title: Cardiac rehabilitation is safe and effective also in the elderly, but don't forget about drugs!
abstract: In the setting of heart failure (HF) pharmacotherapy demonstrates a quantifiable improvement in exercise tolerance also in HF with preserved ejection fraction (HFpEF). For patients with HFpEF, often older, with higher prevalence of hypertension, diabetes mellitus, atrial fibrillation and other comorbidities, endpoints such as quality of life and functional capacity may be more clinically relevant. However several study show as the use of ACE-I and B-blocker were lesser than expected. Beta-blocker therapy is the keystone of pharmacotherapy of HF patients and exercise training is the essential core of rehabilitation programs, it is important to elucidate the relationship between these therapies. Exercise training improves the clinical status of HF, improving left ventricular ejection fraction and improving quality of life, but it is possible that b-blocker may attenuate exercise training adaptations. Despite this, possible adverse b-blocker effects are just presumed and not confirmed by published randomized clinical trials. Metanalysis suggests that b-blocker compared with placebo enhances improvements in cardiorespiratory performance in exercise training intervention. Despite these evidences, prescription of gold standard therapy and adherence are still suboptimal and should be a priority goal for all CR program.
authors.affiliation: Nuovo Regina Margherita Hospital. donatelladelsindaco@virgilio.it.
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Maria Denitza
authors.initials: MD
authors.lastname: Tinti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Stefano
authors.initials: S
authors.lastname: Tolone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
authors.forename: Massimo
authors.initials: M
authors.lastname: Uguccioni
authors.forename: Antonio
authors.initials: A
authors.lastname: Lax
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000072038:Cardiac Rehabilitation / Q000379:methods*; D005081:Exercise Therapy; D017079:Exercise Tolerance; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D055118:Medication Adherence; D011788:Quality of Life; D013318:Stroke Volume
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors