Purpose: Although cardiac rehabilitation (CR) implementation models for resource-constrained areas recommend delivery of any CR treatment components, Sub-Saharan Africa (SSA) constitutes only 17% of globally available CR programs. The aim of this systematic review was to examine the efficacy of employing any CR treatment modality in SSA and assess if this approach of delivery should be encouraged in this resource-constrained region.

Methods: 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.

Results: 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.

Conclusion: The findings of this review supports delivery of exercise treatment modality and comprehensive delivery of CR in SSA. However, efficacy of independent implementation of other CR treatment modalities such as education and psychosocial remains unclear; hence the need for further investigations. Additionally, the future studies should consider increasing sample size and assessing the impact on clinical outcomes such as mortality, morbidity and hospital admission rates.

Implications: Using the existing CR models, countries in SSA should be able to champion rehabilitation of patients with cardiovascular disease (CVD). In addition, there is need to ensure that the management guidelines for CVD in SSA incorporate CR as part of the holistic care.

Funding and acknowledgement: The scholar benefitted from Commonwealth Scholarship for 2018-2019 cohort. The scholar acknowledges the academic support from Doctor Mike Morris and Professor Stephan Fallows of University of Chester.

Key words: Cardiac Rehabilitation, Models, Sub-Saharan Africa