Cardiovascular diseases (CVDs), the leading global cause of death with 19.8 million annual fatalities (32% of total mortality), include heart failure (HF) as a major burden in sub-Saharan Africa, where hospital prevalence reaches 12.0% in Sudan, 17.6% in Burkina Faso, 28.6% in Togo, and 30% in Cameroon, affecting 1% - 3% of the global adult population with a stable incidence of 1 - 20 cases per 1000 person-years, an annual cost of €25,500 per patient, and disproportionately impacting younger, often uninsured and less-educated individuals who commonly present in advanced New York Heart Association (NYHA) functional class IV [1] - [3] . The burden of HF in SSA is rising, with in-hospital mortality ranging from 3.7% - 19.0% [4] .

HF leads to progressive physical deconditioning, impairing functional capacity and quality of life [5] . In a Cameroonian cohort, 54% of patients had moderate daily physical activity, 45% had low activity, and approximately 39.2% exhibited impaired physical fitness associated with obesity, low physical activity, and non-adherence to treatment, negatively affecting their quality of life [6] . Despite reduced mortality from medical treatments, morbidity due to deconditioning persists, increasing rehospitalisations and socioeconomic costs [7] .

Cardiovascular rehabilitation (CR), defined by the WHO as a set of activities aimed at optimising physical, mental, and social conditions [8] , improves functional capacity, reduces hospitalisations, and promotes healthy lifestyle adoption [9] . However, in SSA, CR remains underutilised due to a lack of infrastructure, trained personnel, and awareness [10] [11] . Yaoundé General Hospital (YGH), a leading teaching hospital, established its Cardiovascular and Metabolic Rehabilitation Unit (CMRU) in February 2024, a pioneering initiative for managing HF patients in a resource-constrained setting. This study aims to: 1) describe the sociodemographic, clinical, and therapeutic profiles of HF patients; 2) compare their functional capacity before and after CR; and 3) identify determinants of changes in functional capacity. These findings could inform public health policies to integrate CR into universal health coverage, reducing access inequalities and contributing to the Sustainable Development Goals by 2030 [12] .

This cohort study, conducted at YGH’s CMRU from February 2024 to May 2025, assessed the impact of CR on 33 HF patients. Results demonstrate that CR significantly enhances cardiorespiratory fitness, improves haemodynamic profiles, and reduces dyspnoea in all patients. Post-CR VO₂max_DASI was significantly associated with age, while 6 MWT distance was linked to disease duration, sex, baseline resting HR, and number of sessions.

This study aligns with international literature confirming CR benefits for HF patients. A systematic review by Sadek et al. (2021) showed that structured aerobic exercise in CR significantly improves VO₂max and LVEF in chronic HF patients [17] . For instance, Wissløff et al. (2007) in Norway reported VO₂max increases from 13 ± 1.6 to 19 ± 2.1 mL/kg/min (p < 0.01) and LVEF from 28% ± 7.3% to 38% ± 9.8% (p < 0.01) with intensive CR, while less intensive protocols showed smaller improvements (VO₂max: 13 ± 1.1 to 14.9 ± 0.9 mL/kg/min, p < 0.01; LVEF: 32.8% ± 4.8% to 33.5% ± 5.7%, p > 0.05) [18] . Our study reports comparable or superior improvements in a low-resource setting (6 MWT: +115 m; VO₂max_6 MWT: +2.0 mL/kg/min; VO₂max_DASI: +6.6 mL/kg/min; LVEF: +22.9%), highlighting CR’s efficacy despite modest infrastructure at YGH. The notable LVEF improvement (22.9%), rarely reported in SSA, may reflect the combined effect of session intensity (Borg scale 12 - 14) and therapeutic education, which potentially encouraged medication adherence (though not formally assessed in this study). However, the lack of a control group limits comparisons with randomised trials like those of Wissløff (2007) or Ellingsen (2017) [18] [19] .

The significant improvements in functional capacity and haemodynamic parameters can be attributed to the YGH CMRU’s CR programme, combining aerobic exercises (treadmill, cycle ergometer), light muscle strengthening, and therapeutic education over 10–25 sessions (mean 14.09 ± 4.3), which optimised physical reconditioning and treatment adherence, as supported by the WHO [8] . LVEF improvement may stem from better adherence to pharmacological treatments (loop diuretics: 90.9%; beta-blockers: 87.9%), reinforced by therapeutic education at the CMRU, a mechanism noted by Tüner et al. (2025) in Türkiye [20] .

Older age, limiting VO₂max improvement (β = –0.23, p < 0.001), reflects reduced functional reserve, as reported by other authors [18] - [20] . Greater 6 MWT improvement with more sessions (β = 5.44, p = 0.033) and higher baseline resting HR (β = 3.33, p = 0.007) re-emphasises the importance of session intensity and regularity, aligning with Sadek et al. (2021) [17] . The resolution of dyspnoea (97% NYHA stage I, p < 0.001) may relate to improved physical fitness and reduced oxidative stress, though the lack of a control group limits causal attribution [21] - [23] .

This study, among the first in Central Africa, reinforces CR’s feasibility in low-resource settings. Standardised tests ensure methodological robustness. However, the small sample size (n = 33) limits generalisability, and the absence of a control group complicates causal attribution. High CR costs and lack of health insurance (84.8% without coverage) may have affected adherence.

CR significantly improves functional capacity and haemodynamic parameters in HF patients in Cameroon, despite a resource-constrained setting. These findings underscore the urgency of integrating CR into universal health coverage and developing tailored infrastructure. Personalising programmes for older patients and enhancing therapeutic education could optimise outcomes, contributing to reduced cardiovascular morbidity.

What Is Known About This Topic?

What This Study Adds

The authors thank the administration of Yaoundé General Hospital for authorising this research. The authors also acknowledge the hospital staff and volunteers from the Cardiac Prevention Foundation for their collaboration, which facilitated data collection.

Data supporting the study’s findings are available from the corresponding author (SD) upon reasonable request.

The study was approved by the Ethics Committee of the University of Douala (Ref: 4796/CEI-UDo/03/2025) and YGH (Ref: 0301-25/HGY/DG/DPM/APM-AS). The requirement for informed consent was waived for the retrospective phase due to the use of anonymised secondary data. All procedures complied with applicable guidelines and regulations.

Study conception and design: TH, SD, NNE. Data collection: NNE. Data analysis and interpretation: NNE. Manuscript drafting: All authors. Final manuscript approval: All authors. KF supervised the study. SD and NNE had full access to all study data and took responsibility for data integrity and analysis accuracy. All authors agreed to submit the manuscript in its current form.