Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA.
Geriatric Cardiology Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Geriatric, Research, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Can J Cardiol. 2016 Sep;32(9):1088-96. doi: 10.1016/j.cjca.2016.03.003. Epub 2016 Mar 10.
The biology of aging and the pathophysiology of cardiovascular disease (CVD) overlap, with the effect that CVD is endemic in the growing population of older adults. Moreover, CVD in older adults is usually complicated by age-related complexities, including multimorbidity, polypharmacy, frailty, and other intricacies that add to the risks of ambiguous symptoms, deconditioning, iatrogenesis, falls, disability, and other challenges. Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with cardiovascular conditions. Although CR was originally designed primarily as an exercise training program for younger adults after a myocardial infarction or coronary artery bypass surgery, it has evolved as a comprehensive lifestyle program (promoting physical activity as well as education, diet, risk reduction, and adherence) for a broader range of CVD (coronary heart disease, heart failure, and valvular heart disease). It provides a valuable opportunity to address and moderate many of the challenges pertinent for the large and growing population of older adults with CVD. Cardiac rehabilitation promotes physical function (cardiorespiratory fitness as well as strength and balance) that helps overcome disease and deconditioning as well as related vulnerabilities such as disability, frailty, and falls. Similarly, CR facilitates education, monitoring, and guidance to reduce iatrogenesis and promote adherence. Furthermore, CR fosters cognition, socialization, and independence in older patients. Yet despite all its conceptual benefits, CR is significantly underused in older populations. This review discusses benefits and the paradoxical underuse of CR, as well as evolving models of care that may achieve greater application and efficacy.
衰老的生物学和心血管疾病（CVD）的病理生理学重叠，导致 CVD 在不断增长的老年人群中普遍存在。此外，老年人的 CVD 通常还伴有与年龄相关的复杂性，包括多种合并症、多种药物治疗、衰弱和其他复杂情况，这些都会增加症状不明确、去适应、医源性疾病、跌倒、残疾和其他挑战的风险。心脏康复（CR）是一种综合的生活方式项目，对有心血管疾病的老年患者尤其有益。尽管 CR 最初主要是为心肌梗死或冠状动脉旁路手术后的年轻成年人设计的一种运动训练计划，但它已发展成为一种更广泛的 CVD（冠心病、心力衰竭和瓣膜性心脏病）综合生活方式项目（促进体力活动以及教育、饮食、风险降低和坚持）。它为患有 CVD 的大量且不断增长的老年人群提供了一个解决和缓解许多相关挑战的宝贵机会。心脏康复促进身体功能（心肺适应能力以及力量和平衡），有助于克服疾病和去适应，以及相关的脆弱性，如残疾、衰弱和跌倒。同样，CR 通过教育、监测和指导来减少医源性疾病并促进坚持。此外，CR 还能促进老年患者的认知、社交和独立性。尽管有这些概念上的好处，但 CR 在老年人群中的应用明显不足。这篇综述讨论了 CR 的益处和矛盾的应用不足，以及可能实现更大应用和疗效的不断发展的护理模式。
