We have previously demonstrated that elderly male cardiac patients benefit from participation in early exercise programmes through enhancement of functional capacity and improved psychological responses to exertion. Based on our experience, we present guidelines for early exercise therapy in elderly cardiac patients. It appears that no special considerations need be made to reduce risk beyond those precautions already present in a standard programme for younger patients. In general, it is recommended that exercise therapy in the elderly utilize 70-85% of maximal heart rate, 3 days per week for 40 min per session. Specific modifications include: decreasing intensity of work on certain modalities due to limitations of specific muscle groups, increasing frequency of exercise sessions for persons with particularly low functional capacity, and emphasizing flexibility exercises which should also be included in the regular exercise therapy sessions. Our experience has indicated that elderly cardiac patients have little problem with adherence and safety in the exercise programme and that standard methods of exercise prescription can be utilized with only minor modifications.