CH702558A1 - Rehabilitative and preventive cardiopulmonary training system comprises a control center, one or more training centers and personal mobile devices for interfacing with monitoring equipment - Google Patents

Abstract

Training system comprises a control center (20), one or more training centers (61, 62, 63) equipped with training equipment and monitoring equipment (80) with an electrocardiogram communication interface (89) for exchanging data with the control center. Personal mobile devices (90) which are assigned to the patients interface with the monitoring equipment and comprise a memory device on which a patient-specific training program is recorded. The monitoring equipment is programmed to guide and monitor the training dependent on the program recorded on the personal mobile device of the patient and for transmitting training-activity data to the control center via the communication interface.

Description

Technical domain

[0001] The present invention relates to an interactive primary and secondary cardio-pulmonary prevention system comprising a continuous ECG monitoring and a thoracic impedance channel.

State of the art known

[0002] Regular aerobic physical activity has favorable effects on body weight, blood pressure, plasma lipids, glucose tolerance and insulin sensitivity, and may also have a direct protective effect against the onset of acute cardiac events . Furthermore, regular exercise has favorable psychological effects. Few occupations, in modern industrialized society, require a workload compatible with maintaining good cardiovascular well-being. Therefore practicing sufficient aerobic exercise during leisure time has become an important part of a healthy lifestyle and prevention of coronary heart disease.

[0003] Particularly in the case of individuals suffering from a cardiac pathology or presenting predisposing risk factors for these pathologies, it is essential to prescribe individualized programs adapted to the individual patient, on the basis of the functional, clinical and social context, in order to be able to obtain the best possible compliance, achieve optimal physical condition improvement and reduce the risk of pathological events, following a specific cardio-vascular training program.

[0004] Ideally, these training sessions are performed in post-cardiac rehabilitation facilities; however, they offer a limited number of places, are more expensive than ordinary gyms, and are not easily accessible to all patients. Many patients suffering from milder, or relatively young, diseases encounter psychological difficulties to integrate into a rehabilitation facility, and would prefer to follow a preventive or rehabilitative training plan in a gym, fitness center, or home.

Short summary of the invention

[0005] An object of the present invention is to propose a preventive and rehabilitative training system which is free from the limitations of known systems. According to the invention, these objectives are achieved by means of the object of the appended claims.

Brief description of the figures

[0006] An example of the realization of the invention will be followed with the help of the figures which illustrate:

[0007] Fig. 1 shows the system of the invention in the form of a diagram and illustrates the transfer of data and instructions between its components

[0008] Fig. 2 shows a monitoring device equipped with a personal mobile device, according to an aspect of the invention.

[0009] Fig. 3 illustrates a chest belt that can be used in the context of the invention.

Examples of ways of achieving the invention

[0010] The present invention, designated with the «Cardyou» brand, is a highly customizable system for monitoring and quantifying cardiovascular, preventive and rehabilitative training, aimed at progressively improving physical and cardiological performance, both in public and private settings. With reference to the figures, the structure includes Software 25 for entering personal customer data, managing, developing, controlling and transmitting updates and managing emergencies. The data concerning the training are detected with the help of a thoracic band 70. A hardware monitoring device 80 applicable to the apparatus for cardiovascular training, for data visualization, quantification of the effort and activation of emergencies, integrated by an apparatus mobile data transmission personnel 90. The format (3.1.) Of the structure includes no or more control centers 20, called "hubs", preferably comprising or linked to a medical center 22, responsible for the initial screening and software update, to which the relative training centers refer. called "Spoke" 61, 62, 63 public or private where the workout is performed physically,

[0011] According to one aspect of the invention, patients / clients are subjected to an initial screening. Preferably the initial screening takes place in the hub center 20, but it could also be done in other locations, for example with cardiologists or rehabilitation specialists. The screening aims to achieve one or more of the following objectives: customization subject to discussion of the status; First subdivision in primary prevention and secondary prevention; Evaluation of physical parameters: «Height - Weight - Body composition - Age - Sex Next and remote medical history divided by primary or secondary prevention with data obtained from ergometrid tests: Heart rate Blood pressure Double product Dynamic curves of Fc and Pa Vo2max

Software.

[0012] On the basis of the data obtained in the initial screening phase, and of the evaluation of a cardiologist or an expert, the software 25 determines a training-treatment plan which is registered in a personal portable device 90 which is delivered to the patient. The portable personal device 90 comprises a memory, preferably a non-volatile flash memory, and a connection interface 96. In a preferential variant, illustrated in fig. 2, the portable personal device is a flash memory with a USB interface. However, it would also be possible to use other types of media, such as an «SD» type memory card, or a microprocessor card, or any other appropriate computer data support.

[0013] In the example illustrated by the figures, the training-treatment plan is registered in the personal mobile apparatus 90, and, when the patient goes to a "center" 61, 62, 63 to carry out a training, the apparatus is interfaced to a monitoring apparatus 80 connected with a training machine. In this way the training plan is transferred to the monitoring apparatus 80 (arrow 50 of fig. 1). In a possible variant, it would also be possible, without departing from the scope of the invention, to record the training plan in a centralized database, for example in the hub center 20, and to record sufficient information in the mobile personal apparatus. to allow the monitoring apparatus 80 to obtain the training plan through its communication interface 89 and via the internet 120.

[0014] The physical training-treatment plan can have different forms and foresee different cycles of activity and / or control visits. For example, it could include an initial cycle of 3 months, a second quarterly cycle and then semi-annual cycles, suitably integrated with control visits. The training program provides different modes of activity depending on the underlying pathology to be treated and according to the time of training; and different degrees of load depending on the individual, the activity and the training program. It is essential to prescribe individualized programs adapted to the individual patient, based on his functional, clinical and social context, in order to obtain the best possible compliance. The monitoring device 80, as will be seen better below, is connected to the prescribed training tool (p, eg carpet, bike, step, etc.) and to a sensor of clinical parameters 70, and allows continuous monitoring patient activity and its compliance with the established training plan.

[0015] According to an important aspect of the invention, as will be explained further below, the monitoring device 80 comprises a communication interface 89, for example a WiFi interface, or an Ethernet interface, or a CDMA interface , which allows him to connect to the Internet 120 and establish a two-way communication channel with the hub center 20 during training. Thanks to this feature, the "hub" center receives the patient's training data in real time. These can be analyzed, immediately or at a later time. Preferably the system also provides the possibility that the hub center 20 transmits commands to the monitoring unit 80, for example to make messages appear on the display 85, request information, and / or dynamically modify the training plan registered in the mobile device 90.

[0016] The data relating to the training plan recorded in the mobile device 90 through the software 25 should preferably establish the intensity, duration and frequency, depending on the clinical and personal parameters of the patient, obtained in the screening. The intensity of the exercise, for healthy subjects, is for example defined in terms of target heart rate during maximal exercise, which should be equal to 60-75% of the expected maximum average heart rate for age. This target heart rate is easily achieved with exercises that involve the use of large muscle masses. Walking fast, cycling are examples of these activities and exercises, which can be carried out with appropriate training machines.

[0017] The duration of physical activity should preferably be 30-40 min, including 10 mm of the warm-up phase before the 20-30 min of the aerobic phase, followed by 5-10 min of recovery at the end; the frequency should be 4-5 times a week. Alternatively, with an increase in the duration of aerobic exercise, 2-3 times a week is sufficient. When a previously sedentary subject wishes to become physically active, both the intensity and the duration of the aerobic exercise must be low at the beginning, with an increase parallel to the improvement of the physical well-being obtained.

[0018] For example, the invention system incorporates recommendations on physical activity for patients with already diagnosed coronary artery disease based on a global clinical judgment, including the results of the exercise test. Patients with stable angina pectoris, for example, often get a marked subjective benefit from regular and gradually increasing exercise, but their antianginal medical treatment must be optimized before starting such a program. The intensity and duration of the activity should be low at the beginning and gradually increased according to the limits imposed by the symptoms induced by the exercise. The target heart rates for aerobic exercise in healthy subjects are not applicable to patients treated with B-blockers and, in general, exercise intensity in patients with angina symptoms should not be too "ambitious", patients from acute myocardial infarction or from other ischemic events! and similarly, patients undergoing coronary angioplasty or coronary artery bypass grafting should be advised about the appropriateness of an acceptable physical activity program with gradual increase.

[0019] According to an aspect of the invention, the monitoring device 80 concentrates and transmits to the hub center 20 and to the software 22 the physical / mechanical data coming from the training machine (for example: cadence, speed, power, duration, average values) in association with involuntary data coming from the sensor 70. In a preferential variant of the invention, the sensor 70 comprises a thoracic band in inert material with EGC electrodes 75, preferably twelve in number. Preferably the band is made of inert material and has qualities of resilience, elasticity and flexibility so as to combine a perfect adherence of the electrodes to the chest and ease of use. Preferably, the sensor 70 also includes two additional electrodes to perform a thoracic impedance measurement, useful for highlighting possible clinical conditions related to the cardiac syndrome.

[0020] Preferably the monitoring device 80 transmits to! center "hub" 20 and to the software 22 of the subjective data for the personal quantification of the effort, for example through Borg scale, which the patient enters through the buttons 82, guided by messages on the screen 85 at the end of the activity.

Example of a myocardial infarction training program:

[0021] The software 22 is used to determine the type of exercise: for example, in this case, activities will be preferably prescribed to enhance strength and strength, and to improve flexibility. The training methods will be determined in relation to the capacity to be strengthened: The program is individualized based on the clinical characteristics of each subject. Continuous training (continuous training) or interval training is used for resistance; on the other hand, a series of «station» exercises (circuit training) or interval training is used instead; for flexibility, series of stretching exercises are performed instead.

[0022] The training is carried out with specific equipment for cardiovascular training «moquette - bike - rotex - step -« with a specific frequency (for example 3x week or 5x week). The duration of the session is, for example, one hour, in which the first 10 ́ are heating, the next 40 effettivo of actual training and the last 10 recupero of recovery,

[0023] The intensity of the training is preferably graded on the Target Heart Rate (THR), which generally corresponds to a heart rate between 70 and 85% of the maximum heart rate reached at the exercise test, The THR must clearly be continuously adapted to the training conditions of the subject during the program.

[0024] Some peculiarities must distinguish the rehabilitation of the elderly patient. In fact, only 20% of the infarcted older than 75 is able to carry out a standard program, in this case, the system considers, for example the following options: <tb> a. <sep> perform exercise at a reduced intensity - you can get a sufficient level of training even for intensities 50% lower than normal, <tb> b. <sep> increase the overall duration of the program, <tb> c. <sep> simplify the scheme of the exercises, <tb> d. <sep> take into account age-dependent musculoskeletal changes, <tb> e. <sep> avoid abrupt changes in position and <tb> f. <sep> instead shorten the duration of the single session for the precocious <tb> <sep> appearance of the sense of fatigue.

[0025] During the session the patient is subjected to continuous electrocardiographic monitoring, the electrocardiographic data are detected by band 70 and transmitted, through an interface not shown, to the monitoring device 80 from which they are sent to the hub center 20 through the internet . Preferably the monitoring device 80 comprises software elements adapted to carry out a pre-treatment of the data, for example a compression or an analysis.

Hardware

[0026] According to the example shown, the «Cardyou» monitoring apparatus 80 has a cardiac shape and covers an area of about 50 square cm, it being understood that other shapes and sizes are also possible. It can be applied to machines for cardiovascular training on the market, through a special communication interface 81, both for data and to fix the device in a position that gives a perfect view.

[0027] The 81 interface could be a USB interface, but other variants are also possible, as part of the invention. Preferably the monitoring apparatus 80 is composed of an inert material. The apparatus comprises a communication interface 89 for its connection to the internet with or without wires, for example according to the WiFi, Ethernet, CDMA protocols or any appropriate protocol, for communication with the hub center 20 (arrows 40). In the central part, the data display screen 85, having an area of about 30 cm squared in this embodiment example, allows the visualization in real time of the data obtained from the heart band 70 and / or from the training machine and / or from ! hub center 20 and / or personal device 90.1 data presented by the screen may include, for example: BPM Training evolution Training Guide Estimated time Training results Average training evaluation with incremental graph Comparison of previous sessions Questions concerning the feeling of individual effort

[0028] The «Emergency» key 88 is located in the upper part of the apparatus, to be pressed only and exclusively in the event of an event, for example an illness, a sudden pain or the like. Holding button 88 pressed for a defined time, for example two seconds, an emergency rescue procedure is activated which immediately alerts a predefined emergency response center, notifying the patient's historical and next cardiac situation in real time. Preferably, by pressing the Emergency 88 button briefly, the device will ask on the screen 85 a question such as "Do you need urgent help?" If the answer is yes, the procedure seen previously is activated; if so, if the event does not require immediate intervention on the screen 85 a series of questions will appear to describe the event to the technicians of the hub center 20. For example, the patient can choose between a list of situations including: angina - dyspnea - sudden fatigue - arrhythmia - visual blurring - false alarm - other. In this case the patient will be contacted further, for example the following day or following working day by the medical staff of the hub center 20 or the medical center 22 for appropriate assessments. On the side there is the interface 86 for the housing and the connection with the personal mobile device 90.

[0029] Preferably, the mobile device supplied allows the dynamic updating of the training system. Going for a routine quarterly visit to the hub center 20, the technicians of the medical center 22, after analyzing the status of the person, making use of the historical state of training that the apparatus 80 transmits in its entirety to the center « hubs »20, will proceed with the update of the data concerning the training, which, once inserted in the appropriate interface on the device 80, will be updated automatically. If there are no significant events, the same procedure will occur every semester. According to a variant, this update may also take place outside of periodic visits, via the internet connection 40.

[0030] Preferably, at the end of each single training session, on the screen 85 appears a request to quantify the subjective feeling of effort through the Borg numerical scale, selectable with the two 82 buttons marked with (+) and (-), This evaluation will be recorded and transmitted to the hub center 20 together with the other data, to record the evolution and the state of training of the patient. It is important to have a good protocol to record responses and other feedback during the test. Special observations, both of behavior and of physiological responses can be important for subsequent evaluations or for immediate emergency actions.

Personal mobile device

[0031] The personal mobile apparatus 90 can be interfaced with the monitoring device 80 through an appropriate interface 96, for example a USB port. It has the function of recording the specific training program of the patient, released during the initial screening and updated by the hub center 20 when necessary, and the historical data of the training, as well as making this data available to any «Cardyou» device 80 for personalizing your workout.

Format

[0032] According to one aspect of the invention, a hub center 20 constantly receives data from the spoke centers 61, 62, 63, of data relating to the training of patients in treatment and comprising eg EGC and / or impedance meters and / or Borg assessments and / or mechanical training data, and / or individual communications.

[0033] The hub center 20 deals with initial assessments and hardware updates through the mobile device: Medical examination. Training status analysis Evaluation status and subdivision in primary and secondary prevention Primary: risk factors and endothelial evaluations Secondary: Evaluation of patient status and disease Training evolution

[0034] Preferably, the "hub" center 20 is in continuous interchange with a cardiological medical center 22 nearby for specialist assessments (for example ECG, maximal exercise test etc). If the data received shows the opportunity, the staff of the hub center 20, or the program 25, direct the patient to the medical center 22 for further checks. The medical center can offer more services, for example Dietology.

[0035] According to the cases the "Spoke" centers 61, 62, 63 can be understood as the customer's home, sports center, specialist center or simply fitness center. They host the client during his training giving, in the case of a public place, support on the use of the apparatus as well as in the case of secondary prevention, a place outside the sanitary spaces where they can safely alienate themselves. If the patient decides to buy or rent the necessary equipment, ie the training machines, the monitoring device 80 and the sensor 70, for example, he can, thanks to the invention, carry out the personalized training in the comfort of his own home, under constant remote control from the hub center 20 in complete safety.

[0036] Reference numbers used in the figures <tb> 20 <sep> Center "hub" <tb> 22 <sep> Cardiology department <tb> 25 <sep> Database <tb> 40 <sep> Data transmission through the internet <tb> 50 <sep> Data transmission through personal mobile device <tb> 61 <sep> Center "spoke" 1 <tb> 62 <sep> Center "spoke" 2 <tb> 63 <sep> Center "spoke" 3 <tb> 70 <sep> Chest strap <Tb> 75 <sep> Electrodes <tb> 80 <sep> Monitoring device "cardyou" <Tb> 81 <sep> Interface <Tb> 82 <sep> Buttons <Tb> 85 <sep> Display <tb> 88 <sep> Emergency button <tb> 89 <sep> WiFi or ethernet interface <tb> 90 <sep> Personal mobile device <Tb> 120 <sep> Internet

Claims (4)

1. Cardio-pulmonary rehabilitation and / or preventive training system for patients including; at least one control center (20); one or more training centers (61, 62, 63) equipped with specific equipment for training, and monitoring equipment (80) equipped with a communication interface (89) which allows the exchange of data with the control center (20); personal mobile devices (90) assigned to patients, interfaceable with said monitoring devices and comprising a memory in which a specific training program for the patient is recorded; in which the monitoring apparatuses (80) are programmed to guide and monitor the patient's training, depending on the program recorded in the patient's personal mobile device memory (90), and to transmit the data relating to the training activity of the patient patient at the control center (20) through the communication interface (89). 2. System according to the previous claim, in which at least some of the monitoring apparatuses are in communication with an ECG sensor and / or an impedenzometric sensor (70). 3. System according to the previous claim, in which the monitoring apparatuses (80) comprise an "emergency" key (88) programmed to activate an emergency rescue procedure. 4. System according to the previous claim, in which the monitoring apparatuses (80) comprise a screen 85 and buttons (82), programmed to insert a subjective evaluation of the intensity of effort.