The research team posits that cardiac rehabilitation can greatly improve the prognosis of heart failure patients and also prevent cognitive decline, but the rate in Japan is low as Yamaoka-Tojo highlights: "The participation rate of cardiac rehabilitation during the recovery phase in Japan is significantly lower than in Europe and the US, and great expectation is gathered from the viewpoint of improving prognosis of patients with CVD, suppression of medical expenses, and prevention of long-term care." She and her team hope the situation can be improved through research and education. Yamaoka-Tojo and her team are exploring the association between CVD and cognitive impairment. They are seeking to decipher whether cardiac rehabilitation for chronic heart failure patients can prevent the progression of cognitive dysfunction. This is an area of research that has previously been overlooked, as Yamaoka-Tojo explains: "The main reason for this is that only in Japan are there so many elderly people over 100-years-old. The super-ageing society is accelerating at a tremendous speed and enough research has not been done until now." Important discoveries: The researchers believe that vascular endothelial dysfunction is caused by a disorder of the vascular endothelial glycocalyx (EC-GLX) layer. They have made a number of discoveries to date, namely that comprehensive cardiac rehabilitation improves the vascular endothelial function and cognitive function of elderly chronic heart failure patients. "Comprehensive cardiac rehabilitation aimed at patient education on disease management and increased physical activity is useful for suppressing the increase of elderly heart failure patients with multi-disease prevalent cognitive decline," Yamaoka-Tojo explains. The researchers are now conducting a longitudinal cross-sectional study that involves the risk assessment of CVD and cognitive function targeting an EC-GLX embrittled area, comprehensive rehabilitation using this index on the prevention of cardiovascular disease progression and usefulness in improving cognitive function. Looking ahead, they intend to use the EC-GLX evaluation clarified by their research to identify the effects of CVD management and cardiac rehabilitation. Ultimately, they hope to ensure good health in the ageing population in Japan and beyond.