12243 Egaleo, Athens, Greece
2 Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic
3 Department of Public Health, Faculty of Medicine, Masaryk University Brno, 62500 Brno, Czech Republic
4 Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Tsentar, Plovdiv, Bulgaria
5 Department of Kinesitherapy, Faculty of Public Health “Prof. Dr. Tzecomir Vodenicharov, Ph.D”, Medical University of Sofia, 1431 Sofia, Bulgaria
6 Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
*Correspondence: (Garyfallia Pepera)
Academic Editor: Kazuhiro Izawa
Rev. Cardiovasc. Med. 2021, 22(4), 1143–1155;
Submitted: 15 July 2021 | Revised: 26 August 2021 | Accepted: 31 August 2021 | Published: 22 December 2021
(This article belongs to the Special Issue Cardiac rehabilitation)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Increased rates of morbidity and mortality have led to the increased need for the implementation of secondary prevention interventions. Exercise-based cardiac rehabilitation (CR) represents a multifactorial intervention, including elements of physical exercise and activity, education regarding healthy lifestyle habits (smoking cessation, nutritional habits), to improve the physical capacity and psychological status of cardiac patients. However, participation rates in CR programs remain low due to socioeconomic, geographical and personal barriers. Recently the COVID-19 pandemic restrictions have added another barrier to CR programs. Therefore there is an emerging need to further improve the types and methods of implementing CR. Cardiac telerehabilitation, integrating advanced technology for both monitoring and communicating with the cardiac population, appears to be an innovative CR alternative that can overcome some of the barriers preventing CR participation. This review paper aims to describe the background and core components of center-based CR and cardiac telerehabilitation, and discuss their implications for present day clinical practice and their future perspectives.

Cardiac rehabilitation
Cardiovascular diseases
Exercise training
COVID-19 pandemic
Secondary prevention
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