2026 ESC Guidelines on Cardiac Rehabilitation
An interactive clinical companion — browse graded recommendations, test your recall, and see how the field's evidence is organized. Adapted for PM&R and cardiac rehab practice in India.
This is the first ESC guideline dedicated entirely to cardiac rehabilitation (CR), developed by the ESC Task Force on Cardiac Rehabilitation and endorsed by ESPRM and WONCA. It introduces a new evidence-grading system for 2026 and reframes CR as a comprehensive, multidisciplinary, patient-centred process — not just exercise-based therapy. Below: the writing group's own key messages, followed by how the grading works.
ⓘHow to Read the Grading
Every recommendation carries two codes: a Class of Recommendation (COR) — how strong the guidance is — and a Level of Evidence (LOE) — how solid the evidence behind it is. For 2026, the ESC introduced a new LOE framework, used here for the first time.
| Class I | Evidence and/or general agreement that treatment is beneficial, useful, effective — "is recommended" / "is indicated". |
| Class IIa | Weight of evidence/opinion favours usefulness/efficacy — "should be considered". |
| Class IIb | Usefulness/efficacy less well established — "may be considered". |
| Class III | Evidence or agreement that treatment is not useful/effective, and may be harmful — "is not recommended". |
| A | Conclusive evidence, usually from ≥2 adequately powered RCTs free of major bias, with substantial evidence against the play of chance in meta-analysis. |
| B1 | Suggestive evidence from at least one adequately powered RCT free of major bias, or a meta-analysis of such trials. |
| B2 | Limited evidence from ≥2 adequately powered non-randomized studies with careful bias control, or meta-analysis of small, underpowered RCTs. |
| C | Preliminary evidence from non-randomized studies without careful bias control, a single small underpowered RCT, or expert consensus. |
This A/B1/B2/C framework replaces the older A/B/C system and adds a more granular middle tier — separating trial-based suggestive evidence (B1) from non-randomized/limited evidence (B2).
AZAbbreviations Used
| CR | Cardiac Rehabilitation |
| CTR | Cardiac Telerehabilitation |
| CORE | Cardio-Oncology Rehabilitation |
| ACS / CCS | Acute / Chronic Coronary Syndromes |
| PCI / CABG | Percutaneous Coronary Intervention / Coronary Artery Bypass Graft |
| HF / HFrEF / HFpEF | Heart Failure / with Reduced / Preserved Ejection Fraction |
| LVAD | Left Ventricular Assist Device |
| HTx | Heart Transplantation |
| SAVR / TAVI | Surgical / Transcatheter Aortic Valve Implantation |
| AF | Atrial Fibrillation |
| CIED | Cardiac Implantable Electronic Device |
| ICD / CRT-D/P | Implantable Cardioverter Defibrillator / Cardiac Resynchronization Therapy Device |
| CTR-CVT | Cancer Therapy-Related Cardiovascular Toxicity |
| OSAS | Obstructive Sleep Apnoea Syndrome |
| CKD | Chronic Kidney Disease |
| PAD | Peripheral Arterial Disease |
| VO2peak | Peak Oxygen Uptake |
| 6MWD / 6MWT | Six-Minute Walk Distance / Test |
| HRQoL | Health-Related Quality of Life |
| PRO / PROM | Patient-Reported Outcome / Measure |
| PRE | Patient-Reported Experience |
| ICF | International Classification of Functioning, Disability and Health |
| MACE | Major Adverse Cardiovascular Event |
| SSRI | Selective Serotonin Reuptake Inhibitor |
| GLP-1 RA | Glucagon-Like Peptide-1 Receptor Agonist |
| HIIT | High-Intensity Interval Training |
| AI | Artificial Intelligence |
★Key Messages
＋What's Distinct About These Guidelines
Consultant & In-charge, Physical Medicine & Rehabilitation, Kauvery Hospitals Bangalore & Hosur · Visiting Consultant, Physical Medicine & Rehabilitation, Antara Senior Care (Max Group) Bangalore. He leads the NeuroRehabilitation and Musculoskeletal & Sports Rehab Units at Kauvery Hospitals, and is the founder of The Rehab Doc Official.