LAUSR

egular physical activity is widely recommended for the primary and secondary prevention of cardiovascular disease (CVD), and formal cardiac rehabilitation programs are indicated for a range of cardiovascular and postsurgical conditions. Heart failure (HF) is one of the conditions for which multicomponent cardiac rehabilitation and even exercise training alone improve both exercise capacity and clinical outcomes. 1,2 As a result, cardiac rehabilitation (including exercise training, medication education, dietary recommendations, and psycho-social support) and exercise training alone are codified in US and European guidelines for management of patients with HF regardless of ejection fraction, as class 1 to 2a recommendations. Of note, the efficacy of exercise intervention is significantly affected by adherence. 2 Short-term adherence rates of up to ~80% can be achieved in rigorous clinical trials of exercise interventions, 2 but longer-term sustainability remains either poor or untested globally. This is particularly true once individuals transi-tion out of in-person supervised sessions to the home environment. Several clinical factors are associated with adherence, but these account for very little of the variance in individual adherence. 2 This leaves an enormous gap in the knowledge base necessary to sustain exercise therapy in this high-risk population. Traditional efforts to improve adherence (as detailed in the following) have demonstrated important, albeit modest benefits. 3 For HF in particular, there are relatively few recent or ongo-ing clinical trials investigating adherence to exercise. Increased efforts through alternative paradigms may be necessary to reduce the knowledge gap around effective methods to enhance adherence (including in diverse populations). From this perspective, we briefly review traditional methods to optimize adherence in exercise for CVD, with HF as a