Coronary heart disease (CHD) is a highly prevalent disease in the elderly population, with atherosclerosis as its pathology, which can also be viewed as a chronic inflammatory response of the organism. Regular moderate-intensity exercise can direct the immune response toward an anti-inflammatory state, which is beneficial for improving the health and exercise tolerance. In cardiac rehabilitation, attention to the management of inflammatory factors as well as the improvement of exercise endurance is beneficial for the rehabilitation of elderly patients with coronary artery disease. This study investigates the impact of tiered cardiac rehabilitation programs on levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and the capacity for physical exertion in older CHD patients. From March 2020 to April 2022, 94 elderly patients with CHD visiting our institution were recruited and randomly allocated into either a control group or an observation group, each comprising 47 participants. The standard care group participated in traditional rehabilitation exercises, whereas the experimental group received customized, tiered, cardiac rehabilitation interventions. We assessed the variations in CRP and tumor necrosis factor alpha (TNF-alpha) levels, along with exercise capacity, before and after treatment in both groups. The result shows that significant reductions in CRP and TNF-alpha levels were seen in the experimental group after 4 and 12 weeks, compared to the standard care group. Analysis showed clear trends in CRP and TNF-alpha changes over the interventions, with the experimental group showing better results. CRP levels decreased consistently, while TNF-alpha levels stayed stable. The experimental group also showed improvements in physical endurance measures compared to the control group. Interleukin 6 (IL-6) and fibrinogen (Fib) in the observation group decreased compared with the control group (p < 0.01). After 12 weeks of treatment, CRP and TNF-alpha showed significant negative correlation with exercise endurance index- 6 min walking test (6 MWT), anaerobic threshold (AT), maximum oxygen consumption (VO 2max), and exercise duration (ED); significant positive correlation between cardiac rehabilitation grade and exercise endurance index (6 MWT, AT, VO 2max and ED); and both groups experienced cardiovascular adverse events and exercise muscle injury. The analysis shows that the graded nursing of cardiac rehabilitation can effectively reduce the levels of CRP, TNF-alpha, IL-6, and Fib in elderly patients with CHD and significantly improve the exercise endurance of patients with good safety.

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