Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

{"title":"Engagement With Mobile Health Cardiac Rehabilitation Varies Widely Among Older Adults With Ischemic Heart Disease.","authors":"Claire Graves, Antoinette Schoenthaler, Greg Sweeney, Camila Johanek, Yuchen Meng, Eleonore Grant, Jonathan Whiteson, Barbara George, Kevin Marzo, Lara C Kovell, Andrea B Troxel, Samrachana Adhikari, John A Dodson","doi":"10.1097/HCR.0000000000001047","DOIUrl":"https://doi.org/10.1097/HCR.0000000000001047","url":null,"abstract":"<p><strong>Purpose: </strong>Mobile health cardiac rehabilitation may improve access to care among older adults with ischemic heart disease, but engagement remains poorly understood. We analyzed weekly engagement data from the RESILIENT (Rehabilitation Using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting) trial, a large, randomized trial of mobile health cardiac rehabilitation in older adults conducted in the United States.</p><p><strong>Methods: </strong>Data from 298 intervention participants were analyzed. Weekly engagement was scored from 0 to 11 based on exercise entry (7 points), communication with exercise therapist (2 points), video viewing (1 point), and blood pressure measurement (1 point). Latent class analysis identified digital engagement phenotypes. Participant characteristics were compared, and multivariable logistic regression identified factors associated with phenotype membership.</p><p><strong>Results: </strong>Median age was 71.0 years, 28% were women, 23% were non-White, and 62% were enrolled after elective percutaneous coronary intervention. Latent class analysis identified 3 phenotypes: persistently low (n = 81), intermediate declining (n = 93), and persistently high (n = 124). Participants with persistently low engagement were more likely to be non-White (48% vs 12% vs 15%, P < .001), Medicaid enrolled (22% vs 8% vs 7%, P = .001), have less than high school education (16% vs 4% vs 3%, P < .001), have frailty phenotype (28% vs 10% vs 7%, P < .001), and have a greater mean number of comorbidities (3.1 vs 3.0 vs 2.6; P = .012). After adjustment, non-White race and frailty remained independently associated with low engagement. Improvement in 6-minute walk test distance varied: 20.8 m (low), 29.7 m (intermediate), and 54.5 m (high) (P = .003).</p><p><strong>Conclusions: </strong>Three distinct digital engagement phenotypes emerged. Persistently low engagement was more common among non-White and frail participants, underscoring ongoing disparities despite efforts to overcome the digital divide.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underrepresentation of Rural Populations in Tele-Pulmonary Rehabilitation Trials: A SYSTEMATIC REVIEW.","authors":"Débora M Petry Moecke, Baneesha K Gill, Olivia M Zawadiuk, Pat G Camp","doi":"10.1097/HCR.0000000000001051","DOIUrl":"https://doi.org/10.1097/HCR.0000000000001051","url":null,"abstract":"<p><strong>Purpose: </strong>Access to pulmonary rehabilitation is particularly challenging in rural settings. Tele-pulmonary rehabilitation (tele-PR) is a promising solution, but it is unclear if the supporting evidence includes the populations it is aimed to serve. This review aimed to determine if individuals with chronic obstructive pulmonary disease from rural communities are recruited for tele-PR randomized controlled trials (RCTs).</p><p><strong>Review methods: </strong>A systematic review of Medline, CINAHL, Embase, Web of Science, and Compendex was conducted for RCT on tele-PR from 1995 to March 2025. Data were extracted and synthesized to evaluate the inclusiveness of rural populations.</p><p><strong>Summary: </strong>A total of 41 RCTs were included. Most studies (83%) were conducted in urban areas, with only 17% specifying the inclusion of both urban and rural populations. Based on the available data, rural participants represented less than 3% of the total 4142 participants. Furthermore, 78% of the reviewed tele-PR programs required at least 1 mandatory in-person visit for assessment or follow-up, which likely creates a significant barrier to participation for rural residents. Therefore, despite its potential for rural populations, tele-PR research appears to drastically underrepresent these individuals. This limits the generalizability of current findings and hinders the goal of equitable access to care. Researchers must intentionally recruit, report, and design studies considering the principles of equity and diversity.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary Exercise Testing in Australia and New Zealand: A SURVEY OF CURRENT CLINICAL PRACTICE.","authors":"Kathryn Drury, Belinda Cochrane, Rocco Cavaleri, Charlotte Anderson, Chelsea Niu, Josie Seeto, Simon Green","doi":"10.1097/HCR.0000000000001058","DOIUrl":"https://doi.org/10.1097/HCR.0000000000001058","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary exercise testing (CPX) provides objective assessment of integrative physiological function and is recommended in international guidelines for the investigation of unexplained dyspnea and exercise intolerance. Despite its clinical value, the implementation of CPX is variable worldwide. No previous studies have described CPX practices in Australia and New Zealand.</p><p><strong>Methods: </strong>A cross-sectional online survey of health professionals involved in CPX delivery was conducted between May 2023 and September 2024. Laboratories were identified using professional society lists and hospital websites. The 29-question survey explored staffing, training, protocols, and test application. Descriptive analyses were used to summarize closed- and open-ended responses.</p><p><strong>Results: </strong>Fifty-five laboratories completed the survey, of 71 approached. Most services were based in public hospital respiratory departments and used cycle ergometry with individualized ramp protocols. Cardiopulmonary exercise testing was most commonly used for unexplained breathlessness, perioperative assessment, and functional evaluation. One-third of services used fixed work rate protocols, and 62% of respondents reported no formal CPX training. Multiple step and ramp protocols were identified across sites, with substantial variation in incremental work rates. The most frequently reported barriers to CPX delivery were inadequate staffing, lack of training, and limited space.</p><p><strong>Conclusion: </strong>This is the first survey of CPX practice in Australia and New Zealand. Results highlight substantial variation in training, protocols, and resourcing. These findings can inform professional development strategies and support the generation of standardized practice guidelines. Addressing training gaps, enhancing workforce capacity, and expanding clinical use may increase the quality, consistency, and impact of CPX across the region.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Preparation and Internship Expectations for Clinical Exercise Physiologist: FOCUS ON CARDIOPULMONARY REHABILITATION PROGRAMS.","authors":"Rachael K Nelson, Moriah R Persondek, Melissa A VanZant, Samuel A E Headley, Elizabeth O'Neill, Micah N Zuhl, Steven J Keteyian","doi":"10.1097/HCR.0000000000001050","DOIUrl":"https://doi.org/10.1097/HCR.0000000000001050","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Function and Cardiac Rehabilitation Attendance in Older Adults With Cardiovascular Disease Events: ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY.","authors":"Miriam Chiamaka Okonkwo, Yejin Mok, Thomas K M Cudjoe, Ning Ding, Kristin A Riekert, Anna Kucharska-Newton, Kerry J Stewart, Chiadi E Ndumele, Michelle C Johansen, Kunihiro Matsushita, Lena Mathews","doi":"10.1097/HCR.0000000000001036","DOIUrl":"10.1097/HCR.0000000000001036","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiovascular disease (CVD) and cognitive impairment are highly prevalent in older adults. This investigation explored the association of cognitive function with the likelihood of cardiac rehabilitation (CR) attendance following a CVD hospitalization.</p><p><strong>Methods: </strong>We studied 1262 participants of the Atherosclerosis Risk in Communities Study, aged 65 years of age or older, with CVD events eligible for CR, and with data linked to Medicare claims (1991-2015). Cognitive function was assessed using a comprehensive battery of neurocognitive tests administered at the study visit closest to the CVD event assessing executive function, expressive language, and short-term recall. Cardiac rehabilitation attendance was defined by Current Procedural Terminology codes reimbursed within 1 year following the index hospitalization. We used multivariable logistic regression to examine the association between quartiles of cognitive function and CR attendance.</p><p><strong>Results: </strong>The mean age of participants was 73.7 ± 5.5 years, 43% were female, 15% were Black, and 16% attended CR. Lower cognitive function was linearly associated with CR nonattendance. Compared with the highest quartile (Q4) of cognitive function as the referent, the adjusted OR of CR nonattendance was 2.47: 95% CI, 1.10-5.52 in quartile 1; 1.55: 95% CI, 0.81-2.97 in quartile 2; and 1.25: 95% CI, 0.69-2.26 in quartile 3. We did not find a significant interaction between race, sex, and CR attendance by cognitive function quartiles.</p><p><strong>Conclusions: </strong>Among older adults with CVD, lower cognitive function was robustly associated with CR nonattendance. Interventions aimed at increasing CR attendance should include strategies tailored to individual patient needs.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Different Supervised Exercise Modalities on Cardiorespiratory Fitness in Patients With Peripheral Artery Disease: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS.","authors":"Cheng-Wei Ho, Yan-Rong Ho, Min-Hsiang Chuang, Yea-Chwen Wu, Willy Chou","doi":"10.1097/HCR.0000000000001056","DOIUrl":"https://doi.org/10.1097/HCR.0000000000001056","url":null,"abstract":"<p><strong>Objective: </strong>Supervised exercise is currently recognized as the first-line treatment for patients with peripheral artery disease. However, the comparative benefits of treadmill training, arm-ergometry, and leg-ergometry remain unclear.</p><p><strong>Review methods: </strong>Medline, Embase, and the Cochrane Library were searched from inception to May 7, 2025, for randomized controlled trials in adults with peripheral artery disease. Eligible studies involved supervised treadmill, arm-ergometry, or leg-ergometry interventions lasting 12 to 24 weeks and compared these interventions with other exercise modalities or nonexercise controls. A frequentist random-effects network meta-analysis was conducted to estimate mean differences (MDs) with 95% CI for peak oxygen uptake, maximal walking distance, and pain-free walking distance.</p><p><strong>Summary: </strong>Eleven trials involving 519 participants were included. Arm-ergometry increased peak oxygen uptake by 1.85 mL/kg/min (95% CI, 0.99-2.71 mL/kg/min, P < .01), and treadmill training increased peak oxygen uptake by 1.46 mL/kg/min (95% CI, 1.12-1.81 mL/kg/min, P < .01) compared with control. Treadmill training increased maximal walking distance (MD = 191.25: 95% CI, 66.84-315.65 m, P < .01), whereas arm-ergometry showed no significant difference (MD = 121.35: 95% CI, -45.61 to 288.32 m, P = .15). In addition, pain-free walking distance improved with treadmill training (MD = 181.88: 95% CI, 154.99-208.76 m, P < .01), arm-ergometry (MD = 78.11: 95% CI, 54.62-101.60 m, P < .01), and leg-ergometry (MD = 51.08: 95% CI, 8.27-93.89 m, P = .02) compared with control.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Responses to Arm-Crank Exercise on the Cardiovascular Function of Patients With Peripheral Artery Disease: A Randomized Crossover Trial.","authors":"Gustavo O Silva, Paolo M Cunha, Max D Oliveira, Jéssika K T N F Silva, Breno Q Farah, Nelson Wolosker, Hélcio Kanegusuku, Marilia A Correia, Raphael M Ritti-Dias","doi":"10.1097/HCR.0000000000001018","DOIUrl":"10.1097/HCR.0000000000001018","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the acute cardiovascular responses to arm-cranking (AC) exercise in patients with peripheral artery disease (PAD), comparing it to walking and a nonexercise control condition.</p><p><strong>Methods: </strong>This study is a randomized crossover trial with single-blind data collection in which 17 patients with PAD and claudication (53% men, 66 ± 7 years old, 26.7 ± 4.4 kg/m 2 body mass index, 0.63 ± 0.12 ankle-brachial index) were included. They performed 3 experimental conditions (walking, AC, and control) in random order. The exercise conditions were composed of 15 bouts of 2 minutes (15 × 2) with an intensity equivalent to 4 to 6 on a modified (1-10) Borg Rating of Perceived Exertion scale. We measured blood pressure (BP), cerebral blood flow, heart rate variability, and brachial and femoral artery flow-mediated dilation before and after the conditions. Generalized estimated equations were used to analyze the acute response among experimental conditions, with P < .05 considered significant.</p><p><strong>Results: </strong>We observed post-exercise hypotension in both AC and walking, with a greater net effect in the AC condition compared with walking (systolic BP: AC = -14 ± 14 mm Hg; walking = -6.7 ± 8.9 mm Hg, P < .001; diastolic BP: AC = -5.8 ± 8.4 mm Hg; walking = -1.2 ± 4.1 mm Hg, P = .011). Brachial and femoral artery flow-mediated dilation, cerebral blood flow, and heart rate variability did not change after any of the conditions.</p><p><strong>Conclusion: </strong>Vascular function, cerebral blood flow, and heart rate variability remained unchanged after AC and walking. However, both walking and AC induced post-exercise hypotension in patients with PAD, with a greater magnitude in the AC condition.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"296-305"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ACE Equation Gives Equivalent Mortality Risk Estimates to the Duke Treadmill Score and Duke Nomogram.","authors":"Alexander H K Montoye, Morgan R Fonley, Bradford S Westgate, Lars Brudin, Thomas Lindow","doi":"10.1097/HCR.0000000000001009","DOIUrl":"10.1097/HCR.0000000000001009","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to develop an equation, the Alma College Estimation (ACE) equation, to estimate survival equivalent to the Duke treadmill score (DTS) and Duke nomogram.</p><p><strong>Methods: </strong>Combinations of ST segment deviation (0, 1, 2, 3, and 4 mm), angina (0 = none, 1 = nonlimiting, and 2 = limiting), and metabolic equivalents of task (2-20) were graphed on the Duke nomogram, and the ACE equation was developed to predict annual mortality likelihood from nomogram measurements. Secondary analyses analyzed data from a clinical cohort of 10,673 patients who underwent a graded maximal exercise test at a county hospital in Sweden between 2005 and 2016. Following ACE equation development, survival estimates were compared between the equation to traditional line plotting on the Duke nomogram using mean absolute error and equivalence testing. Also, 5-year survival estimates from the ACE equation, nomogram, and DTS were categorized into low, intermediate, and high risk and compared using percent agreement.</p><p><strong>Results: </strong>The developed ACE equation is a non-linear, exponential function. The 5-year survival estimates (100 - [5 × annual mortality risk]) from the ACE equation were significantly equivalent to within 1% of the nomogram ( P < .001, mean difference 0.1% ± 1.0%), with low mean absolute error (all combinations: 0.7% ± 0.7%, clinical cohort: 0.7% ± 1.0%). Percent agreement in risk categories ranged from 83% to 94%.</p><p><strong>Conclusions: </strong>The ACE equation produced similar survival estimates to the Duke nomogram and DTS. This equation improves precision over the DTS and ease of use over the Duke nomogram, and therefore, may serve as a valuable tool for clinicians assessing prognosis from exercise test findings.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"257-264"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of People With Peripheral Artery Disease Into Cardiac Rehabilitation Exercise Programs: A Scoping Review.","authors":"Krist Feka, Claire V Burley, Belinda J Parmenter, Mia A Schaumberg, Tony Stanton, Christopher D Askew","doi":"10.1097/HCR.0000000000001026","DOIUrl":"10.1097/HCR.0000000000001026","url":null,"abstract":"<p><strong>Purpose: </strong>Supervised exercise therapy is a class IA recommendation for the management of people with peripheral artery disease (PAD). However, access to exercise programs is limited for most patients. Cardiac rehabilitation (CR) programs are widely available and have the potential to facilitate broader access to exercise therapy. The quality of evidence supporting the efficacy of CR in people with PAD is unclear. This review aimed to summarize the characteristics and quality of studies that have integrated people with PAD into CR.</p><p><strong>Review methods: </strong>Electronic databases (Scopus, PubMed, Web of Science, CINAHL, CENTRAL) were searched from inception up to March 20, 2024. Eligible studies included any that integrated people with PAD into exercise-based CR. Reviews, gray literature, case reports, and surveys were excluded. This review was registered with Open Science Framework on February 24, 2023 ( https://osf.io/n7qm3 ). Of 12 966 articles identified, 21 studies were included comprising 4095 participants with PAD. There were only 2 randomized-controlled trials. Most participants (68%) were included in CR due to cardiac disease with a comorbidity of PAD. Only 5 studies fully adhered to current PAD exercise recommendations. While there were limited high-quality data, CR was associated with improvements in walking capacity, quality of life, and long-term mortality and morbidity rates. However, there were limited PAD-specific assessments and inconsistent outcome measures.</p><p><strong>Summary: </strong>The number of randomized-controlled trials is low, and further high-quality studies are needed to assess the efficacy of CR in people with PAD. Future trials should aim to follow PAD-specific exercise recommendations and assess PAD-specific outcomes.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"244-256"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Rehabilitation Program-Related Factors Associated With Morbidity Among Patients in Low-Resource Settings: Analysis From the International Cardiac Rehabilitation Registry.","authors":"Sana A Elashie, Sherry L Grace, Farzana A Hashmi, Leong Be Kim, Masoumeh Sadeghi, Gabriela L M Ghisi, Jorge A Lara Vargas, Martin Heine, Manal S Al Shamari, Maria J Sepulveda, Karam I Turk-Adawi","doi":"10.1097/HCR.0000000000001023","DOIUrl":"10.1097/HCR.0000000000001023","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiovascular disease is a leading cause of morbidity globally, particularly in low-resource settings. The effectiveness of cardiac rehabilitation (CR) is well-established; however, the nature of services in low-resource settings differs. This study sought to investigate program characteristics associated with lower all-cause morbidity among CR participants from low-resource settings.</p><p><strong>Methods: </strong>This was a prospective observational study analyzing the International Council of Cardiovascular Prevention and Rehabilitation's International CR Registry. Programs with annual assessment data at the time of study were included, and their characteristics were assessed in a survey. Self and program-reported patient morbidity included all- and cardiac-cause hospitalization, emergency department visits, cardiovascular disease events, and procedures 1 year from initial assessment. A multilevel modified Poisson regression model was used to account for clustering of patients within CR programs, estimating the adjusted incidence rate ratios (IRR) for morbidity.</p><p><strong>Results: </strong>Of the 690 patients from programs in 6 countries across 4 regions (Colombia, Iran, Malaysia, Mexico, Pakistan, and Qatar), 637 (92%) were retained, of which 479 (75%) had morbidity data. Seven patients died and 93 suffered morbidity; this was most commonly noncardiac hospitalization (29 events) and emergency department visits (18 events). The regression analysis revealed a significantly lower incidence of morbidity associated with the following program factors: higher number of risk factors assessed (IRR = 0.55: 95% CI, 0.39-0.77), greater number of CR health care professionals (IRR = 0.76: 95% CI, 0.65-0.89), and CR located in academic/tertiary care institution (IRR = 0.61: 95% CI, 0.50-0.75).</p><p><strong>Conclusion: </strong>Globally, CR programs could benefit from prioritizing comprehensive risk assessment and strengthening CR teams to potentially reduce morbidity.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"273-280"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}