**2.2 Clinician's telemonitoring system**

On the clinician side, the system is based on a high-end PC where all the information from up to six patients can be displayed and analyzed (see **Figures 6** and **7**). The session starts by first establishing patient and clinician authentication credentials with the MedBike server. Once established, each patient is attributed an encryption key to encode the information transmitted during the session.

For each patient, the clinician set a unique exercise program using an exercise program editor. Each patient-specific exercise program can have an arbitrary number of stages with different lengths and target power outputs. Typically, these exercise programs include a warm-up, exercise, and cool-down stages. Other programs can also be specified such as high-intensity interval training (HIIT) parameters. These exercise programs include:

**Figure 5.** *Patient's VR display.*

Global values: These values apply to all stages of the exercise prescription.


**101**

*MedBike: Virtual Reality for Remote Cardiac Rehabilitation*

• Weekly goal: This is the recommended number of single player exercise ses-

• Target oxygen saturation: Optionally, a target minimum oxygen saturation

• Stage Name: the name of the stage (e.g., warm-up, exercise, etc.).

• Stage Duration: the length of the stage, in minutes and seconds.

resistance to work against to increase their power output.

• Target Cadence: optionally, a target cadence in RPM.

session report (which are stored on the MedBike server) include:

• The session mode as either clinical or single player

Per-Stage Values: These values define the various exercise stages in the prescription. Stages can be added, removed, and their position adjusted. Each stage includes

• Target Power: the target power in Watts for this stage. These values are used to adjust the difficulty of the bicycling experience for the patient. If the power requirements input here are high, then the patient will be given a higher

• Target Heart Rate: specify minimum and maximum heart rate targets for the

• RPE Prompts: specified, the system can automatically prompt patients for RPE

• Blood pressure (BP) measurements: if specified, the system can automatically initiate a blood pressure measurement after a certain percentage of the stage is

The system generates a post session report which was developed in partnership with cardiac rehabilitation clinicians, to best meet there clinical reporting requirements. The system also allows the clinician access to past session reports. A typical

○ The heart rate Min/Avg/Max values and % of blood oxygen saturation

○ The blood pressure (mmHg) at the beginning of the exercise, during the

○ Total displacement performed during the exercise in the virtual world

*DOI: http://dx.doi.org/10.5772/intechopen.85651*

sions per week.

the following values:

patient.

completed.

at predetermined times.

• The session time and date

• The session biodata summary

exercise, and after the exercise

○ Min/Avg/Max power and cadence

○ The RPE peak value

• The bike session summary

• The session duration

value can be specified.

*MedBike: Virtual Reality for Remote Cardiac Rehabilitation DOI: http://dx.doi.org/10.5772/intechopen.85651*

*Assistive and Rehabilitation Engineering*

**100**

**Figure 5.**

*Patient's VR display.*

**Figure 4.**

*MedBike system dataflow.*

100 (full resistance).

Global values: These values apply to all stages of the exercise prescription.

• Target resistances: It is specified by the minimum and maximum resistance allowed for the bike trainer to use. These values range from 0 (no resistance) to

• Rate of perceived exertion (RPE) Scale and Target RPE: The RPE scale to use and the optimal range of RPE values. Optimal values specified here will appear in green on patient's tablets, except for the pediatric scale, which has its own color coding. Default optimal values for the adult scale are between 11 and 15.


Per-Stage Values: These values define the various exercise stages in the prescription. Stages can be added, removed, and their position adjusted. Each stage includes the following values:


The system generates a post session report which was developed in partnership with cardiac rehabilitation clinicians, to best meet there clinical reporting requirements. The system also allows the clinician access to past session reports. A typical session report (which are stored on the MedBike server) include:

	- The heart rate Min/Avg/Max values and % of blood oxygen saturation
	- The RPE peak value
	- The blood pressure (mmHg) at the beginning of the exercise, during the exercise, and after the exercise
	- Min/Avg/Max power and cadence
	- Total displacement performed during the exercise in the virtual world
	- A complete ECG recording of the session, viewable on a mm-calibrated grid;
	- Annotated ECG recording;
