Effects of Cardiac Rehabilitation Exercise Protocols on Physical Function in Patients with Chronic Heart Failure: An Experience from a Resource Constraint Nation

Abstract

Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p < 0.05. Results: EG and CG were comparable in age and physical characteristics. Physical function and cardiovascular parameters were comparable at baseline (p > 0.05). Significant improvements were noticed at fourth week among participants' ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO2 max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no sig-* Corresponding author. T. O. Awotidebe et al. 548nificant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO 2 max (10.3 ± 0.5 mL/kg/min) (p < 0.05) than CG: ADL (42.0% ± 5.0%), 6MWD (321.0 ± 25.7 m) and VO 2 max (8.9 ± 0.4 mL/kg/min) at eighth (p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.

An Overview of Exercise Training in Cardiac Rehabilitation Programs in Sub-Saharan Africa: A Systematic Review

“…Therefore, studying, in the SSA region, the contribution of exercise training to improving physiological functions of patients with such diseases could be of great relevance. The trials involved only aerobic 14,15 and combined 16,17 training programs. In addition to pharmacological 24 and non-pharmacological therapeutic strategies, 25 exercise training is an essential intervention for improving physical function in CVD patients.…”

“…The trials included basically two different exercise programs: aerobic 14,15 and combined training. 16,17 Training sessions were held 3 times per week for 8 to 12 weeks at different training intensities.…”

Effects of cardiac rehabilitation treatment modalities in Sub-Saharan Africa: A systematic review

“…Overall, methods used in 50% of the studies [32][33][34][35][36] were rated 'good', 40% [37][38][39][40] were rated 'fair' and the remainder41 had a poor rating; statistical power was a challenge across 60% of the articles. Table 2 illustrates the results of quality assessment of the methods used in the enrolled studies.…”

“…Three studies were randomised controlled trials [32][33][34] , two studies were non-randomised controlled trials25,31 and the remainder were uncontrolled trials [36][37][38][39][40] . All except one 38 studies were prospectively done, and most of the studies (60%) were done in South Africa [35][36][37][38]40,41 , followed by Nigeria (30%) [32][33][34] and only one 39 was conducted in Benin.…”

“…Three studies were randomised controlled trials [32][33][34] , two studies were non-randomised controlled trials25,31 and the remainder were uncontrolled trials [36][37][38][39][40] . All except one 38 studies were prospectively done, and most of the studies (60%) were done in South Africa [35][36][37][38]40,41 , followed by Nigeria (30%) [32][33][34] and only one 39 was conducted in Benin. Three studies 32,33,40 examined the effect of a comprehensive CR that involved resistance and aerobic training plus counselling and education therapies, and two studies 36,38 analysed the impact of aerobic training and education.…”