Cardiac rehabilitation against frailty and sarcopenia in older individuals: a literature review

Frailty and sarcopenia are highly prevalent in older adults with cardiovascular disease (CVD), contributing to reduced functional capacity, increased hospitalisation, and poorer quality of life. These syndromes share pathophysiological pathways characterised by chronic low-grade inflammation, hormonal decline, impaired nutrient utilisation, oxidative stress, and mitochondrial dysfunction. Together, these processes accelerate muscle mass loss, neuromuscular impairment, and diminished physiological reserve, ultimately predisposing patients to disability and adverse outcomes. This review summarises the interplay between sarcopenia, frailty, and CVD, underscoring the therapeutic role of physical activity and cardiac rehabilitation (CR). Resistance training remains the cornerstone of treatment, with strong evidence for improvements in muscle strength and functional performance, although gains in muscle mass are less robust. Conventional CR programmes, however, may not suit all patients. For example, older adults recovering from transcatheter aortic valve implantation for severe aortic stenosis (AS) frequently experience early mobility limitations. In such cases, adapted interventions, including bodyweight resistance training or electrical muscle stimulation (e.g., belt electrode skeletal muscle electrical stimulation), provide safe and effective muscle activation during the recovery phase. Overcoming barriers to implementation requires personalised, scalable, and multidisciplinary approaches. Further research should refine diagnostic criteria, optimise intervention protocols, and evaluate long-term outcomes. Early, tailored rehabilitation strategies are essential in improving prognosis and preserving quality of life in this vulnerable population.