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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="review-article" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Russian Journal of Physiotherapy, Balneology and Rehabilitation</journal-id><journal-title-group><journal-title xml:lang="en">Russian Journal of Physiotherapy, Balneology and Rehabilitation</journal-title><trans-title-group xml:lang="ru"><trans-title>Физиотерапия, бальнеология и реабилитация</trans-title></trans-title-group></journal-title-group><issn publication-format="print">1681-3456</issn><issn publication-format="electronic">2413-2969</issn><publisher><publisher-name xml:lang="en">Eco-Vector</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">679029</article-id><article-id pub-id-type="doi">10.17816/rjpbr679029</article-id><article-id pub-id-type="edn">QUGEGJ</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>Review</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>Обзоры</subject></subj-group><subj-group subj-group-type="article-type"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title xml:lang="en">Physical Exercise and Cardiac Rehabilitation in Chronic Heart Failure: Opportunities, Challenges, and Improvement Strategies</article-title><trans-title-group xml:lang="ru"><trans-title>Физические тренировки и кардиореабилитация при хронической сердечной недостаточности: возможности, проблемы и пути оптимизации</trans-title></trans-title-group><trans-title-group xml:lang="zh"><trans-title>慢性心力衰竭患者的体育训练与心脏康复： 现状、问题与优化路径</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-3651-3376</contrib-id><name-alternatives><name xml:lang="en"><surname>Sultanova</surname><given-names>Alina R.</given-names></name><name xml:lang="ru"><surname>Султанова</surname><given-names>Алина Рамиловна</given-names></name><name xml:lang="zh"><surname>Sultanova</surname><given-names>Alina R.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>snhfromdol@mail.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-9190-5785</contrib-id><name-alternatives><name xml:lang="en"><surname>Dzhanaev</surname><given-names>Vladislav T.</given-names></name><name xml:lang="ru"><surname>Джанаев</surname><given-names>Владислав Таймуразович</given-names></name><name xml:lang="zh"><surname>Dzhanaev</surname><given-names>Vladislav T.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>vladik_dz@mail.ru</email><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0008-2623-9243</contrib-id><name-alternatives><name xml:lang="en"><surname>Brykov</surname><given-names>Ilya A.</given-names></name><name xml:lang="ru"><surname>Брыков</surname><given-names>Илья Андреевич</given-names></name><name xml:lang="zh"><surname>Brykov</surname><given-names>Ilya A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>iljabrykov8@gmail.com</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0001-9622-0766</contrib-id><name-alternatives><name xml:lang="en"><surname>Shvedko</surname><given-names>Danila A.</given-names></name><name xml:lang="ru"><surname>Шведко</surname><given-names>Данила Андреевич</given-names></name><name xml:lang="zh"><surname>Shvedko</surname><given-names>Danila A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>Shvedko2002@gmail.com</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-7681-611X</contrib-id><name-alternatives><name xml:lang="en"><surname>Mitkinykh</surname><given-names>Anastasiya S.</given-names></name><name xml:lang="ru"><surname>Митькиных</surname><given-names>Анастасия Сергеевна</given-names></name><name xml:lang="zh"><surname>Mitkinykh</surname><given-names>Anastasiya S.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>a24276035@gmail.com</email><xref ref-type="aff" rid="aff4"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0003-8402-1932</contrib-id><name-alternatives><name xml:lang="en"><surname>Dadasheva</surname><given-names>Zainap N.</given-names></name><name xml:lang="ru"><surname>Дадашева</surname><given-names>Зайнап Насруллаевна</given-names></name><name xml:lang="zh"><surname>Dadasheva</surname><given-names>Zainap N.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>dznzaynap@gmail.com</email><xref ref-type="aff" rid="aff5"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-4605-5022</contrib-id><name-alternatives><name xml:lang="en"><surname>Gasanov</surname><given-names>Gafgaz E.</given-names></name><name xml:lang="ru"><surname>Гасанов</surname><given-names>Гафгаз Этибарович</given-names></name><name xml:lang="zh"><surname>Gasanov</surname><given-names>Gafgaz E.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>caucasus3000@mail.ru</email><xref ref-type="aff" rid="aff6"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0006-8458-5289</contrib-id><name-alternatives><name xml:lang="en"><surname>Gukyamukhova</surname><given-names>Amaliya I.</given-names></name><name xml:lang="ru"><surname>Гукъямухова</surname><given-names>Амалия Индрисовна</given-names></name><name xml:lang="zh"><surname>Gukyamukhova</surname><given-names>Amaliya I.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>Amaliya02_02@mail.ru</email><xref ref-type="aff" rid="aff7"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0004-5107-770X</contrib-id><name-alternatives><name xml:lang="en"><surname>Tokaeva</surname><given-names>Maryan A.</given-names></name><name xml:lang="ru"><surname>Токаева</surname><given-names>Марьян Айнудиновна</given-names></name><name xml:lang="zh"><surname>Tokaeva</surname><given-names>Maryan A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>marisha.tokaeva@mail.ru</email><xref ref-type="aff" rid="aff7"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0005-5025-3684</contrib-id><name-alternatives><name xml:lang="en"><surname>Kaptelinina</surname><given-names>Tatyana E.</given-names></name><name xml:lang="ru"><surname>Каптелинина</surname><given-names>Татьяна Евгеньевна</given-names></name><name xml:lang="zh"><surname>Kaptelinina</surname><given-names>Tatyana E.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>kaptelinina87@mail.ru</email><xref ref-type="aff" rid="aff8"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-4962-7873</contrib-id><name-alternatives><name xml:lang="en"><surname>Urmanova</surname><given-names>Angelina E.</given-names></name><name xml:lang="ru"><surname>Урманова</surname><given-names>Ангелина Евгеньевна</given-names></name><name xml:lang="zh"><surname>Urmanova</surname><given-names>Angelina E.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>gelya.urmanova@mail.ru</email><xref ref-type="aff" rid="aff7"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0005-7267-9651</contrib-id><name-alternatives><name xml:lang="en"><surname>Vankova</surname><given-names>Sofya A.</given-names></name><name xml:lang="ru"><surname>Ванькова</surname><given-names>Софья Андреевна</given-names></name><name xml:lang="zh"><surname>Vankova</surname><given-names>Sofya A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>vankovas2001@mail.ru</email><xref ref-type="aff" rid="aff9"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Bashkir State Medical University</institution></aff><aff><institution xml:lang="ru">Башкирский государственный медицинский университет</institution></aff><aff><institution xml:lang="zh">Bashkir State Medical University</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">North Ossetian State Medical Academy</institution></aff><aff><institution xml:lang="ru">Северо-Осетинская государственная медицинская академия</institution></aff><aff><institution xml:lang="zh">North Ossetian State Medical Academy</institution></aff></aff-alternatives><aff-alternatives id="aff3"><aff><institution xml:lang="en">Ryazan State Medical University named after academician I.P. Pavlov</institution></aff><aff><institution xml:lang="ru">Рязанский государственный медицинский университет им. акад. И.П. Павлова</institution></aff><aff><institution xml:lang="zh">Ryazan State Medical University named after academician I.P. Pavlov</institution></aff></aff-alternatives><aff-alternatives id="aff4"><aff><institution xml:lang="en">Kirov State Medical University</institution></aff><aff><institution xml:lang="ru">Кировский государственный медицинский университет</institution></aff><aff><institution xml:lang="zh">Kirov State Medical University</institution></aff></aff-alternatives><aff-alternatives id="aff5"><aff><institution xml:lang="en">I.P. Pavlov First St. Petersburg State Medical University</institution></aff><aff><institution xml:lang="ru">Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова</institution></aff><aff><institution xml:lang="zh">I.P. Pavlov First St. Petersburg State Medical University</institution></aff></aff-alternatives><aff-alternatives id="aff6"><aff><institution xml:lang="en">Kuban State Medical University</institution></aff><aff><institution xml:lang="ru">Кубанский государственный медицинский университет</institution></aff><aff><institution xml:lang="zh">Kuban State Medical University</institution></aff></aff-alternatives><aff-alternatives id="aff7"><aff><institution xml:lang="en">North Caucasus State Academy</institution></aff><aff><institution xml:lang="ru">Северо-Кавказская государственная академия</institution></aff><aff><institution xml:lang="zh">North Caucasus State Academy</institution></aff></aff-alternatives><aff-alternatives id="aff8"><aff><institution xml:lang="en">Rostov State Medical University</institution></aff><aff><institution xml:lang="ru">Ростовский государственный медицинский университет</institution></aff><aff><institution xml:lang="zh">Rostov State Medical University</institution></aff></aff-alternatives><aff-alternatives id="aff9"><aff><institution xml:lang="en">National Research Mordovian State University named after N.P. Ogarev</institution></aff><aff><institution xml:lang="ru">Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева</institution></aff><aff><institution xml:lang="zh">National Research Mordovian State University named after N.P. Ogarev</institution></aff></aff-alternatives><pub-date date-type="preprint" iso-8601-date="2025-06-04" publication-format="electronic"><day>04</day><month>06</month><year>2025</year></pub-date><pub-date date-type="pub" iso-8601-date="2025-08-16" publication-format="electronic"><day>16</day><month>08</month><year>2025</year></pub-date><volume>24</volume><issue>4</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><issue-title xml:lang="zh"/><fpage>254</fpage><lpage>270</lpage><history><date date-type="received" iso-8601-date="2025-04-30"><day>30</day><month>04</month><year>2025</year></date><date date-type="accepted" iso-8601-date="2025-05-22"><day>22</day><month>05</month><year>2025</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2025, Eco-Vector</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2025, Эко-Вектор</copyright-statement><copyright-statement xml:lang="zh">Copyright ©; 2025,</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="en">Eco-Vector</copyright-holder><copyright-holder xml:lang="ru">Эко-Вектор</copyright-holder><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://eco-vector.com/for_authors.php#07</ali:license_ref></license></permissions><self-uri xlink:href="https://rjpbr.com/1681-3456/article/view/679029">https://rjpbr.com/1681-3456/article/view/679029</self-uri><abstract xml:lang="en"><p>Chronic heart failure (CHF) remains one of the leading causes of morbidity, disability, and mortality worldwide. The primary clinical manifestations of CHF—dyspnea, fatigue, and exercise intolerance—significantly impair patients’ quality of life. Cardiac rehabilitation (CR) effectively improves physical performance, functional status, and compliance in patients with CHF. Conventional CR programs include moderate-intensity aerobic exercise, resistance training, respiratory muscle training, risk factor modification, and patient education. However, engagement in CR remains extremely low. Major barriers include insufficient referrals from healthcare providers, financial constraints, transportation difficulties, and limitations related to social, cognitive, and digital accessibility. This article discusses new strategies for expanding cardiac rehabilitation coverage, including the development of hybrid and home-based programs, the use of digital technology for remote monitoring, and the potential integration of artificial intelligence to personalize treatment approaches. Special attention is given to addressing digital inequality and ensuring broader access to CR programs for vulnerable populations. Innovative cardiac rehabilitation models have the potential to transform the care paradigm for patients with heart failure by increasing access to rehabilitation services and improving clinical outcomes.</p></abstract><trans-abstract xml:lang="ru"><p>Хроническая сердечная недостаточность (ХСН) остаётся одной из ведущих причин заболеваемости, инвалидизации и смертности во всём мире. Основными клиническими проявлениями ХСН являются одышка, утомляемость и непереносимость физических нагрузок, что значительно снижает качество жизни пациентов. Кардиореабилитация (КР) представляет собой эффективное вмешательство, направленное на восстановление физической работоспособности, улучшение функционального состояния и повышение приверженности терапии у больных ХСН. В традиционную структуру КР входят аэробные тренировки средней интенсивности, тренировки с отягощениями, дыхательные тренировки, а также модификация факторов риска и образовательные мероприятия. Однако уровень участия в программах КР остаётся крайне низким. К числу основных препятствий относятся недостаточное направление со стороны медицинских работников, финансовые барьеры, трудности транспортировки, а также ограничения, связанные с социальной, когнитивной и цифровой доступностью. В статье рассматриваются новые стратегии повышения охвата кардиореабилитацией, включая развитие гибридных и домашних программ, применение цифровых технологий для дистанционного мониторинга и перспективы интеграции искусственного интеллекта для персонализации подходов к лечению. Особое внимание уделено необходимости устранения цифрового неравенства и обеспечению более широкого доступа к программам КР для уязвимых групп населения. Инновационные модели кардиореабилитации способны существенно изменить парадигму ведения пациентов с сердечной недостаточностью, повысив доступность реабилитационных услуг и улучшив их клинические исходы.</p></trans-abstract><trans-abstract xml:lang="zh"><p>慢性心力衰竭（chronic heart failure, CHF）仍是全球范围内导致发病率、致残率和死亡率升高的主要原因之一。CHF的主要临床表现包括呼吸困难、疲劳和运动不耐受，这些症状显著降低患者的生活质量。心脏康复（cardiac rehabilitation, CR）是一种针对CHF患者的有效干预手段，旨在恢复身体耐力、改善功能状态，并提高治疗依从性。传统CR方案包括中等强度的有氧训练、阻力训练、呼吸肌训练，以及危险因素控制和健康教育。然而，参与CR项目的患者比例仍然极低。其主要障碍包括医务人员转诊不足、经济障碍、交通困难，以及社会、认知和数字获取方面的限制。本文探讨了提升心脏康复服务覆盖率的新策略，包括发展混合式和居家康复方案、引入用于远程监测的数字技术，并展望人工智能在个体化治疗中的应用潜力。特别强调了消除数字鸿沟，并提升弱势群体参与CR项目的可及性。创新型心脏康复模式有能力显著改变心力衰竭患者的管理范式，提高康复服务的可及性，并改善临床结局。</p></trans-abstract><kwd-group xml:lang="en"><kwd>heart failure</kwd><kwd>cardiac rehabilitation</kwd><kwd>physical exercise</kwd><kwd>resistance training</kwd><kwd>respiratory muscle training</kwd><kwd>remote monitoring</kwd><kwd>digital technology</kwd><kwd>chronic heart failure</kwd><kwd>quality of life</kwd><kwd>patient engagement</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>cердечная недостаточность</kwd><kwd>кардиореабилитация</kwd><kwd>физические тренировки</kwd><kwd>тренировка с отягощениями</kwd><kwd>тренировка дыхательных мышц</kwd><kwd>дистанционный мониторинг</kwd><kwd>цифровые технологии</kwd><kwd>хроническая сердечная недостаточность</kwd><kwd>качество жизни</kwd><kwd>участие пациентов</kwd></kwd-group><kwd-group xml:lang="zh"><kwd>心力衰竭</kwd><kwd>心脏康复</kwd><kwd>体育锻炼</kwd><kwd>阻力训练</kwd><kwd>呼吸肌训练</kwd><kwd>远程监测</kwd><kwd>数字技术</kwd><kwd>慢性心力衰竭</kwd><kwd>生活质量</kwd><kwd>患者参与</kwd></kwd-group><funding-group/></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Larina VN, Skiba IK. 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