**4.3 Feasibility study results**

*Assistive and Rehabilitation Engineering*

lipids).

Inclusion criteria was:

grafting (CABG);

**4.2 Feasibility study method**

2.How MedBike can improve patient compliance to CR (frequency of exercise

3.The effectiveness of MedBike at improving fitness levels (quantified using a standardized exercise tolerance test via a bicycle ergometer) and reduce cardiovascular risk (as determined by measuring BP, A1c, smoking status, and

We hypothesized that home-based CR using the MedBike system is feasible and will effectively improve program compliance using VR gamification and patient risk factor reduction by real-time monitoring. To prove this hypothesis 11 subjects (5 controls) were recruited into a feasibility randomized pilot control trial.

• Recent percutaneous cardiac intervention (PCI) or coronary artery bypass

Each qualifying and consenting patient was enrolled in a standardized cardiac rehab program (based on the University of Alberta's Jim Pattison Centre for Heart Health protocol) consisting of 8 weeks of personalized exercise prescription. At the beginning of the study, patients were enrolled and randomized into the MedBike group, or standard of care group (control). Those randomized into the MedBike arm of the study were provided with the custom built MedBike VR exercise biking system with remote patient monitoring and clinical video conferencing; the standard of care group participated in a standard supervised exercise program carried out at the Jim Pattison Centre for Heart Health. In the MedBike group, the system was delivered to patient homes prior to the beginning of their first connected exercise session with the clinician. The control group received a standard exercise program which included one supervised in-hospital session per week, with a recommended additional four unsupervised exercise sessions, outside of the hospital. The additional four sessions were also recommended to the MedBike group with the option of using the MedBike system in the offline unsupervised mode (exercise data was still stored and sent to the MedBike server). Before beginning the exercise program, each patient was consulted with to design an exercise program that best allows for their clinical and physical development. Effort tolerance was largely based on an initial exercise tolerance test (ETT), which is used to direct the level to which the patient can begin their physical exercise regime. The ETT was also used to gauge exercise improvement during the study by performing a baseline and post-test at 8 weeks. During supervised sessions, the MedBike group used only the exercise bike. The control group were encouraged to only use cycling as their form of cardiorespiratory training during their hospital sessions, however, they were also given the option to perform, in addition, strength training and additional cardio exercises. This may have biased the comparison results of the ETT, but not the quantity or duration of total exercise performed over the 8 weeks. The MedBike platform was set up with the ability of the clinician to modify the exercise program and cycling resistance in real time, allowing for personalized program progression. Clinical communication was allowable through bi-directional video/audio feeds,

sessions and number of total hours spent exercising);

• A left ventricular ejection fraction (LVEF) ≥45%;

• Internet connection (~5 mb/s download).

**108**

No difference in ETT improvement (1.69 vs. 1.57 min) was observed. On the other hand, MedBike patients exercise adherence and participation was higher:


Since this was a small feasibility trial, it was not fully powered, nor was it reliable to calculate the statistical significance of our findings, but it did allow us to gain some preliminary information on efficacy trends. Our work suggested that:

