Cardiac rehabilitation (CR) is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. Cardiovascular disease is prevalent in older adults and is the leading cause of death and major disability in adults ≥75 years of age. The mean age of patients eligible for CR is increasing, with greater complexity and specific geriatric features, such as multimorbidity, frailty, and disability. In this population, CR interventions should be aimed to prevent disability and preserve the residual functional capacity. Every patient should be assessed with a multidimensional evaluation that includes clinical, functional, emotional, cognitive and social domains. Exercise-based CR programs have shown to be effective in improving function and quality of life, by reducing disability and age-related deconditioning and contributing favorably to improved health outcomes in an aged population. Very old and frail patients seem to get an even greater potential benefit, and an early start after an acute event can prevent the post-hospital syndrome. Despite these proven benefits, CR is often underused in this population and a great effort should be done to encourage them to attend these programs. There are just a few studies about CR programs in very old and frail patients, therefore a future goal should be to fill this gap.