LT-MCS devices are implanted in patients with end-stage HF who commonly present with severely impaired functional capacity. Despite the lack of generally accepted recommendations for patients with LT-MCS, evidence is gathering that cardiac rehabilitation is beneficial. The goal is to return an MCS-supported patient to a normal and independent life. Besides the typical goals of cardiac rehabilitation, which include improvements in functional capacity and motor strength, specific additional goals in patients with LT-MCS are to educate them to understand the operation and handling of the device, self-management of sub-therapeutic INR, driveline exit site care as well as psychological and social counselling. In addition to the index rehabilitation immediately after LT-MCS implantation, repeated rehabilitation can become necessary in patients who exhibit adverse events (e.g. neurological complications) or those presenting with extreme deconditioning.