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.

Autor: 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.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 May 24; Vol. 19 (5), pp. e0297564. Date of Electronic Publication: 2024 May 24 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0297564
Abstrakt: 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.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Namanja et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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