Abstract: Cardiac surgery patients often present with multiple comorbidities, the risk of perioperative complications and the complexity of postoperative rehabilitation have significantly increased, posing higher demands on comprehensive perioperative management.Preoperative exercise pre-rehabilitation, as a multidisciplinary collaborative intervention strategy, has been demonstrated to significantly improve the clinical prognosis of patients undergoing elective cardiac surgery by enhancing their cardiopulmonary function, muscle strength, and overall physiological functional reserve, thereby increasing the body's tolerance to surgical stress.Although phase-specific research achievements have been made domestically and internationally in the field of exercise pre-rehabilitation, its standardized implementation and clinical translation on a global scale still face numerous obstacles, necessitating systematic review and in-depth exploration.Therefore, this study aimed to conduct a systematic review of the intervention protocols, clinical efficacy, safety, and feasibility of preoperative exercise pre-rehabilitation in patients undergoing elective cardiac surgery, with the goal of providing theoretical evidence and practical references for optimizing perioperative management pathways and promoting the implementation of enhanced recovery after surgery concepts.