Sam Olden is the Head of Clinical and Consultant Physiotherapist at CP+R (Clinical Prevention and Rehabilitation). He is a member of the BGS Falls and Bone Health SIG Committee.
World Physiotherapy Day 2026 takes place on 8 September, and this year’s theme focuses on cardiovascular disease and stroke. As a physiotherapist who has worked across both frailty and cardiovascular care, I am pleased to have the opportunity to use this day as a reminder of how we can influence the cardiovascular health of older adults and why it is important that we do just that.
Cardiovascular disease (CVD) is the leading cause of death globally, responsible for more than 30% of global deaths. Yet much of the cardiovascular disease burden can be prevented or managed with robust lifestyle change and medical management.
I first became involved in cardiovascular medicine while working in cardiac rehabilitation. Since then, I have spent time working as a Consultant Practitioner in Frailty, served as an Executive Committee member for the British and Irish Hypertension Society and have come back full circle, returning to work within private cardiac rehabilitation for CP+R (Clinical Prevention and Rehabilitation). One of the key things that keeps drawing me back to working with people with, or at risk of, cardiovascular disease is the sheer strength of opportunities we have to alter the course of someone’s disease trajectory and, if done at scale, the health of a whole population.
As a physiotherapist, this allows me to use my whole spectrum of skills to support behaviour change through lifestyle choices, employ exercise as medicine and use my latterly acquired prescribing knowledge to support medical management as part of the wider MDT.
Working in cardiac rehabilitation (CR), one of our biggest challenges is uptake. We have a plethora of evidence for how effective this intervention can be, particularly for older adults. However, the latest national data shows that in most places around one in two individuals will not take up the offer of CR, and this drops to just over one or two in 10 taking up the offer with heart failure.
Unfortunately, frailty is often seen as a reason not to refer or take up CR. Conversely, frailty is not a contraindication, it is a strong indicator of the need for CR. When we further scrutinise the national data, we see a higher dropout rate in CR for those from lower socioeconomic areas, which we know is compounded for older adults through limited social support and supportive pathways.
Improving uptake in CR, particularly in older adults, must be a national priority, for the following reasons:
- Older adults often have the most to benefit physically, psychologically and socially from CR.
- Older adults often have the highest clinical need with higher proportions of multimorbidity, polypharmacy and modifiable risk factors.
- CR is a cost-effective model of care that mirrors much of what we support in wider frailty care through multifactorial assessment and treatment with a combination of personalised lifestyle and medical interventions.
- CR has the opportunity through technology to reach more older adults than ever through hybrid, remote and in-person programmes, remote monitoring systems and flexible means of delivery.
So how do we improve uptake for older adults in CR?
I feel strongly that we must first recognise that frailty is a reason to refer, not to exclude. We can reframe CR to be a wider lifestyle and activity intervention based around ‘resilience’ training – not just exercise classes for the heart.
We need to ensure programmes are adapted for functional limitation, frailty and working with older adults; for example, to include frailty and falls prevention training for staff and attendees.
We should also offer flexible formats to reduce inaccessibility for individuals who can no longer drive or are unable to use public transport. Delivering a virtual programme is a perfect example of this and has been shown to be just as effective.
On a system level, we need to integrate CR into more pathways for easier access and work closely with patients to understand what the barriers are to local uptake. This includes opening programmes to heart failure more readily and including preventative pathways.
My message for this year’s World Physiotherapy Day is a call to action that frailty should prompt referral to CR, not prevent it. CR should share a common goal and outcomes with the wider geriatric medicine community and with uptake as low as it currently is, we have a significant opportunity to alter the course of CVD trajectories and, in turn, the national impact on the health of our older adult population.
