This American Heart Association scientific statement, published in Circulation (2026; DOI 10.1161/CIR.0000000000001456; PMID 42422933), summarizes current evidence and recommendations regarding exercise training for patients with cardiovascular disease who belong to high-risk populations. The authors note broad consensus that aerobic exercise training improves cardiorespiratory fitness and lowers the risk of adverse cardiovascular events in patients with cardiovascular disease. The statement is authored by Jerome L. Fleg and colleagues representing the AHA Exercise, Cardiac Rehabilitation, and Sports Cardiology Science Committee and several AHA councils.
The document specifically considers groups that warrant special considerations for exercise training. These include individuals with:
The statement examines functional deficits typical of these groups, their responses to exercise training, modifications required to maximize safety and efficacy, and existing knowledge gaps.
Across most of the high-risk populations reviewed, the authors identify several common themes:
There are increased barriers to participation in exercise training at multiple levels (patient, provider, system).
Baseline cardiorespiratory fitness is generally low in these groups, producing a heightened need for targeted exercise interventions.
Exercise prescriptions often require modifications, with greater emphasis on strength, balance, and flexibility in addition to aerobic training.
Programs frequently need accommodations such as enhanced supervision and specialized equipment to ensure safety and feasibility.
The statement emphasizes tailoring exercise programs to the unique, heterogeneous needs of high-risk patients. Common recommendations highlighted include:
Incorporating strength, balance, and flexibility training alongside aerobic conditioning to address functional deficits.
Providing enhanced supervision when necessary and using specialized equipment or assisted modalities for patients with mobility impairments or device-based therapies.
Adjusting intensity, duration, and progression based on baseline fitness, comorbid conditions, and individual functional goals.
Considering multidisciplinary approaches that integrate rehabilitation, cardiology, nursing, and other specialties to optimize program design and delivery.
The statement does not provide granular protocol prescriptions in the abstract; details beyond these summarized recommendations were not reported in the source abstract.
When exercise programs are appropriately designed to match the needs of high-risk populations, the statement reports that participants achieve functional improvements and gains in quality of life. These benefits can match or exceed those observed in more traditional cardiac rehabilitation populations, demonstrating that tailored exercise interventions can be both effective and meaningful for patient-centered outcomes.
The authors identify persistent knowledge gaps and outline priorities for future research, including:
Developing patient-centered training regimens that address the unique and heterogeneous needs of high-risk subgroups.
Evaluating the impact of tailored exercise programs on both clinical outcomes (for example, cardiovascular events) and patient-centered outcomes (for example, function and quality of life).
Advancing strategies for scalable and equitable delivery of exercise therapies that are proven safe and effective across diverse settings and populations.
The abstract indicates these research needs but does not enumerate specific trial designs or timelines; such details were not reported in the source abstract.
This review and scientific statement appears in Circulation, 2026 Aug 25;154(8):e319-e338, with electronic publication on 2026 Jul 9. The DOI is 10.1161/CIR.0000000000001456 and the PubMed identifier is 42422933. The article is listed as a free article with full-text links available through the journal platform (Atypon) and the Circulation site. Keywords highlighted by the authors include AHA Scientific Statements; arthritis; cardiomyopathies; cardiorespiratory fitness; cardiovascular diseases; frailty; and spinal cord injuries.