The European Society of Cardiology (ESC) recently released a clinical guideline focusing on cardiac rehabilitation. The 2026 ESC Cardiac Rehabilitation guideline emphasizes the importance of cardiac rehabilitation for patients with CVDs and provides comprehensive guidance on the indications for cardiac rehabilitation and the management of patients in Phase II cardiac rehabilitation programs. It also provides guidance for patients with cancer who are undergoing or recovering from cardiotoxic therapies. This is the first ESC guideline on cardiac rehabilitation.

Included in the guideline are key messages, which we outline below. For the complete look at the 2026 ESC guideline on cardiac rehabilitation, view the full-text version.

Key Messages from the 2026 ESC Guideline on Cardiac Rehabilitation

The 2026 ESC guideline features ten key messages, which we summarize below. Consult the full-text version for the complete version of the following key messages.

  • Patients’ Perspective on Cardiac Rehabilitation
    • Success in cardiac rehabilitation depends on tailored interventions, psychological resilience, integrating rehab into daily life, and ensuring patients have continued support beyond the program. Cardiac rehabilitation should effectively equip patients with personalized guidance, practical tools, and emotional support. 
  • The Rationale For Cardiac Rehabilitation: Who Benefits, What It Achieved, and Why It Matters
    • Individualized delivery, early initiation, and the inclusion of lifestyle, educational, and psychosocial components are critical in the effectiveness of cardiac rehabilitation to improve outcomes across diverse patient populations.
  • Indications for Cardiac Rehabilitation
    • Patients with ACS, CCS, chronic HF (both HFrEF and HFpEF), advanced HF, and LVAD, after HTx are recommended to initiate cardiac rehabilitation. Cardiac rehabilitation is also recommended for patients early after an episode of decompensated heart failure. Emerging evidence suggests that cardiac rehabilitation is effective in patients following SAVR or TAVI, ACHD, AF, CIEDs, and those with cancer undergoing cardiotoxic therapies. ESC notes that frailty and comorbidities are not reasons to withhold cardiac rehabilitation.
  • Quality Standards of Cardiac Rehabilitation
    • Ongoing training and communication ensure program effectiveness. Cardiac rehabilitation based on EAPC-defined metrics is recommended to enhance standardization and ensure high-quality care.
  • Core Components of Cardiac Rehabilitation
    • ESC outlines patient assessment, self-management/behavior change/education, optimizing cardiovascular pharmacotherapies, physical activity and sedentary behaviour counseling, exercise training, nutrition and body composition management, smoking cessation, psychosocial management, sexual counseling, managing frailty and comorbidities related to cardiovascular risk, counseling on environmental cardiovascular risk factors, and interventions to enhance return to work as core components of cardiac rehabilitation. 
  • Telemedicine and Digital Technologies in Cardiac Rehabilitation
    • Digital tools, including smartphone apps and wearable sensors, can help achieve better rehabilitation outcomes. 
  • Delivering Cardiac Rehabilitation
    • Cardiac rehabilitation should be delivered through a patient-centered approach using center-based, home-based CR, CTR, or hybrid models tailored to clinical risk and patient needs and preferences. Cardiac telerehabilitation and hybrid CR should be considered effective alternatives to traditional models.  
  • Improving Cardiac Rehabilitation Participation
    • Automatic referral systems, early initiation, and physician endorsement improve patient enrollment. CTR and hybrid CR increase patient access and adherence. Tailored interventions see benefit among various patient populations. 
  • Considering Sex, Ethnicity, and Age in Cardiac Rehabilitation 
    • Cardiac rehabilitation must be personalized to address disparities related to sex, ethnicity, and age, patients who face unique barriers. Tailored models can improve participation and effectiveness. 
  • Patients’ Perspectives on Long-Term Management After Cardiac Rehabilitation
    • Cardiac rehabilitation provides the tools, education, and motivations needed to sustain behavior change in patients. Individualized self-management strategies, digital tools, and emotional support foster confidence and adherence. 

Check out our other cardiology content and be sure to sign up for alerts to stay informed on the latest published guidelines and articles.