This PACUPod episode reviews Wu et al.'s randomized trial in JAMA Network Open evaluating early cardiac rehabilitation initiated during the CICU for patients with acute decompensated heart failure. In this single-center study of 120 high-risk CICU patients, participants were randomized to an early, progressive, personalized cardiac rehab program during CICU stay (AHF-CR) or to usual care without structured early rehab. Primary outcomes were discharge Short Physical Performance Battery (SPPB) score and six-month all-cause rehospitalization; exploratory outcome included the Perme ICU Mobility score during the CICU stay. Results showed no significant difference in discharge SPPB (median difference 1.0 point; 95% CI crossed zero; p=0.16) or six-month rehospitalization (26.6% vs 28.3%). The rehab group did exhibit improved mobility in the CICU (Perme score median difference 2.76; adjusted p=0.04) and there were no safety concerns. The findings suggest early CICU mobilization is feasible and safe, but restricting rehab to the CICU without post-discharge continuation did not improve discharge function or reduce readmissions. Context with prior rehab literature indicates longer, outpatient or integrated rehab programs (e.g., REHAB-HF) may yield larger functional and clinical benefits, while meta-analyses (Imrpress 2023) show benefits with earlier exercise-based rehab when extended beyond ICU. The episode highlights the importance of rehab timing, duration, and continuity after discharge, as well as multidisciplinary coordination to optimize outcomes for ADHF patients.