Department of Physiotherapy, Kamuzu University of Health Sciences, Malawi.
Department of Physiotherapy, Apollo Hospital, India.
Malawi Med J. 2021 Dec;33(4):287-296. doi: 10.4314/mmj.v33i4.10.
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.
Records 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.
Searches 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.
The 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.
尽管心脏康复（CR）实施模式建议提供任何 CR 治疗成分，但撒哈拉以南非洲（SSA）仅占全球可用 CR 计划的 17%。本研究的目的是评估在 SSA 采用任何 CR 治疗方式的益处，并评估在这个资源有限的地区是否应该鼓励这种方法。
通过 CINAHL、MEDLINE、Cochrane 图书馆、非洲在线期刊、PubMed、Web of Science 和谷歌学术电子检索记录，并手动检索灰色文献。如果参与者患有任何心血管疾病，且研究在 SSA 进行，则纳入报告任何 CR 治疗方式有效性的文章。使用 Downs 和 Black（1998）清单对每一项纳入研究进行质量评估，并使用修改后的标准工具提取数据。
检索确定了 1666 条记录，检查了 24 篇全文文章，10 篇文章被纳入综述；纳入研究中，60%、30%和 10%分别在南非、尼日利亚和贝宁进行。这些研究实施了运动、心理社会和教育 CR 治疗方式，并且采用了综合或改良的方法。综合 CR 和联合有氧和抗阻运动的实施改善了身体（13%，p=0.001）、社会（40%，p=0.001）和心理方面的生活质量，降低了焦虑（-12%，p<0.05）和抑郁（-6%，p<0.001）。综合 CR 和有氧运动都降低了收缩压（平均降低幅度[RMR]为-6 至-14mmHg）、舒张压（RMR-4 至-6mmHg）和静息心率（RMR-7 至-17bpm）。总的来说，所有类型的运动都使峰值摄氧量增加了 1-5ml.kg-1.min-1。
研究结果支持在 SSA 实施运动治疗方式和综合实施 CR。然而，CR 的教育和心理社会治疗成分独立实施的效果尚不清楚；因此，需要进一步的研究。
