Core Exercise in Sports Injury Rehabilitation: A Narrative Review of Cardiorespiratory Effects and Implications for Collaborative Clinical Practice

Objectives: Core stability exercise is a routine component of sports injury rehabilitation, so clinicians may assume that it also maintains or restores cardiorespiratory fitness (CRF) as athletes progress toward return to sport. This narrative review aimed to clarify what core-oriented exercise can and cannot be expected to contribute to CRF and to translate the evidence into practical guidance for collaborative rehabilitation teams. Methods: Targeted searches of electronic databases and citation tracking were used to identify human studies, systematic reviews, and consensus documents addressing four physiologically distinct domains: acute cardiovascular response, respiratory muscle and pulmonary adaptation, exercise economy, and maximal aerobic capacity. Study characteristics were appraised narratively, and the evidence for each domain was graded qualitatively as consistent, limited, or mixed. Results: Core exercises acutely raise heart rate and oxygen uptake, but their metabolic cost is low (a plank costs approximately 2.3 metabolic equivalents [METs]). Small trials, mostly in non-injured, pediatric, or clinical populations, reported improved respiratory muscle strength, although several programs included breathing components. Two small six-week trials found no significant change in maximal oxygen uptake, whereas two 12-week trials in sedentary adults reported increases, and a systematic review found improved spirometric variables but no significant pooled effect on maximal oxygen uptake. Effects on exercise economy were mixed. Pilates, a whole-body method, improved CRF in meta-analyses, but the certainty of evidence was very low to low and Pilates was not superior to other exercise. No study of the effect of core training on CRF in injured athletes was identified. Conclusions: Core exercise should not be assumed to maintain or restore CRF during rehabilitation. Aerobic conditioning should be programmed explicitly using modalities compatible with tissue-loading restrictions and coordinated among physicians, physical therapists, athletic trainers, and sports scientists. Adequately powered trials that match total training stimulus in injured athletes are needed.