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

Abstract

Purpose Although Cardiac Rehabilitation (CR) implementation models recommend delivery of any CR treatment component, Sub-Saharan Africa (SSA) constitutes only 17% of globally available CR programs. The aims of this review were to assess the benefits of employing any CR treatment modality in SSA, and evaluate if this approach should be encouraged in this resource-constrained region.MethodologyRecords were identified electronically via CINAHL, MEDLINE, Cochrane library, African journal online, PubMed, Web of science and google scholar, and grey literature was hand-searched. Articles reporting effectiveness of any CR treatment modality were included if participants had any cardiovascular disease and if the study was conducted in SSA. Quality assessment for each enrolled study was done using Downs and Black (1998) checklist and data was extracted using a modified standard tool.ResultsSearches identified 1666 records, 24 full text articles were examined and 10 were included for the review; 60%, 30% and 10% of the enrolled studies were done in South Africa, Nigeria and Benin respectively. The studies implemented exercise, psychosocial and education treatment modalities of CR, and the approach of delivery was either comprehensive or modified. Comprehensive CR and delivery of combined aerobic and resistance exercises improved physical (13%, p=0.001), social (40%, p=0.001) and mental aspects of quality of life and reduced anxiety (-12%, p<0.05) and depression (-6%, p<0.001) respectively. Comprehensive CR and aerobic training both reduced systolic blood pressure (range of mean reduction [RMR] -6 to -14mmHg), diastolic blood pressure (RMR -4 to -6mmHg) and resting heart rate (RMR -7 to -17bpm). Overall, all types of exercises showed a 1-5ml.kg-1.min-1 increase in peak oxygen consumption.ConclusionThe findings support delivery of exercise treatment modality and comprehensive delivery of CR in SSA. However, efficacy of independent implementation of education and psychosocial therapeutic components of CR remains unclear; hence the need for further investigations

Interest of Cardiac Rehabilitation in Patients with Heart Disease in a Cardiology Department in Senegal

“…In general, better glycemic control is observed with physical activity. Physical exercise in cardiac patients has a beneficial effect widely demonstrated in many studies [19] [20] [21] [22] [23]. They showed an improvement equivalent to treatment with beta-blockers [11] [24] [25].…”

Quality of Acute Coronary Syndrome Care and in-hospital Outcome in a Resource-poor Setting in Northern Ghana

“…Despite its proven bene ts and the increasing burden of cardiovascular diseases, little emphasis has been placed on cardiac rehabilitation programs in the African region where it is almost nonexistent [44]. Available evidence, however, supports the feasibility and bene t of a cardiac rehabilitation program, whether in its comprehensive form or modi ed to suit the local context, in low-income countries in Africa [45,46].…”

Delivering effective, comprehensive, multi-exercise component cardiac rehabilitation (CR) for chronic heart failure patients in low resource settings in sub-Saharan Africa: Queen Elizabeth Central Hospital—(QECH-CR) randomised CR study, Malawi

“…In this regard, CR is underutilized on the African continent and has been reported to be non-existent in Malawi and many other parts of Africa [20], and patients with CHF rarely receive the holistic CR intervention. Several models of delivering CR have been suggested, which encourage developing settings to use low-cost resources and approaches to increase accessibility and utilization of the intervention [21,22].…”