Development and Feasibility of a Smartphone, ECG and GPS Based System for Remotely Monitoring Exercise in Cardiac Rehabilitation

Abstract

BackgroundDespite its efficacy and cost-effectiveness, exercise-based cardiac rehabilitation is undertaken by less than one-third of clinically eligible cardiac patients in every country for which data is available. Reasons for non-participation include the unavailability of hospital-based rehabilitation programs, or excessive travel time and distance. For this reason, there have been calls for the development of more flexible alternatives.Methodology and Principal FindingsWe developed a system to enable walking-based cardiac rehabilitation in which the patient's single-lead ECG, heart rate, GPS-based speed and location are transmitted by a programmed smartphone to a secure server for real-time monitoring by a qualified exercise scientist. The feasibility of this approach was evaluated in 134 remotely-monitored exercise assessment and exercise sessions in cardiac patients unable to undertake hospital-based rehabilitation. Completion rates, rates of technical problems, detection of ECG changes, pre- and post-intervention six minute walk test (6 MWT), cardiac depression and Quality of Life (QOL) were key measures. The system was rated as easy and quick to use. It allowed participants to complete six weeks of exercise-based rehabilitation near their homes, worksites, or when travelling. The majority of sessions were completed without any technical problems, although periodic signal loss in areas of poor coverage was an occasional limitation. Several exercise and post-exercise ECG changes were detected. Participants showed improvements comparable to those reported for hospital-based programs, walking significantly further on the post-intervention 6 MWT, 637 m (95% CI: 565–726), than on the pre-test, 524 m (95% CI: 420–655), and reporting significantly reduced levels of cardiac depression and significantly improved physical health-related QOL.Conclusions and SignificanceThe system provided a feasible and very flexible alternative form of supervised cardiac rehabilitation for those unable to access hospital-based programs, with the potential to address a well-recognised deficiency in health care provision in many countries. Future research should assess its longer-term efficacy, cost-effectiveness and safety in larger samples representing the spectrum of cardiac morbidity and severity.

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

“…However, home based programs had higher completion rates with a significantly higher adherence (95% CI 1.01 to 1.07). 33 A C C E P T E D M A N U S C R I P T 38 In the Heartcycle study, session adherence was high, but exercise time and early cessation of sessions were problematic, and completion of phase II was only 34%. 39 Nevertheless, interest by patients in mobile options is high 40 and there are data that mobile health interventions in the form of text messaging improve compliance with existing CR programs.…”

The Effect of a Memory Training Application for a Patient with Traumatic Brain Injury

“…These studies have been performed using internet-based virtual reality or computer software programs. With the rapid spread of tablet PCs and smartphones, many applications have been developed for rehabilitation 11,13,15,16,19,20) . Some studies have demonstrated the usefulness of smartphones for improvement of memory impairment [22][23][24] .…”

“…With the rapid development of modern technology and the use of computers in communications, many applications and telerehabilitation programs have been developed for rehabilitation various functions, including cognition [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . However, little is known about applications for memory training based on telerehabilitation for patients with TBI.…”

ECG Signal Classification for Remote Area Patients Using Artificial Neural Networks in Smartphone

“…Thus, significant parameters are found from complex relationship between inputs and outputs. Various study about remote monitoring and diagnosis utilized different technology like smartphone and GPS [9], [10]. One of those is the application of mobile technology and cloud computing that inspired various designs of health monitoring system [11].…”