**4.2 Feasibility study method**

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,

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*MedBike: Virtual Reality for Remote Cardiac Rehabilitation*

• total number of hours exercised (318 vs. 239 hours);

• average number of sessions per week (7.88 vs. 6.15).

• total number of exercise sessions (315 vs. 246);

• average sessions per subject (63 vs. 49.2);

sion adherence within the rehab program;

communicating with the clinician;

perform rehabilitation sessions;

during a session;

**5. Conclusion**

whereby the clinical could communicate with one single patient individually or the group of patients collectively. The remote monitoring medical grade sensors of the system allowed for ongoing heart rhythm, blood pressure and oxygen saturation assessment; relevant data was selected from the session recordings and included in

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:

• Using VR gamification MedBike system can increase individual exercise ses-

• The installation of MedBike in each home was relatively easy but better system

• Despite a few issues with unreliable home internet connections, the bandwidth of the average home internet services was enough to allow the clinician to

• Many patients also greatly appreciated not having to go to the hospital to do the exercise program. They also appreciate not having to pay for parking and the

We presented in this paper the technical aspects and the measured performance of MedBike. Developing MedBike around Unity 3D has been an excellent design choice because of its flexibility and ease of programming new functions. In addition, Unity 3D is one of the video game industry standards and the development of

• The clinician interface and data display were sufficiently good to be useful

• Most of the patients enjoyed doing exercise using the virtual game.

system ability to integrate their rehab program into their lifestyle.

diagnostic tools are needed to perform better on-site remote testing;

• We were able to demonstrate that MedBike can indeed be used by nontechnical patients. Most patients had no problem starting the system and

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

the custom report.

**4.3 Feasibility study results**

whereby the clinical could communicate with one single patient individually or the group of patients collectively. The remote monitoring medical grade sensors of the system allowed for ongoing heart rhythm, blood pressure and oxygen saturation assessment; relevant data was selected from the session recordings and included in the custom report.
