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Original article
Available online 29 October 2025
Evaluation of the efficacy of cardiac rehabilitation in older adults. A prospective cohort study
Evaluación de la eficacia de la rehabilitación cardiaca en adultos mayores. Estudio de cohorte prospectivo
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Ana Abrantesa,
, Catarina Gregórioa, Miguel Raposoa, João Cravoa, Sofia Estevesa, Margarida Martinsa, Sandra Miguel Correiab, Gisela Afonsob, Graça Araujob, Pedro Alves da Silvaa, Nelson Cunhaa, Inês Aguiar-Ricardoa, Fausto J. Pintoa, Ana Abreua,c
a Serviço de Cardiologia, Unidade Local de Saúde Santa Maria, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
b Department of Physical and Rehabilitation Medicine, Unidade Saúde Local Santa Maria, Lisbon, Portugal
c Instituto Medicina Preventiva e Instituto de Saúde Ambiental, Terra, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
This item has received
Received 24 June 2025. Accepted 02 October 2025
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Tables (4)
Table 1. Demographic and clinical characteristics of the patients at baseline.
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Table 2. Primary and secondary outcomes.
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Table 3. Major adverse cardiovascular events rate.
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Table 4. Subgroup analysis of primary and secondary outcomes according to age.
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Abstract
Introduction and objectives

The benefits of cardiac rehabilitation (CR) in older adults are supported by limited data, with most studies showing smaller improvements compared to younger individuals. Our aim was to evaluate the efficacy of CR programs in older adults (≥65 years) compared to younger ones.

Methods

A single-center, prospective cohort study included consecutive patients referred to phase 2 CR, between 2017 and 2023. Participants were divided into 2 groups: older (≥65 years) and younger (<65 years). Data on physical capacity, metabolic profile, and functional status were collected at baseline and after CR. The program included supervised exercise, educational sessions, dietary planning and treatment adjustments. Primary outcome was defined as improvement of at least 1mL/kg/min on peak VO2 after program completion. Secondary outcomes included risk factor management, cardiovascular outcomes and safety.

Results

446 patients were included, 175 (39%) older. The primary outcome was achieved by 89 older and 168 younger patients, without statistical difference (OR, 0.36; 95%CI, 0.34–1.18). Both groups showed significant and similar improvements in aerobic physical capacity (including, VO2 peak, percentage of predicted VO2 reached, O2 pulse and distance in the 6minute-walking-test), metabolic profile and New York Heart Association functional class. Major adverse cardiovascular events during a mean 2 year follow-up were similar across groups, with no safety issues reported.

Conclusions

CR programs were equally effective in older and younger patients, improving physical, functional, and metabolic outcomes. These findings highlight the importance of CR referrals for older adults to optimize cardiovascular health.

Keywords:
Cardiac rehabilitation
Older population
Cardiopulmonary exercise testing
Abbreviations:
6MWT
CPET
CR
Resumen
Introducción y objetivos

Los beneficios de la rehabilitación cardiaca (RC) en adultos mayores están respaldados por evidencia limitada, y la mayoría de los estudios muestran menores mejoras en comparación con personas más jóvenes. Nuestro objetivo fue evaluar la eficacia de los programas de RC en adultos mayores (≥ 65 años) frente a los más jóvenes (< 65 años).

Métodos

Estudio de cohorte prospectivo, unicéntrico, con pacientes derivados a fase 2 de RC entre 2017 y 2023. Los participantes se dividieron en 2 grupos: mayores (≥ 65 años) y menores (< 65 años). Se evaluaron la capacidad física, el perfil metabólico y el estado funcional antes y después de la intervención. El programa incluyó ejercicio supervisado, sesiones educativas, planificación dietética y ajustes terapéuticos. El resultado primario fue una mejora ≥ 1ml/kg/min en el VO2 pico tras el programa. Los secundarios incluyeron control de factores de riesgo, eventos cardiovasculares y seguridad.

Resultados

Se incluyeron 446 pacientes, 175 (39%) adultos mayores. El resultado primario fue alcanzado por 89 mayores y 168 jóvenes, sin diferencias significativas entre ellos (OR=0,36; IC95%, 0,34–1,18). Ambos grupos mejoraron de forma significativa y similar en la capacidad física perfil metabólico y clase funcional de la New York Heart Association. No se reportaron eventos adversos relevantes, y los eventos cardiovasculares mayores durante un seguimiento de 2 años fueron similares.

Conclusiones

Los programas de RC fueron igualmente efectivos en mayores y jóvenes, mejorando capacidad física, estado funcional y perfil metabólico. Se resalta la importancia de incluir a adultos mayores en RC.

Palabras clave:
Rehabilitación cardiaca
Población mayor
Prueba de ejercicio cardiopulmonar

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