CARDIAC REHABILITATION IN THE ELDERLY

Rehabilitation for patients with heart disease consists of exercise tr aining, behavioral interventions, counseling, and education with the g oal of improving physiologic and psychosocial status. The Cardiac Reha bilitation Clinical Practice Guidelines, recently published in the Uni ted States, list the most substantial benefits of cardiac rehabilitati on as an improvement in exercise tolerance, symptoms, blood lipid leve ls, and psychosocial wellbeing, and ct reduction in cigarette smoking, stress, and mortality. With the evidence-base on the elderly in the G uidelines derived from 1 non-randomized controlled trial and 7 observa tional studies, the efficacy and effectiveness of cardiac rehabilitati on is based almost exclusively on data generated on young and middle-a ged males. We have located an additional 10 randomized and 2 non-rando mized controlled trials published since the Guidelines, but only one p rovided age-specific data. The elderly are the fastest growing segment of the population, and may be more responsive to the effects of cardi ac rehabilitation as they often have greater initial disability and le ss independence than younger patients. While referral of elderly perso ns to cardiac rehabilitation services appears safe and warranted in th e secondary prevention of heart disease, the lack of rigorous scientif ic evidence has created an important clinical research and clinical po licy vacuum which urgently needs to be filled. (Aging Clin. Exp. Res. 10: 273-283, 1998) (C) 1998, Editrice Kurtis.