Journal Article

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

Rojek, Amanda, Worringham, Charles, Stewart, Ian

2011

Overview

Despite 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. We 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. The 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Angioplasty / Availability / Biotechnology/Bioengineering / Cardiac patients / Cardiovascular disease / Cardiovascular Disorders / Cardiovascular Disorders/Myocardial Infarction / Cell Phone / Change detection / Coronary Disease - physiopathology / Coronary Disease - rehabilitation / Coronary vessels / Cost effectiveness / Echocardiography / EKG / Electrocardiography / Exercise - physiology / Feasibility / Feasibility Studies / Female / Fitness training programs / Geographic Information Systems / Global positioning systems / GPS / GPS receivers / Health care / Heart - physiology / Heart - physiopathology / Heart diseases / Heart Rate / Heart surgery / Hospitals / Humans / Intervention / Male / Mental depression / Middle Aged / Monitoring, Physiologic - instrumentation / Morbidity / Mortality / Participation / Patient monitoring equipment / Patients / Physical training / Quality of life / Real time / Rehabilitation / Rehabilitation - methods / Remote monitoring / Smart phones / Smartphones / Studies / Telemedicine / Travel time / Walking / Walking - physiology / Working conditions