Purpose of Review With recent improvements in cardiovascular care and prevention, the demographic of individuals enrolled into cardiac rehabilitation (CR) is shifting towards an older set of individuals. Management plans for elderly cardiovascular patients must consider processes associated with aging, sarcopenia, cognitive impairment, and inflammation all contributing to declining functional capacity.; Recent Findings Increased debility at baseline does not translate into a significantly higher risk associated with physical activity but does require better access. High-intensity interval training protocols have shown benefits while preserving safety over the standard of moderate-intensity continuous training.; Summary In elderly populations, CR needs to include more than just exercise; addressing psychosocial stress burdens as an independent part of CR has the potential to improve adherence and outcomes. Doing this through new programs and at home and through mobile devices has the potential to greatly increase adherence and access, and can help remedy current underutilization of CR in the US medical system.