Invited ReviewCardiac Rehabilitation in Frail Older Adults With Cardiovascular Disease A NEW DIAGNOSTIC AND TREATMENT PARADIGMFlint, Kelsey M. MD, MSCS; Stevens-Lapsley, Jennifer PhD, PT; Forman, Daniel E. MDAuthor Information Division of Cardiology, Rocky Mountain Regional VA Medical Center, and University of Colorado School of Medicine, Aurora (Dr Flint); Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, and Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Dr Stevens-Lapsley); and Section of Geriatric Cardiology and the Aging Institute, University of Pittsburgh, and Geriatric Research, Education, and Clinical Center and Division of Cardiology, the Veterans Administration Pittsburgh Healthcare System, Pennsylvania (Dr Forman). Correspondence: Kelsey M. Flint, MD, MSCS, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Cardiology 111B, F2-143, Aurora, CO 80045 (email@example.com). The authors declare no conflicts of interest. Journal of Cardiopulmonary Rehabilitation and Prevention: March 2020 - Volume 40 - Issue 2 - p 72-78 doi: 10.1097/HCR.0000000000000492 Buy Metrics AbstractIn Brief Older adults with cardiovascular disease (CVD) pose challenges to cardiac rehabilitation (CR) clinicians because their disease is often coupled to physical frailty. Older patients with CVD and frailty may be less likely to tolerate conventional CR exercise training due to multidimensional (ie, strength, mobility, and balance) physical impairments. Furthermore, conventional CR typically emphasizes endurance training without addressing the intrinsic skeletal muscle impairments of frail patients that often manifest as deficits in strength, mobility, and balance, undercutting feasibility and any likely benefits. However, if appropriately modified to meet the needs of frail older adults, CR may be a powerful tool for this challenging population. To best serve frail, older adults with CVD, CR programs can incorporate well-validated strategies to assess frailty and physical function that also fit within the workflows and patient populations of individual programs. Such frailty assessments provide opportunities to identify specific targets (eg, weakness) that need to be addressed before a subsequent aerobic training program can be successfully implemented and sustained. The current review focuses on the use of physical frailty measures in older adults with CVD, with practical considerations for their clinical use in contemporary CR, as well as directions for future research. Older adults with cardiovascular disease are also often frail, with multidimensional physical deficits that may preclude meaningful participation in standard cardiac rehabilitation (CR). This review focuses on enhanced physical function assessments in older CR patients to better recognize frailty as a clinical target that can potentially be addressed more effectively with novel CR approaches. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.