Cardiac rehabilitation in the elderly: novel challenges for a time-tested intervention

Abstract

Cardiovascular diseases (CVD) are one of the main causes of morbidity and mortality worldwide. Elderly patients are a particularly challenging subgroup, given the myriad pathophysiological adaptations associated with the ageing process, which interact with different cardiovascular risk factors and pathologies. Older individuals are not only at greater cardiovascular risk, including after a cardiovascular event, but are also less likely to received certain evidence-based treatments, while being at increased risk of potential treatment side-effects. Given this background, CVD management can be particularly complex in the elderly. Beyond this, the overall epidemiological trends in several high-income countries (in terms of demographical patterns), further stress the importance of risk mitigation strategies in older individuals. Cardiac rehabilitation (CR) is a highly recommended intervention in multiple guidelines, having been extensively studied in younger populations. It represents a comprehensive and multi-layered framework focusing on various aspects of CVD, and as such its use could be particularly relevant in this population. In this review we aim at presenting a pragmatic overview on the physiological changes associated with ageing, as well as their association with different cardiovascular risk factors and overall cardiovascular risk, and to describe the current state-of-the-art concerning the role of CR among elderly individuals.