An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise.

Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping "desired behaviours" into specific system's specifications, borrowing concepts from Fogg's Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.

Internet-based training of coronary artery patients: the Heart Cycle Trial.

Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System). This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity, arrhythmias and adherence to training prescriptions, wirelessly via the internet, to a medical team that provided feedback and adjusted training prescriptions. Exercise capacity was evaluated prior to and 6 months after intervention. 118 patients (58 ± 10 years, 105 men) with CAD referred for CR were randomized (IG: n = 55, CG: n = 63). However, 15 patients (27 %) in the IG and 18 (29 %) in the CG withdrew participation and technical problems prevented a further 21 patients (38 %) in the IG from participating. No training-related complications occurred. For those who completed the study, peak VO2 improved more (p = 0.005) in the IG (1.76 ± 4.1 ml/min/kg) compared to CG (-0.4 ± 2.7 ml/min/kg). A newly designed system for home-based CR appears feasible, safe and improves exercise capacity compared to national CR. Technical problems reflected the complexity of applying remote monitoring solutions at an international level.

Evaluation of a newly designed shirt-based ECG and breathing sensor for home-based training as part of cardiac rehabilitation for coronary artery disease.

BACKGROUND: Participation in phase-III cardiac rehabilitation (CR) remains low but adherence could potentially be improved with supervised home-based CR. New technological approaches are needed to provide sufficient supervision with respect to safety and performance of individual exercise programmes. DESIGN: The newly designed closed-loop tool, HeartCycle's guided exercise (GEX) system, will support professionals and patients during exercise-based CR. Patients wear a dedicated shirt with incorporated wireless sensors, and ECG, heart rate (HR), breathing frequency (BF), and activity are monitored during exercise. This information is streamed live to a mobile device (PDA) that processes these parameters. METHODS: A phase-I study was performed to evaluate feasibility, function, and reliability of this GEX device and compare it to conventional cardiac exercise testing (CPX, spiroergometry) in 50 patients (seven women, mean ± SD age 69 ± 9 years, body mass index 26 ± 3 kg/m(2), ejection fraction 58 ± 10%). ECG, HR, and BF were monitored using standard equipment and the GEX device simultaneously. Furthermore, HR recorded on the PDA was compared with CPX measurements. RESULTS: The fit of the shirt and the sensor was good. No technical problems were encountered. All occurring arrhythmia were reliably detected. There was an acceptable comparability between HR on the GEX device vs. CPX, a good comparability between HR on the PDA vs. CPX, and a moderate comparability between BF on the GEX device vs. CPX CONCLUSIONS: Comparability between CPX and the GEX device was acceptable for HR measurement and moderate for BF; arrhythmias were reliably detected. HR processing and display on the PDA was even better comparable. The whole system seems suitable for monitoring home-based CR. Further studies are now needed to implement training prescription to facilitate individual exercise.

BIOTEX--biosensing textiles for personalised healthcare management.

Textile-based sensors offer an unobtrusive method of continually monitoring physiological parameters during daily activities. Chemical analysis of body fluids, noninvasively, is a novel and exciting area of personalized wearable healthcare systems. BIOTEX was an EU-funded project that aimed to develop textile sensors to measure physiological parameters and the chemical composition of body fluids, with a particular interest in sweat. A wearable sensing system has been developed that integrates a textile-based fluid handling system for sample collection and transport with a number of sensors including sodium, conductivity, and pH sensors. Sensors for sweat rate, ECG, respiration, and blood oxygenation were also developed. For the first time, it has been possible to monitor a number of physiological parameters together with sweat composition in real time. This has been carried out via a network of wearable sensors distributed around the body of a subject user. This has huge implications for the field of sports and human performance and opens a whole new field of research in the clinical setting.

Getting rid of the wires and connectors in physiological monitoring.

One of the main limitations towards an easy-touse, comfortable, and reliable product for physiological monitoring comes from wires and associated connectors. Wireless solutions for data transmission are more and more common in every domain, but for biopotential and impedance measurements, at least one galvanic line will always be needed. This paper describes a new technology that can make possible the measurement of biopotentials and body impedances with high quality standard using only one wire. As this wire requires neither shield nor isolation, one can imagine a conductive garment that simply connects several sensors distributed over the body. From the user point of view, the product would be 'cableless'.

Continuous monitoring of coordinated cardiovascular responses.

The continuous separate monitoring of cardiac and vascular functions provide important insights on cardiovascular regulation. In the last years several attempts have failed at demonstrating the feasibility of using Pulse Wave Velocity as a surrogate indicator of arterial blood pressure. Upon the hypothesis that the cause of PWV unreliability is vasomotor activity, in this paper we develop an extended model of lumped arterial tree that copes with changes in vessels diameter. The benefit of this approach is twofold: on the one hand one might correct the effects of vasomotor activity on the estimation of arterial blood pressure on the basis of PWV, and on the other hand one obtains continuous non-invasive estimations of Cardiac Output and Total Peripheral Resistance.

Smart garments for safety improvement of emergency/disaster operators.

The main purpose of the European project ProeTEX is to develop equipment to improve safety, coordination and efficiency of emergency disaster intervention personnel like fire-fighters or civil protection rescuers. The equipment consists of a new generation of "smart" garments, integrating wearable sensors which will allow monitoring physiological parameters, position and activity of the user, as like as environmental variables of the operating field in which rescuers are working: both commercial and newly developed textile and fibre based sensors will be included. The garments will also contain an electronic box to process data collected by the sensors and a communication system enabling the transmission of data to the other rescuers and to a monitoring station. Also a "smart" victim patch will be developed: a wearable garment which will allow monitoring physiological parameters of injured civilians involved in disasters, with the aim of optimizing their survival management.

On-body diagnosis for wearable systems serving biomedical needs.

Early diagnosis as well as a healthy and preventive lifestyle can help slowing the onset of many health problems and save millions of lives per year. To achieve this objective, long-term monitoring of human vital signs are required to obtain knowledge on a person's health status. Continuous monitoring of vital signs is mandatory, but continuous transmission is expensive, in terms of financial costs as well as power consumption for battery operated portable systems. Clothing is like a second skin to us: intelligent biomedical clothes may make everyday life easier for people in poor health, helping them to lead productive lives, senior citizens and also for athletes. Clothing means fashion and fun: smart clothes will combine health problem prevention, entertainment, comfort, convenience and communication with fashion. This paper presents essential issues in wearable electronics, including interface with the garment, signal sensing and enhancement, signal processing of signal combination, on-body diagnosis and on-body and distant communication. The paper reports on experience acquired through related projects running at the Swiss Center for Electronics and Microtechnology.

Homecare: a telemedical application.

The advent of telecommunication and information technologies and the miniaturisation of technologies have enabled the evolution of telemonitoring systems. Early systems for hospitals and clinics, which usually required the patients to be wired to desktop devices, have evolved into homecare that requires devices to be lighter and simpler to use. In addition to miniaturisation and extended autonomy, further requirements for the telemonitoring system include local intelligence (that is, the system can take decisions without referring to external advice) and no moving parts to allow the patient to move freely during measurement periods. Body and local communication networks can prolong the connection of the homecare patient with a monitoring centre through the public networks. Additional medical functions and processing have been added to homecare equipment for telemedicine and patient discomfort is decreasing because of miniaturisation, autonomy and increased versatility of new systems. The applications have evolved rapidly from manually triggered alarms and single physiological parameter monitors to autonomous telemedical monitoring tailored to complete needs. This will eventually make telemedicine beneficial to patients, doctors and society.