Barriers to Cardiac Rehabilitation Implementation and uptake in Africa: A Scoping Review Protocol

Cardiovascular disease (CVD) represents the most significant non-communicable disease burden globally, contributing more to morbidity and mortality than any other condition. Africa carries a disproportionately heavy portion of this burden, with CVDs remaining the leading contributors to illness and death across the region. As a critical secondary prevention strategy, Cardiac Rehabilitation (CR) offers a multidisciplinary framework designed to enhance patient recovery and prevent future cardiac events. Modern CR has advanced into an inclusive approach that integrates traditional exercise-based training with comprehensive education, nutritional and weight management, risk factor modification, and counseling personalized to individual patient needs. Traditionally delivered through center-based models, CR is now increasingly complemented by pioneering non-center-based remote approaches utilizing telehealth, virtual reality, wearable sensor-assisted home programs, and smartphone applications. While evidence suggests that home-based CR is a safe and effective alternative—showing outcomes comparable to center-based delivery—the specific landscape of these programs across Africa remains poorly understood. Despite the established benefits of CR in improving functional status and long-term quality of life, its availability and utilization across the continent are critically limited. The primary challenge lies in the multidimensional barriers to CR in Africa, which span patient-level, technological, and systemic domains. At the patient level, limited digital literacy and physical comorbidities are often compounded by cultural fatalism and gender-based restrictions on health autonomy. These issues are intensified by structural technology barriers, such as unreliable connectivity and high data costs, alongside severe health system failures characterized by a near-total absence of formal programs and trained professionals. Furthermore, socioeconomic and contextual challenges, including language mismatches and rural isolation, prevent equitable access, while cross-cutting issues like a weak local evidence base hinder the scaling of sustainable solutions. This paper aims to explore these barriers to provide a foundation for co-designed, hybrid models that can ensure effective CR delivery within the African context.