Skip to main content

Advertisement

Log in

Particular Utility of Cardiac Rehabilitation in Relation to Age

  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Considerable evidence indicates that physical activity, exercise training, and cardio-respiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention, including in the elderly population. However, cardiac rehabilitation and exercise training (CRET) programs have been greatly under-utilized in patients with CHD, and this has been especially noted in populations of elderly patients, where CRET services have been covered by Medicare. We reviewed the benefits of formal CRET programs on CHD risk factors, including exercise capacity, indices of obesity, plasma lipids, inflammation, psychosocial stress, as well as overall morbidity and mortality, including recent studies in the elderly. These data support the routine referral of elderly CHD patients to formal CRET programs, and greater efforts are needed to vigorously encourage patients to attend these highly beneficial programs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Lavie CJ, Thomas RJ, Squires RW, et al. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc. 2009;84:373–383. This is a major review of the benefits of ET and formal CRET programs.

    Article  PubMed  Google Scholar 

  2. Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention. Prog Cardiovasc Dis. 2011;53:397–403.

    Google Scholar 

  3. Lavie CJ, Milani RV. Benefits of cardiac rehabilitation and exercise training programs in elderly coronary patients. Am J Geriatr Cardiol. 2001;10:323–7.

    Article  PubMed  CAS  Google Scholar 

  4. Pasquali SK, Alexander KP, Peterson ED. Cardiac rehabilitation in the elderly. Am Heart J. 2001;142:748–55.

    Article  PubMed  CAS  Google Scholar 

  5. Williams MA, Maresh CM, Esterbrooks DJ. Early exercise training in patients older than age 65 years compared with that in younger patients after acute myocardial infarction or coronary artery bypass grafting. Am J Cardiol. 1985;55:263–6.

    Article  PubMed  CAS  Google Scholar 

  6. Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol. 1993;22:678–83.

    Article  PubMed  CAS  Google Scholar 

  7. Lavie CJ, Milani RV. Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort. Am J Cardiol. 1995;76:177–9.

    Article  PubMed  CAS  Google Scholar 

  8. Thomas RJ, King M, Lui K, et al. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists. Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:1400–33.

    Article  PubMed  Google Scholar 

  9. Ades PA, Waldmann ML, Polk DM, et al. Referral patterns and exercise response in the rehabilitation of female coronary patients ages >62 years. Am J Cardiol. 1992;69:1422–5.

    Article  PubMed  CAS  Google Scholar 

  10. Ades PA, Waldmann ML, McCann WJ, et al. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med. 1992;152:1033–5.

    Article  PubMed  CAS  Google Scholar 

  11. Lavie CJ, Milani RV. Effects of cardiac rehabilitation programs in very elderly patients ≥75 years of age. Am J Cardiol. 1995;76:177–9.

    Article  PubMed  CAS  Google Scholar 

  12. Lavie CJ, Milani RV. Benefits of cardiac rehabilitation and exercise training in elderly women. Am J Cardiol. 1997;79:664–6.

    Article  PubMed  CAS  Google Scholar 

  13. Milani RV, Lavie CJ. Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease. Am J Cardiol. 1998;81:1233–6.

    Article  PubMed  CAS  Google Scholar 

  14. • Lavie CJ, Milani RV. Impact of aging on hostility in coronary patients and effects of cardiac rehabilitation and exercise training in elderly persons. Am J Geriatr Cardiol. 2004;13:125–30. This is a relatively contemporary study of the benefits of formal cardiac rehabilitation on major coronary risk factors in 268 elderly patients.

    Article  PubMed  Google Scholar 

  15. Lavie CJ, Milani RV, Lavie TJ. Impact of cardiac rehabilitation, exercise training, and fitness on psychological distress. In: Hauppauge SL, editor. Psychological factors and cardiovascular disorders: The role of Psychiatric Pathology & Maladaptive Personality Features. NY: Nova Science; 2009. p. 312–29.

    Google Scholar 

  16. Krantz DS, Baum A, Wideman M. Assessment of preferences for self-treatment and information in health care. J Pers Soc Psychol. 1980;39:977–90.

    Article  PubMed  CAS  Google Scholar 

  17. Lavie CJ, Milani RV. Disparate effects of improving aerobic exercise capacity and quality of life after cardiac rehabilitation in young and elderly coronary patients. J Cardiopulm Rehabil. 2000;20:235–40.

    Article  PubMed  CAS  Google Scholar 

  18. Milani RV, Lavie CJ, Spiva H. Limitations of estimating metabolic equivalents in exercise assessment in patients with coronary artery disease. Am J Cardiol. 1995;75:940–2.

    Article  PubMed  CAS  Google Scholar 

  19. Lavie CJ, Milani RV. Metabolic equivalent (MET) inflation: not the MET we used to know. J Cardiopulm Rehabil Prev. 2007;27:149–50.

    PubMed  Google Scholar 

  20. Kavanagh T, Mertens DJ, Hamm LF, et al. Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation. Circulation. 2002;106:666–71.

    Article  PubMed  Google Scholar 

  21. Kavanagh T, Mertens DJ, Hamm LF, et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol. 2003;42:2139–43.

    Article  PubMed  Google Scholar 

  22. Lavie CJ, Milani RV. Lipid therapy in the elderly—emphasis on clinical event reduction and safety. Am J Geriatr Cardiol. 2006;15:245–7.

    Article  PubMed  Google Scholar 

  23. Lavie CJ. Assessment and treatment of lipids in elderly persons. Am J Geriatr Cardiol. 2004;13(3, Suppl 1):2–3.

    Article  PubMed  Google Scholar 

  24. Maroo BP, Lavie CJ, Milani RV. Efficacy and safety of intensive statin therapy in the elderly. Am J Geriatr Cardiol. 2008;17:92–100.

    PubMed  Google Scholar 

  25. Maroo BP, Lavie CJ, Milani RV. Secondary prevention of coronary heart disease in elderly patients following myocardial infarction: are all HMG-CoA reductase inhibitors alike? Drugs Aging. 2008;25:649–64.

    Article  PubMed  CAS  Google Scholar 

  26. Cardenas GA, Lavie CJ, Cardenas V, et al. The importance of recognizing and treating low levels of high-density lipoprotein cholesterol: a new era in atherosclerosis management. Rev Cardiovasc Med. 2008;9:239–58.

    Article  PubMed  Google Scholar 

  27. Lavie CJ, Milani RV. Effects of nonpharmacologic therapy with cardiac rehabilitation and exercise training in patients with low levels of high-density lipoprotein cholesterol. Am J Cardiol. 1996;78:1286–9.

    Article  PubMed  CAS  Google Scholar 

  28. Milani RV, Lavie CJ. Prevalence and effects of nonpharmacologic treatment of “isolated” low-HDL cholesterol in patients with coronary artery disease. J Cardiolpulm Rehab. 1995;15:439–44.

    Article  CAS  Google Scholar 

  29. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–32.

    Article  PubMed  Google Scholar 

  30. Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training programs in metabolic syndrome and diabetes. J Cardiopulm Rehabil. 2005;25:59–66.

    Article  PubMed  Google Scholar 

  31. Lavie CJ, Milani RV, O’Keefe JH. Dyslipidemia intervention in metabolic syndrome: emphasis on improving lipids and clinical event reduction. Am J Med Sci. 2011;341(5):388–93.

    Google Scholar 

  32. Milani RV, Lavie CJ. Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. Am J Cardiol. 2003;92:50–4.

    Article  PubMed  Google Scholar 

  33. Artham SM, Lavie CJ, Milani RV, et al. Value of weight reduction in patients with cardiovascular disease. Curr Treat Options Cardiovasc Med. 2010;12:21–35.

    Article  PubMed  Google Scholar 

  34. Sierra-Johnson J, Romero-Corral A, Somers VK, et al. Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index. Eur J Cardiovasc Prev Rehabil. 2008;15:336–40.

    Article  PubMed  Google Scholar 

  35. Ades PA, Savage PD, Toth MJ, et al. High-calorie-expenditure exercise: a new approach to cardiac rehabilitation for overweight coronary patients. Circulation. 2009;119:2671–8.

    Article  PubMed  Google Scholar 

  36. Artham SM, Lavie CJ, Patel DA, Ventura HO. Obesity paradox in the elderly: is fatter really fitter? Aging Health. 2009;5:177–84.

    Article  Google Scholar 

  37. Lavie CJ, Milani RV, Patel D, et al. Disparate effects of obesity and left ventricular geometry on mortality in 8088 elderly patients with preserved systolic function. Postgrad Med. 2009;121:119–25.

    Article  PubMed  Google Scholar 

  38. Musunuru K, Kral BG, Blumenthal RS. The use of high-sensitivity assays for C-reactive protein in clinical practice. Nat Clin Pract Cardiovasc Med. 2008;5:621–35.

    Article  PubMed  CAS  Google Scholar 

  39. Lavie CJ, Milani RV, Verma A, O’Keefe JH. C-reactive protein and cardiovascular diseases—is it ready for primitive? Am J Med Sci. 2009;338:486–92.

    Article  PubMed  Google Scholar 

  40. Lavie CJ, Church TS, Milani RV, et al. Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation. J Cardiopulm Rehabil Prev. 2011;31:137–45.

    Google Scholar 

  41. Milani RV, Lavie CJ, Mehra MR. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol. 2004;43:1056–61.

    Article  PubMed  CAS  Google Scholar 

  42. Lavie CJ, Morshedi-Meibodi A, Milani RV. Impact of cardiac rehabilitation on coronary risk factors, inflammation, and the metabolic syndrome in obese coronary patients. J Cardiometab Syndr. 2008;3:136–40.

    Article  PubMed  Google Scholar 

  43. Caulin-Glaser T, Falko J, Hindman L, et al. Cardiac rehabilitation is associated with an improvement in C-reactive protein levels in both men and women with cardiovascular disease. J Cardiopulm Rehabil. 2005;25:332–6. quiz 337–338.

    Article  PubMed  Google Scholar 

  44. Lavie CJ, Milani RV, O’Keefe JH, et al. Impact of exercise training on psychological risk factors. Prog Cardiovasc Dis. 2011;53:464–70.

    Google Scholar 

  45. Lavie CJ, Milani RV. Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation. Arch Intern Med. 2006;166:1878–83.

    Article  PubMed  Google Scholar 

  46. Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med. 2007;120:799–806.

    Article  PubMed  Google Scholar 

  47. •• Milani, RV, Lavie CJ. Reducing psychosocial stress: a novel mechanism of improving survival from exercise training. Am J Med. 2009;122:931–8. This study suggests that most of the mortality reduction with CRET is due to reducing psychological stress in patients with high baseline levels.

    Article  PubMed  Google Scholar 

  48. Milani RV, Lavie CJ, Mehra MR, et al. Impact of exercise training and depression on survival in heart failure due to coronary heart disease. Am J Cardiol. 2011;107:64–8.

    Article  PubMed  Google Scholar 

  49. Artham SM, Lavie CJ, Milani RV. Benefits of exercise training in secondary prevention of coronary and peripheral arterial disease. Vasc Dis Prev. 2008;5:156–68.

    Google Scholar 

  50. O’Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989;80:234–44.

    Article  PubMed  Google Scholar 

  51. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001;1:CD001800.

    PubMed  Google Scholar 

  52. Witt BJ, Jacobsen SJ, Weston SA, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004;44:988–96.

    Article  PubMed  Google Scholar 

  53. •• Suaya JA, Stason WB, Ades PA, et al. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol. 2009;54:25–33. In a study of 600,000 Medicare patients, the marked benefits of CRET on morbidity and mortality are demonstrated. Moreover, elderly patients who attended more CRET sessions had the most benefit.

    Article  PubMed  Google Scholar 

  54. Suaya JA, Shepard DS, Normand SL, et al. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116:1653–62.

    Article  PubMed  Google Scholar 

  55. •• Hammill BG, Curtis LH, Schulman KA, et al. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation 2010;121:63–70. In a study of over 30,000 elderly, a strong dose–response relationship between compliance/attendance with CRET and major long-term outcome was noted.

    Article  PubMed  Google Scholar 

  56. Thomas RJ. Cardiac rehabilitation/secondary prevention programs a raft for the rapids: why have we missed the boat? Circulation. 2007;116:1644–6.

    Article  PubMed  Google Scholar 

  57. Squires RW. Are cardiac rehabilitation programs underutilized by patients with coronary heart disease? Nat Clin Pract Cardiovasc Med. 2008;5:192–3.

    Article  PubMed  Google Scholar 

  58. Thomas RJ, Miller NH, Lamendola C, et al. National survey on gender differences in Cardiac Rehabilitation Programs: patient characteristics and enrollment patterns. J Cardiopulm Rehabil. 1996;16:402–12.

    Article  PubMed  CAS  Google Scholar 

  59. Cortés O, Arthur HM. Determinants of referral to cardiac rehabilitation program in patients with coronary artery disease: a systematic review. Am Heart J. 2006;151:249–56.

    Article  PubMed  Google Scholar 

  60. Van Camp SP, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA. 1986;256:1160–3.

    Article  PubMed  Google Scholar 

  61. Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116:572–84.

    Article  PubMed  Google Scholar 

  62. Lavie CJ, Milani RV. Aerobic and resistance exercise training in the elderly. Am J Geriatr Cardiol. 2007;16:36–7.

    Article  PubMed  Google Scholar 

  63. Artero EG, Lee D-C, Ruiz JR, et al. A prospective study of muscular strength and all-cause mortality in men with hypertension. J Am Coll Cardiol. 2011;57:1831–37.

    Google Scholar 

  64. Braith RW, Stewart KJ. Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation. 2006;113:2642–50.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carl J. Lavie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lavie, C.J., Milani, R.V. & Arena, R.A. Particular Utility of Cardiac Rehabilitation in Relation to Age. Curr Cardiovasc Risk Rep 5, 432–439 (2011). https://doi.org/10.1007/s12170-011-0192-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12170-011-0192-2

Keywords