Although cardiac rehabilitation is currently underused in patients who have undergone percutaneous revascularization, heart transplantation, and heart valve surgery, and in patients with chronic heart failure, the efficacy of this important therapeutic modality warrants its more widespread application. Cardiac rehabilitation and supervised exercise training are effective for increasing functional capacity, favorably modifying disease-related risk factors, decreasing symptoms, detecting the signs and symptoms of disease before they become serious complications, and improving quality of life for affected patients. Among the limitations in the literature for the diagnoses discussed are studies with small sample sizes and the lack of adequate control groups. Furthermore, the intervention used has mostly been exercise training without the broader range of secondary prevention components that are currently recommended for cardiac rehabilitation, such as patient education, risk factor modification, and nutrition counseling, all of which are likely to augment the proven benefits of exercise. Clinicians should recognize that there are no supportive data for the efficacy of casual advice such as “go home and walk,” “lose some weight,” and “cut the fat in your diet.” A formal referral to cardiac rehabilitation would increase the likelihood of participation and long-term compliance. A supervised hospital-based or clinic-based program, which assures that patients are receiving an appropriate exercise prescription in a safe environment, with related comprehensive lifestyle modification programs, represents the best opportunity for patient success. The challenge for cardiac rehabilitation programs is to provide services that are appropriate for older patients so that they can take full advantage of this effective therapy, thereby optimizing independence, health, and quality of life.