Digital Technologies in Cardiac Rehabilitation for High-Risk Cardiovascular Patients: A Narrative Review of Mobile Health, Virtual Reality, Exergaming and Virtual Education

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and longterm adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centrebased model and to support more flexible, patientcentred care. Methods: This narrative review synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and telerehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multicomponent digital CR solutions. Only original studies with clinical, functional, or patientreported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealthenabled homebased or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centrebased CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved riskfactor profiles and quality of life to a degree comparable with facetoface CR. Conclusions: Digital technologies can credibly support core objectives of CR in highrisk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patientcentred rehabilitation.