Mobile Technologies to Promote Physical Activity during Cardiac Rehabilitation: A Scoping Review.

Promoting regular physical activity (PA) and improving exercise capacity are the primary goals of cardiac rehabilitation (CR). Mobile technologies (mTechs) like smartphones, smartwatches, and fitness trackers might help patients in reaching these goals. This review aimed to scope current scientific literature on mTechs in CR to assess the impact on patients' exercise capacity and to identify gaps and future directions for research. PubMed, CENTRAL, and CDSR were systematically searched for randomized controlled trials (RCTs). These RCTs had to utilize mTechs to objectively monitor and promote PA of patients during or following CR, aim at improvements in exercise capacity, and be published between December 2014 and December 2019. A total of 964 publications were identified, and 13 studies met all inclusion criteria. Home-based CR with mTechs vs. outpatient CR without mTechs and outpatient CR with mTechs vs. outpatient CR without mTechs did not lead to statistically significant differences in exercise capacity. In contrast, outpatient CR followed by home-based CR with mTechs led to significant improvement in exercise capacity as compared to outpatient CR without further formal CR. Supplying patients with mTechs may improve exercise capacity. To ensure that usage of and compliance with mTechs is optimal, a concentrated effort of CR staff has to be achieved. The COVID-19 pandemic has led to an unprecedented lack of patient support while away from institutional CR. Even though mTechs lend themselves as suitable assistants, evidence is lacking that they can fill this gap.

Physical Activity in Cardiac Rehabilitation: Towards Citizen-Centered Digital Evidence-Based Interventions.

Physical activity is a vital part of cardiac rehabilitation (CR). However, heart-healthy physical activity levels in people with cardiovascular disease drop significantly after CR. This exploratory study employs qualitative and survey methods within a co-creation approach. The aim is to understand the mechanisms of healthy behavior and habit formation in order to create a novel evidence-based (post-)rehabilitation approach that employs digital means to sustain long-term physical activity levels in people with cardiovascular disease.

Mobile Phone-Supported Physiotherapy for Frozen Shoulder: Feasibility Assessment Based on a Usability Study.

BACKGROUND: Patients with frozen shoulder show limited shoulder mobility often accompanied by pain. Common treatment methods include physiotherapy, pain medication, administration of corticosteroids, and surgical capsulotomy. Frozen shoulder often lasts from months to years and mostly affects persons in the age group of 40 to 70 years. It severely reduces the quality of life and the ability to work. OBJECTIVE: The objective of this study was to evaluate the feasibility of a mobile health (mHealth) intervention that supports patients affected by "stage two" frozen shoulder. Patients were supported with app-based exercise instructions and tools to monitor their training compliance and progress. These training compliance and progress data supplement the patients' oral reports to the physiotherapists and physicians and can assist them in therapy adjustment. METHODS: In order to assess the feasibility of the mHealth intervention, a pilot study of a newly developed app for frozen shoulder patients was conducted with 5 patients for 3 weeks. The main function of the app was the instruction for exercising at home. Standardized questionnaires on usability such as System Usability Scale (SUS) and USE (Usefulness, Satisfaction, and Ease of use), and Technology Acceptance Model-2 (TAM-2) were completed by the study participants at the end of the study. Additionally, a nonstandardized questionnaire was completed by all patients. The correctness of the exercises as conducted by the patients was assessed by a physiotherapist at the end of the study. The mobility of the shoulder and pain in shoulder movement was assessed by a physiotherapist at the start and the end of the study. RESULTS: The pilot study was successfully conducted, and the app was evaluated by the patients after 3 weeks. The results of the standardized questionnaires showed high acceptance (TAM-2) and high usability (SUS) of the developed app. The overall usability of the system as assessed by the SUS questionnaire was very good (an average score of 88 out of 100). The average score of the TAM-2 questionnaire on the intention to further use the app was 4.2 out of 5, which indicated that most patients would use the app if further available. The results of the USE questionnaires highlighted that the patients learned how to use the app easily (an average score of 4.2 out of 5) and were satisfied with the app (an average score of 4.7 out of 5). The frequency of app usage and training was very high based on patient reports and verified by analysis of the usage data. The patients conducted the exercises almost flawlessly. CONCLUSIONS: Our results indicate the feasibility of the mHealth intervention, as the app was easy to use and frequently used by the patients. The app supported the patients' physiotherapy by providing clear exercising instructions.

Training of carbohydrate estimation for people with diabetes using mobile augmented reality.

BACKGROUND: Imprecise carbohydrate counting as a measure to guide the treatment of diabetes may be a source of errors resulting in problems in glycemic control. Exact measurements can be tedious, leading most patients to estimate their carbohydrate intake. In the presented pilot study a smartphone application (BE(AR)), that guides the estimation of the amounts of carbohydrates, was used by a group of diabetic patients. METHODS: Eight adult patients with diabetes mellitus type 1 were recruited for the study. At the beginning of the study patients were introduced to BE(AR) in sessions lasting 45 minutes per patient. Patients redraw the real food in 3D on the smartphone screen. Based on a selected food type and the 3D form created using BE(AR) an estimation of carbohydrate content is calculated. Patients were supplied with the application on their personal smartphone or a loaner device and were instructed to use the application in real-world context during the study period. For evaluation purpose a test measuring carbohydrate estimation quality was designed and performed at the beginning and the end of the study. RESULTS: In 44% of the estimations performed at the end of the study the error reduced by at least 6 grams of carbohydrate. This improvement occurred albeit several problems with the usage of BE(AR) were reported. CONCLUSIONS: Despite user interaction problems in this group of patients the provided intervention resulted in a reduction in the absolute error of carbohydrate estimation. Intervention with smartphone applications to assist carbohydrate counting apparently results in more accurate estimations.

Can smartphone-based logging support diabetologists in solving glycemic control problems?

Treatment of diabetic patients strongly relies on the continuous logging of parameters relevant to glycemic control. Keeping diabetes diaries can be tedious which can affect the data quality and completeness. Mobile technologies could provide means to overcome these limitations. However, studies analyzing the direct effect on the treatment of patients are rare. In the presented study diabetic patients were supplied with a smartphone application to record various parameters relevant for glycemic control. Questions regarding the completeness of diabetes diaries were answered by the patients before and after the study. The attending diabetologist analyzed the data obtained from the smartphone-based diaries to determine whether these provided solutions for problems in glycemic control. The analysis of the available smartphone data provided the basis for therapeutic recommendations that can improve the daily glycemic control for almost all participants. Importantly, especially the newly developed implicit-activity logging, registering the participants' movements, provided important means to generate these recommendations.

Secure transport and adaptation of MC-EZBC video utilizing H.264-based transport protocols.

Universal Multimedia Access (UMA) calls for solutions where content is created once and subsequently adapted to given requirements. With regard to UMA and scalability, which is required often due to a wide variety of end clients, the best suited codecs are wavelet based (like the MC-EZBC) due to their inherent high number of scaling options. However, most transport technologies for delivering videos to end clients are targeted toward the H.264/AVC standard or, if scalability is required, the H.264/SVC. In this paper we will introduce a mapping of the MC-EZBC bitstream to existing H.264/SVC based streaming and scaling protocols. This enables the use of highly scalable wavelet based codecs on the one hand and the utilization of already existing network technologies without accruing high implementation costs on the other hand. Furthermore, we will evaluate different scaling options in order to choose the best option for given requirements. Additionally, we will evaluate different encryption options based on transport and bitstream encryption for use cases where digital rights management is required.