Mitochondrial Bioenergetics and Cardiac Rehabilitation: Bridging Basic Science and Clinical Practice

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Abstract
Cardiovascular diseases (CVDs) are the leading cause of global morbidity and mortality, underscoring the necessity of long-term secondary prevention strategies such as comprehensive cardiac rehabilitation (CR). CR is a clinically validated, cost-effective intervention that mitigates cardiovascular risk, improves functional capacity, and enhances patient prognosis. Emerging evidence emphasizes the pivotal role of mitochondrial bioenergetics in mediating the systemic benefits of exercise-based CR, particularly through mechanisms involving mitochondrial biogenesis, dynamics, and mitophagy. This review synthesizes molecular insights with clinical guidelines by evaluating four national CR guidelines—from Poland, France, the United States, and Portugal—alongside a comprehensive recommendation issued by the European Society of Cardiology (ESC). The analysis focused on key components of CR, including exercise modalities (aerobic, resistance, and high-intensity interval training) and prescription parameters such as frequency, intensity, and duration. Only guidelines fulfilling predefined inclusion criteria with complete and detailed data were included; documents lacking essential information were excluded from the final synthesis.

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