Cardiac rehabilitation for older adults: current evidence and future potential

ABSTRACT

Introduction

Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes.

Areas covered

Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management.

Expert opinion

Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.

KEYWORDS:

• Cardiac rehabilitation
• cardiovascular diseases
• frailty
• exercise training
• old age
• geriatric syndromes

Article highlights

• The needs of older adults with CVD is increasing germane to CR as the population of older adults continues to grow.

• Cardiovascular disease in older adults tends to be associated with geriatric syndromes that add to the complexity of care.

• Cumulative data substantiate the benefits and importance of CR in recovery for older adults, but many older adults with CVD are often too functionally or cognitively compromised to initiate or sustain the aerobic activity required.

• Reengineering CR to address geriatric syndromes and overcome strength and balance deficits in older frailer adults is needed, with goals to better enable older adults to participate and maintain independence.

• The utilization of CR falls sharply with age. Barriers to referral as well as enrollment must be addressed in order to enhance the use of this program.

• New models of care, such as remote CR, offer the opportunity to increase access as well as effectiveness of CR, but refinements are needed to best enable remote CR to be safe and effective for the wide range of eligible older adults, including those who are frail, sedentary, and fearful.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded in part by the National Institute On Aging through grant no. R01AG060499.