Construction of an evidence-based exercise rehabilitation protocol for older adults undergoing heart valve intervention: A modified delphi study.
BACKGROUND Patients undergoing interventional treatment (e.g., TAVR) are predominantly older adults characterized by frailty and multiple comorbidities. While exercise-based cardiac rehabilitation is beneficial, existing guidelines are often generalized, with limited structured protocols specifically tailored to the safety needs and physical limitations of this vulnerable population. OBJECTIVES To construct an evidence-based, expert consensus protocol for exercise rehabilitation specifically tailored for older adults after interventional treatment for valvular heart disease. METHOD A systematic literature review and evidence synthesis were conducted, followed by two rounds of modified Delphi consultations with 17 multidisciplinary experts from six provinces in China. Authority coefficients (Cr) were calculated to assess expert validity, and consensus was evaluated using Kendall's W and coefficients of variation. RESULTS Expert engagement was high, with response rates of 77.3% and 100% in the two rounds, and high authority (Cr > 0.7). Consensus was achieved across feasibility, appropriateness, and effectiveness (Kendall's W, P < 0.05). The final protocol comprises 8 dimensions and 36 items. Key geriatric-focused features include preoperative frailty and fall risk assessments, staged low-intensity prehabilitation, and culturally adapted home-based exercises (e.g., Tai Chi/Baduanjin) to support safety and adherence. A multi-level safety-oriented framework was developed, incorporating risk stratification, individualized low-intensity exercise prescription, continuous physiological monitoring, and structured follow-up during rehabilitation. CONCLUSIONS This consensus-based protocol addresses the needs of older valve intervention patients by integrating safety monitoring with individualized, progressive exercise prescriptions. It provides a practical, safety-oriented framework for healthcare professionals to implement early mobilization and home-based rehabilitation, ultimately supporting functional recovery in high-risk elderly patients.