Rehabilitation of Elderly Patients

As populations age in both developed and developing countries, more elderly patients with cardiac disease will be enrolled in rehabilitation programs. Coronary heart disease is the most common problem. Elderly coronary patients are medically complex because of the frequent complications of coronary disease and concomitant problems of diabetes, cerebral and peripheral vascular disease, hypertension, and chronic obstructive pulmonary disease.

The exercise capacity of elderly cardiac patients reflects the nature of their disease, other concomitant diseases, and, frequently, the decondi-tioning resulting from a sedentary lifestyle, all superimposed on the physiological effects of aging. Exercise training may help reduce the consequent limitations of activity and provide the sense of well-being and self-esteem necessary to prolong active and independent life.

Important considerations for exercise training in elderly cardiac patients include the following:

- High impact activities should be avoided.

- Prolonged warm-up and cool-down periods are necessary.

- Training should begin at low intensity and progress gradually.

- Repeated short periods of activity may be as beneficial as a single, more prolonged session.

- Exercise intensity should be reduced in hot and humid environments because of patients' impaired thermoregulation.

- Exercise-related orthostatic hypotension resulting from delayed baroreceptor responsiveness should be assessed.

- Specific muscle-strengthening activities can aid in self-care.33-35

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