The safety of exercise for older patients with severe aortic stenosis undergoing conservative management: A narrative review.

The incidence of aortic stenosis (AS) increases with age and is a serious problem in an aging society. In recent years, transcatheter aortic valve implantation (TAVI) has been performed widely; however, older patients may be ineligible for TAVI or surgical treatment because of medical ineligibility. Symptom-based rehabilitation is required for these patients to maintain and improve their physical function and ability to perform activities of daily living. No studies have examined exercise safety for older patients with severe AS who are ineligible for TAVI or surgery. We summarized the safety of exercise for older patients with severe AS, collecting 7 studies on maximal exercise stress tests and 16 studies on preoperative physical examinations. From this review, it may be unlikely that exercise under appropriate management can cause hemodynamic changes, leading to death. However, there were no studies on exercise intervention for older patients with AS who are chosen for conservative management. The optimal exercise intensity for symptomatic older patients with AS undergoing conservative management and the effects of continuous exercise intervention require future study.

Relationship between the face scale for rating of perceived exertion and physiological parameters in older adults and patients with atrial fibrillation.

BACKGROUND: The Borg scale is used to determine exercise intensity in rehabilitation but can be difficult for older adults to understand. By contrast, face scale that are used to evaluate pain are much easier to understand thanks to the inclusion of illustrations. On the other hand, the prevalence of atrial fibrillation (AF) increases with age. This study aimed to determine the validity of the face scale for rating perceived exertion (RPE-face scale) in older adults and patients with AF during cardiopulmonary exercise test. Furthermore, the relationship between face scale and anaerobic threshold (AT) was also investigated. METHODS: A total of 90 patients with sinus rhythm (SR) (74 men, 16 women) and 22 with AF were enrolled. Participants' responses were recorded using the RPE-face scale and compared with exercise intensity, heart rate, oxygen uptake, and minute ventilation during the exercise test. We determined the AT by the V-slope method. RESULTS: Correlations between RPE-face scale and physiological parameters were significantly positive for men with SR and women with SR and AF. However, differences in the correlation coefficient between age and SR or AF were not statistically significant. The cutoff value for AT of the RPE-face scale was "4," showing high sensitivity and specificity. CONCLUSIONS: The RPE-face scale can be used to determine the intensity of physical exercise, unaffected by age, gender, SR, or AF.