Cardiac rehabilitation and elderly patients. (Commentary)

Coronary artery disease affects at least 25% of the elderly population and contributes significantly to premature disability in many patients who may then no longer be capable of living independently [1]. On average, an elderly Person costs the health service nine times as much as a young adult[2] and the cost for an elderly cardiac patient is expected to be even more. An intervention such as exercise conditioning, which could improve functional capacity, may minimize dependence in the elderly cardiac patient[3]. Cardiac rehabilitation is defined as a process by which patients with cardiac disease are restored to their optimal physical, medical, psychological, social, emotional, vocational and economic status[4].

Ageing is associated with a diminution of exercise capacity due to changes in the maximal heart rate, stroke volume, cardiac output, left ventricular thickness and beta-adrenergic sensitivity[5-7] leading to a reduction in aerobic power. In addition there is accumulation of body fat, loss of lean tissue and demineralization of bone[8]. Many of the functional changes observed in elderly subjects are analogous to an acute loss of physical condition and an exercise programme might partly reverse these changes[8, 9]. Exercise capacity after myocardial infarction is impaired by the associated reduction in physical activity and infarct-related damage to the myocardium. A substantial increase in the functional capacity occurs by 11 weeks after uncomplicated myocardial infarction, even in patients who have undergone no formal exercise training[10]. An exercise programme increases a patient's maximal exercise after myocardial infarction by 15% to 25% more than that occurring spontaneously. Such improved …