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Volume 15
Issue 12
10.3390/jcm15124598
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Review

Cardiac Rehabilitation and Cognitive Impairment: Elective Affinities or Fatal Attraction

by
Valeria Visco
1,
Francesco Loria
2,
Antonio Squillante
2,
Francesca Palmieri
1,
Federica Piani
3,
Ilaria Fucile
4,
Carmine Izzo
1,5,
Maria Rosaria Rusciano
1,
Cristina Gatto
1,
Rónán O’Caoimh
6,
David William Molloy
6,
Costantino Mancusi
4,
Giorgia Bruno
1,
Nicola Virtuoso
5,
Carmine Vecchione
1,7 and
Michele Ciccarelli
1,2,*
1
Department of Medicine, Surgery, and Dentistry, University of Salerno, 84081 Salerno, Italy
2
Cardiac Rehabilitation Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
3
Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Physiology and Pathophysiology, Medical University of Graz, 8010 Graz, Austria
4
Department of Advanced Biomedical Sciences, “Federico II” University, 80131 Naples, Italy
5
Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
6
Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, T12WE28 Cork City, Ireland
7
Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(12), 4598; https://doi.org/10.3390/jcm15124598 (registering DOI)
Submission received: 27 March 2026 / Revised: 27 May 2026 / Accepted: 11 June 2026 / Published: 13 June 2026
(This article belongs to the Special Issue The Role of Cardiac Rehabilitation After Myocardial Infarction, Coronary Artery Bypass Surgery, and in Other Cardiac Diseases)
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Abstract

Cardiac rehabilitation (CR) is strongly recommended in secondary cardiovascular prevention; indeed, in patients after cardiac surgery or with coronary artery disease or heart failure, this intervention is recommended to decrease mortality, morbidity, and disability, and to improve quality of life and cardiorespiratory fitness. Moreover, each step of the cardiovascular continuum denotes a potential risk factor for the progression of cognitive frailty; this interaction is highly prevalent, affecting approximately one-third of all patients in cardiology settings. For these reasons, CR should consider the patient’s cognitive domain; however, cognitive assessment is still rarely integrated into standard CR protocols. Therefore, this comprehensive review presents current evidence and recent updates on the interaction between CR and cognitive impairment, focusing on physiological mechanisms, core components, benefits, and strategies for implementing CR in patients with cognitive frailty to optimize recovery and prognosis.
Keywords: cardiac rehabilitation; cognitive impairment; cognition; cognitive frailty; heart–brain axis; cardiovascular disease; coronary artery disease; heart failure; cardiac surgery cardiac rehabilitation; cognitive impairment; cognition; cognitive frailty; heart–brain axis; cardiovascular disease; coronary artery disease; heart failure; cardiac surgery
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MDPI and ACS Style

Visco, V.; Loria, F.; Squillante, A.; Palmieri, F.; Piani, F.; Fucile, I.; Izzo, C.; Rusciano, M.R.; Gatto, C.; O’Caoimh, R.; et al. Cardiac Rehabilitation and Cognitive Impairment: Elective Affinities or Fatal Attraction. J. Clin. Med. 2026, 15, 4598. https://doi.org/10.3390/jcm15124598

AMA Style

Visco V, Loria F, Squillante A, Palmieri F, Piani F, Fucile I, Izzo C, Rusciano MR, Gatto C, O’Caoimh R, et al. Cardiac Rehabilitation and Cognitive Impairment: Elective Affinities or Fatal Attraction. Journal of Clinical Medicine. 2026; 15(12):4598. https://doi.org/10.3390/jcm15124598

Chicago/Turabian Style

Visco, Valeria, Francesco Loria, Antonio Squillante, Francesca Palmieri, Federica Piani, Ilaria Fucile, Carmine Izzo, Maria Rosaria Rusciano, Cristina Gatto, Rónán O’Caoimh, and et al. 2026. "Cardiac Rehabilitation and Cognitive Impairment: Elective Affinities or Fatal Attraction" Journal of Clinical Medicine 15, no. 12: 4598. https://doi.org/10.3390/jcm15124598

APA Style

Visco, V., Loria, F., Squillante, A., Palmieri, F., Piani, F., Fucile, I., Izzo, C., Rusciano, M. R., Gatto, C., O’Caoimh, R., Molloy, D. W., Mancusi, C., Bruno, G., Virtuoso, N., Vecchione, C., & Ciccarelli, M. (2026). Cardiac Rehabilitation and Cognitive Impairment: Elective Affinities or Fatal Attraction. Journal of Clinical Medicine, 15(12), 4598. https://doi.org/10.3390/jcm15124598

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