Risk stratification in Cardio-respiratory training: Innovation on using Polar watches via Bluetooth for simultaneous heart rate monitoring in PT gymnasium

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Authors (including presenting author) :
Lai HN(1), Cheung HL(1) , Lam SL(1), Lai WK(1)
Affiliation :
(1)Physiotherapy Department, Shatin Hospital
Introduction :
High patient volume, unstable medical conditions and increasing frailty of elderly patients were challenges encountered during rehabilitation in Shatin Hospital (SH). To closely monitor patients’ condition and prevent adverse cardiac complications during cardio-respiratory training, risk stratification and continuous heart rate monitoring was implemented in PT department.
Objectives :
(1)To enhance patient safety during cardio-respiratory training; (2)To improve staff awareness on patient’s screening and detecting risky patients; and (3)To facilitate staff in patient monitoring in gymnasium.
Methodology :
With reference to American College of Sports Medicine (ACSM) guideline and NTEC guidelines on exercise prescription, risk stratification for cardio-respiratory training was introduced in Physiotherapy (PT) Department. After screening of patients’ medical history, risk factors of coronary artery disease and major signs and symptoms, physiotherapists classify patient’s risk level (mild, moderate or high) and calculate target heart rate. Depending on different risk levels, the recommended exercise intensity, level of supervision and heart rate monitoring are varied. Traditionally, pulse oximeter or blood pressure machine is used to monitor patients’ heart rate during cardio-respiratory training. However, this equipment is difficult to provide simultaneous monitoring of several patients in gymnasium. To facilitate continuous heart rate monitoring, use of Polar A370 watch (fitness watches with heart rate sensor) with connection to iPad system via Bluetooth was implemented in January 2018. Heart rate readings of different patients were shown simultaneously in the television to facilitate staff in close monitoring of patients performing cardio-respiratory training. Colour of the screen will change when heart rate reaches different ranges to increase staff awareness.
Result & Outcome :
In 60 patients receiving common exercise training in PT gymnasium, 25 of them performed cardiorespiratory training (included upper, lower limb ergometer and recumbent stepper) in one week on average. The exercise heart rate was collected with Polar watches. 96% of patients performed exercise within their training zone while 4% exceeded safe training zone and exercise was terminated. Polar watches alert physiotherapist in detecting risky patients to enhance safe exercise training in gymnasium. Staff evaluation questionnaire showed that 94.7% of staff agreed that risk stratification and use of Polar is useful and provided better monitoring of patients during cardiorespiratory training. Polar watches facilitate early detection on risky patients to prevent adverse consequences during exercise training. Further data collection and review will be conducted for continuous improvement to ensure patient safety in the future.

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