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2026 Update of the Core Components of Cardiovascular Rehabilitation: A Position Statement from the Australian Cardiovascular Health and Rehabilitation Association (ACRA)
Journal article   Open access   Peer reviewed

2026 Update of the Core Components of Cardiovascular Rehabilitation: A Position Statement from the Australian Cardiovascular Health and Rehabilitation Association (ACRA)

Dion Candelaria, Julie Redfern, Robert Zecchin, Roschelle Brown, Nicole Freene, Shihoko Fukumori, Robyn Gallagher, Sarah Gauci, Andrew Goodman, Darren Hicks, …
Heart, Lung and Circulation, Vol.Advanced access
26-Jun-2026
DOI: https://doi.org/10.1016/j.hlc.2026.05.008
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1-s2.0-S1443950626004105-main4.69 MBDownloadView
Published Version (Advanced Access) Open Access CC BY-NC-ND V4.0

Abstract

cardiovascular disease cardiac rehabilitation secondary prevention core components Australian cardiovascular health and rehabilitation association ACRA
Introduction: Cardiovascular disease (CVD) remains a leading cause of death and disability both globally and in Australia [1,2]. In 2022, an estimated 1.3 million Australian adults were living with CVD [2]. Up to 57% of CVD cases and 22% of all-cause deaths are attributable to key modifiable risk factors, highlighting the substantial potential for prevention [3]. Cardiovascular rehabilitation and secondary prevention programs are highly effective strategies for reducing repeat cardiac and new stroke events, improving quality of life, and supporting long-term cardiovascular health [4–6]. The benefits of cardiovascular rehabilitation are well established and widely endorsed by national [4] and international clinical practice guidelines [5,6]. Cardiovascular rehabilitation has traditionally been delivered via structured, multidisciplinary programs that provide comprehensive risk factor management through supervised exercise training, education, psychosocial support, and by supporting adherence to evidence-based medical therapy [4,7,8]. Programs are delivered across a range of healthcare settings (public, private and community health) and through different modes, including in-person, telehealth, and digital/virtual formats. Models of care also vary and may include centre-based, home-based, hybrid and hub-and-spoke approaches [9]. Contemporary thinking frames cardiovascular rehabilitation within the broader concept of lifelong cardiovascular health, rather than as a time-limited intervention [10]. The 2026 World Heart Federation Roadmap on cardiac rehabilitation [9] defines a cardiovascular health programme as: “...the systematic provision of ongoing care and support for individuals with, or at elevated risk of, CVD, which in combination with all aspects of evidence-based prevention and rehabilitation will lead to lifelong cardiovascular well-being. Care should be person-centred and encompass all aspects of lifestyle optimisation, clinical management of risk factors, psychosocial support, and adherence to guideline-directed medical therapy.” This definition reinforces the central role of cardiovascular rehabilitation in supporting lifelong cardiovascular health [10]. In 2014, the Australian Cardiovascular Health and Rehabilitation Association (ACRA) published the inaugural national core components for cardiovascular rehabilitation and secondary prevention to guide practice and promote consistent, high-quality care [11]. Over the past decade, remote and hybrid models, including telehealth, virtual platforms, digital programs and wearable technologies, have gained widespread acceptance, accelerated by the COVID-19 pandemic and rapid technological advances [12].These contemporary delivery modes offer opportunities to improve equity of access, flexibility, and person-centred care, while addressing evolving workforce and health system needs [13]. Regardless of delivery format, all cardiovascular rehabilitation programs should comply with all core components and evidence-based best practices. Maintaining robust standards is essential to ensure quality, consistency, and equity of care across diverse settings. The aim of this position statement was to update the core components of cardiovascular rehabilitation in Australia to reflect societal, technological, and health system changes since its first iteration in 2014 [11], whilst reaffirming the fundamental principles and enduring evidence base. Recognising variation in local contexts and resources, this document is not intended to be prescriptive and does not function as a clinical guideline. Rather, it informs the delivery of evidence-based, context-sensitive cardiovascular rehabilitation and defines the core components needed to promote lifelong preventative care following a cardiovascular diagnosis. Methods: This position statement was developed by a nationally representative, multidisciplinary writing group composed of clinician and academic ACRA members convened through an expression-of-interest call. Additional subject matter experts and two consumers were also appointed. The group reviewed the 2014 version, identified areas requiring update, and undertook an iterative process of evidence gathering and literature synthesis. Subgroups were assigned to draft specific sections based on their areas of expertise. They critically appraised the most current and highest-quality evidence, including meta-analyses, systematic reviews, randomised controlled trials, international guidelines and relevant Australian clinical guidelines or guidance documents to ensure national coherence. Although a comprehensive, systematic search was not conducted, the co-authors used a structured, consensus-driven approach to identify and assess available evidence, drawing on their disciplinary expertise to ensure that the most contemporary and methodologically robust sources informed each section. This process included cross-checking key evidence across subgroups to maintain consistency and rigour. All authors contributed to iterative revisions and resolved discrepancies through discussions. The position statement was internally peer reviewed by three independent international experts. The final manuscript was reviewed and endorsed by the 2026 ACRA Executive Management Committee.

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