In a recent analysis, only 12.2% of over 600,000 such patients participated in CR; those who did participate experienced 21-34% lower mortality over the next 5 years than non-users (Suaya et al., 2009). Furthermore, patients who attended 25 or more of the recommended 36 CR sessions were 19% less likely to die than those attending fewer sessions. Other analyses have demonstrated similar benefits on both total mortality and recurrent MI with a graded dose-response in Medicare patients (Hammill et al., 2010).
Given that the major barrier to participation in CR programs among the elderly is failure of physician referral (Ades et al., 1992), an important challenge is to improve these dismal referral rates. Greater education of practitioners regarding the benefits of CR in the elderly is clearly required as well as facilitation of the referral process and increases in reimbursement to the CR providers. Additional barriers to CR participation in the elderly include lack of transportation to the facility and the need to care for a dependent spouse. In these situations, home exercise training may be a useful substitute for supervised training. Nevertheless, recent data suggest that automatic referral strategies may dramatically increase CR participation rates; in a recent Canadian study, automatic referral increased referral rates to 70% compared to 32% using usual methods (Grace et al., 2011).
Conclusions
Advancing age is accompanied by an accelerating reduction of aerobic exercise capacity, best quantified by peak VO2. This decline in aerobic capacity is exacerbated by many comorbidities common to the elderly. However, numerous observational and interventional studies have demonstrated the beneficial effects of exercise training in older adults, both in healthy and diseased individuals. A major challenge confronting the medical community and society is to markedly increase the participation of the elderly in such activities.
In a recent analysis, only 12.2% of over 600,000 such patients participated in CR; those who did participate experienced 21-34% lower mortality over the next 5 years than non-users (Suaya et al., 2009). Furthermore, patients who attended 25 or more of the recommended 36 CR sessions were 19% less likely to die than those attending fewer sessions. Other analyses have demonstrated similar benefits on both total mortality and recurrent MI with a graded dose-response in Medicare patients (Hammill et al., 2010).
Given that the major barrier to participation in CR programs among the elderly is failure of physician referral (Ades et al., 1992), an important challenge is to improve these dismal referral rates. Greater education of practitioners regarding the benefits of CR in the elderly is clearly required as well as facilitation of the referral process and increases in reimbursement to the CR providers. Additional barriers to CR participation in the elderly include lack of transportation to the facility and the need to care for a dependent spouse. In these situations, home exercise training may be a useful substitute for supervised training. Nevertheless, recent data suggest that automatic referral strategies may dramatically increase CR participation rates; in a recent Canadian study, automatic referral increased referral rates to 70% compared to 32% using usual methods (Grace et al., 2011).
Conclusions
Advancing age is accompanied by an accelerating reduction of aerobic exercise capacity, best quantified by peak VO2. This decline in aerobic capacity is exacerbated by many comorbidities common to the elderly. However, numerous observational and interventional studies have demonstrated the beneficial effects of exercise training in older adults, both in healthy and diseased individuals. A major challenge confronting the medical community and society is to markedly increase the participation of the elderly in such activities.
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