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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.
Namanja, Alice; Nyondo, Daston; Banda, Tendai; Mndinda, Ephraim; Midgely, Adrian; Hobkirk, James; Carroll, Sean; Kumwenda, Johnstone.
Affiliation
  • Namanja A; Rehabilitation Sciences Department, Kamuzu University of Health Sciences, Blantyre Malawi.
  • Nyondo D; Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre Malawi.
  • Banda T; Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre Malawi.
  • Mndinda E; Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre Malawi.
  • Midgely A; Sport and Physical Activity, Edge Hill University, England, United Kingdom.
  • Hobkirk J; School of Sport, Exercise & Rehabilitation Sciences, University of Hull, England, United Kingdom.
  • Carroll S; School of Sport, Exercise & Rehabilitation Sciences, University of Hull, England, United Kingdom.
  • Kumwenda J; School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre Malawi.
PLoS One ; 19(5): e0297564, 2024.
Article in En | MEDLINE | ID: mdl-38787817
ABSTRACT

BACKGROUND:

The delivery of Cardiac Rehabilitation (CR) and attaining evidence-based treatment goals are challenging in developing countries, such as Malawi. The aims of this study were to (i) assess the effects of exercise training/ CR programme on cardiorespiratory and functional capacity of patients with chronic heart failure (CHF), and (ii) examine the effectiveness of a novel, hybrid CR delivery using integrated supervised hospital- and home-based caregiver approaches.

METHODS:

A pre-registered (UMIN000045380), randomised controlled trial of CR exercise therapy in patients with CHF was conducted between September 2021 and May 2022. Sixty CHF participants were randomly assigned into a parallel design-exercise therapy (ET) (n = 30) or standard of care (n = 30) groups. Resting hemodynamics, oxygen saturation, distance walked in six-minutes (6MWD) and estimated peak oxygen consumption (VO2 peak) constituted the outcome measures. The exercise group received supervised, group, circuit-based ET once weekly within the hospital setting and prescribed home-based exercise twice weekly for 12 weeks. Participants in both arms received a group-based, health behaviour change targeted education (usual care) at baseline, 8-, 12- and 16-weeks.

RESULTS:

Most of the participants were female (57%) with a mean age of 51.9 ±15.7 years. Sixty-five percent (65%) were in New York Heart Association class III, mostly with preserved left ventricular ejection fraction (HFpEF) (mean Left Ventricular Ejection Fraction 52.9 ±10.6%). The 12-weeks ET led to significant reductions in resting haemodynamic measures (all P <0.05). The ET showed significantly higher improvements in the 6MWD (103.6 versus 13.9 m, p<0.001) and VO2 peak (3.0 versus 0.4 ml·kg-1·min-1, p <0.001). Significant improvements in 6MWD and VO2 peak (both p<0.001), in favour of ET, were also observed across all follow-up timepoints.

CONCLUSION:

This novel, randomised, hybrid ET-based CR, delivered to mainly HFpEF patients using an integrated hospital- and home-based approach effectively improved exercise tolerance, cardiorespiratory fitness capacities and reduced perceived exertion in a resource-limited setting.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Exercise Therapy / Cardiac Rehabilitation / Heart Failure Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Exercise Therapy / Cardiac Rehabilitation / Heart Failure Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2024 Document type: Article