Rehabilitating elderly cardiac patients

The aging cardiovascular system undergoes many anatomic and physiologic changes. Increased vascular resistance, myocardial "stiffness," abnormalities of rhythmicity of the sinoatrial node, irregular cardiac rhythms, and alterations in heart rate and blood pressure responses are all seen more frequently in older patients. These changes are likely to impair these patients' ability to make the rapid adjustments necessary to maintain cardiac output during exercise and activity. When cardiovascular disease processes are superimposed on the "normal" concomitants of aging, greater alterations in hemodynamic response to exercise activity are noted than usually occur in younger cardiac patients. Exercise testing of older cardiac patients is safe and is usually needed to prescribe an appropriate intensity of exercise activity. The choice of the exercise protocol, the timing of the exercise test in relation to taking prescribed cardiac medication, the choice of exercise equipment, and special considerations for devices such as pacemakers and automatic implantable cardiodefibrillators must be considered before the exercise test is done. Many of these factors and the presence of either silent or overt cardiac symptoms or untoward hemodynamic events will also affect the exercise prescription. Elderly patients usually show substantial functional improvement when participating in a cardiac rehabilitation program and comply well with prescribed exercise. Early educational intervention may be crucial to reducing disability in these patients.