Adherence to Exercise and Functional Rehabilitation Programs in Patients with Cardiovascular Diseases: Barriers and Strategies

Adherence to exercise and rehabilitation programs is crucial for effectively managing and preventing cardiovascular disease (CVD). While cardiac rehabilitation (CR) offers clear benefits, patient engagement can be suboptimal, with noticeable gender gaps affecting program success and outcomes. This review examines adherence patterns to exercise and rehab in individuals with CVD, focusing on gender differences, barriers to participation, and potential improvement strategies. we integrate diverse findings into a practical, gender-aware model for CR delivery that can be adopted and evaluated across settings. Optimal adherence to CR programs leads to a 27% decrease in all-cause mortality, a 31% reduction in cardiac-related deaths, lower rates of rehospitalization, and improvements in functional capacity and quality of life. On the other hand, non-adherence is associated with decreased functional abilities, higher risk of re-injury, and poorer long-term outcomes. Women, in particular, may benefit significantly from participation in CR but are often undertreated or underrepresented. Consistent adherence to exercise and CR poses a significant challenge in cardiovascular care, with evident gender disparities necessitating tailored solutions. Women face various barriers, biological, psychological and social, that require gender-specific approaches to rehab program design and delivery. Promising strategies include technology-enabled interventions, home-based programs, multidisciplinary team care, and a family-centered model that considers individual patient needs. Moving forward, efforts should focus on program delivery and ongoing support systems to maximize adherence and fully realize the benefits of CR for all patients.