Personalized IoT-based Physical Activity Monitoring System for Heart Failure Patients

Globally, the prevalence of HF increases with age, affecting 1-2% of adults in developed countries. In Türkiye, more than one million HF cases were recorded in 2016, with a hospital admission rate of 2.5%, resulting in an estimated cost of 36.5 million TL to the healthcare system. By 2022, the prevalence of HF in Türkiye was reported to be 2.114%, representing approximately three million patients. Among younger individuals aged 18-50 years, the prevalence is 12% and the incidence is 0.3%, making Türkiye one of the countries with the highest burden of HF in younger populations. These statistics highlight the importance of risk management through lifestyle modifications and the promotion of physical activity, even among younger patients. Given the frequency of hospitalizations and the economic impact, HF represents a major public health concern in Türkiye, underscoring the need for greater involvement of healthcare professionals in providing support and self-management education for these patients.

In recent years, advances in pharmacological and device-based therapies for HF have improved survival and reduced hospitalization rates; however, overall health outcomes remain unsatisfactory. Both the progression of the disease and acute exacerbations negatively affect functional capacity and delay recovery. Reduced functional capacity is a typical finding in HF and is recognized as an indicator of poor prognosis and diminished quality of life. Following hospital discharge, symptoms such as fatigue, dyspnea, and edema contribute to exercise intolerance and limit daily activities. For this reason, improving functional capacity through regular physical activity, strengthening adherence to exercise, and reducing sedentary behaviors are considered essential goals in the management of HF. Regular physical activity enhances functional capacity, improves quality of life, and contributes positively to the pathophysiology of the disease. Nevertheless, the majority of patients remain prone to sedentary behavior, with fewer than half engaging in regular physical activity.

Recent studies have examined the factors that hinder physical activity and contribute to sedentary behavior in patients with HF. Physiological and psychosocial factors such as fatigue, shortness of breath, and lack of motivation make participation in and sustainability of exercise difficult. Although current HF guidelines strongly recommend exercise-based rehabilitation, barriers such as occupational responsibilities, transportation difficulties, costs, and geographic limitations restrict participation. In Türkiye, there has not yet been a comprehensive study addressing the reasons for insufficient physical activity in this patient group. Existing research has mainly focused on exercise intolerance and limitations in daily activities. On the other hand, home-based or community-based exercise and physical activity programs are being proposed as strong alternatives to center-based rehabilitation. These programs, through regular monitoring and personalized motivational support, can improve adherence and promote both physical and psychosocial recovery. Technologically supported approaches, in particular, provide effective outcomes through personalized interventions tailored to individual needs. Systematic reviews indicate that home-based rehabilitation supported by wearable sensors may be as effective as center-based approaches while also improving adherence. Moreover, interventions such as tele-rehabilitation and exergaming, when combined with behavioral strategies, have further contributed to improvements in adherence. Nevertheless, the lack of personalized technology-based solutions tailored to individual needs remains a limitation to success. Our proposed project aims to fill this gap by offering a personalized, technology-assisted physical activity intervention that supports both physical and psychosocial recovery in patients with HF.

Traditional exercise protocols have shown beneficial effects on functional capacity and health parameters in HF patients, but these protocols are generally not adapted to individual health conditions. Exercise adherence, defined as the extent to which individuals follow the recommended frequency, duration, and intensity of exercise, is a key factor in HF management. When standardized protocols fail to meet individual needs, adherence may be moderate in the early months but tends to decline over time. Adherence becomes even more challenging when physical activity goals are not individualized according to heart rate reserve. From a patient-centered perspective, tailoring exercise in terms of type, intensity, duration, frequency, and personal needs is considered essential for effectively promoting adherence. However, studies have consistently shown that adherence to exercise programs among HF patients is lower than expected. For example, adherence rates in large-scale trials have ranged between one-third and one-half of participants, with completion rates often falling below 50%. These findings confirm that fewer than half of HF patients engage in regular physical activity. Therefore, individualized and technology-assisted interventions are urgently needed to improve adherence and support sustained participation in physical activity.

Technological opportunities hold great potential for improving physical activity in patients with HF. Wearable smart devices and mobile applications enable real-time monitoring of health data, offering more dynamic and personalized solutions compared with traditional exercise methods. These technologies allow patients to monitor their health status at home, optimize their physical activity, and provide real-time feedback to healthcare professionals. Mobile applications have been developed to track step counts and sedentary behaviors in order to enhance activity levels in HF patients, while others have focused on supporting self-care behaviors without directly monitoring exercise parameters. Some digital health tools have integrated monitoring of metrics such as step count and heart rate to better tailor activity goals. However, most studies to date have been short-term, highlighting the need for further research on sustaining long-term motivation and effectiveness. Earlier applications were often limited to pedometer-based activity tracking or focused primarily on the acceptability of mobile technology after cardiac rehabilitation. While many studies have emphasized step counts and walking distance as the main indicators of activity, recent evidence suggests that combining these with more in-depth biological data, such as heart rate and energy expenditure, may provide a more comprehensive and physiologically grounded assessment in HF patients.

Unlike traditional approaches supported by wearable devices and mobile applications, this project proposal focuses on defining personalized physical activity goals shaped by real-time data according to the individual characteristics of patients. Through technological integration, patients will be able to increase their physical activity, reduce sedentary behaviors, maintain motivation, and receive continuous real-time feedback. By providing individualized targets based on personal heart rate reserve, the project aims to deliver a more patient-centered and tailored approach. In this way, patients will remain motivated throughout the physical activity process and achieve greater success in reaching their goals. The system will dynamically update personalized targets according to each patient's current health status, allowing participation in activities at an appropriate intensity without excessive strain. The mobile application developed within the project will serve not only as a monitoring tool but also as a real-time feedback mechanism. These feedback features will evaluate patients' activity performance, deliver instant motivational messages and alerts, and provide guiding notifications for those who do not reach their goals, helping them overcome challenges. For example, when a patient reaches the targeted duration within their optimal heart rate zone, the system will send congratulatory messages to reinforce progress. Conversely, patients who fail to achieve their goals will receive supportive and motivational notifications to encourage persistence. Through this approach, individuals will continuously receive tailored support while working toward their personalized targets, enabling them to sustain motivation and adherence over time. The project aims to ensure long-term engagement in physical activity based on individualized progress. With dynamic monitoring and real-time feedback, patients will be able to continuously track their activities and observe tangible improvements in their health outcomes. Through this innovative approach, we aim to enhance physical activity in HF patients, strengthen adherence to treatment, and reduce sedentary time. Therefore, this technology-based intervention is expected to increase patient motivation, improve physical activity levels, and ultimately lead to better health outcomes.

In the literature, studies examining exercise adherence or physical activity compliance have generally based their interventions on structured and standardized exercise protocols. These protocols typically prescribe similar durations and intensities of exercise for all patients, while individual differences are often overlooked. For example, in previous trials, participants were commonly expected to achieve 150 minutes of moderate-intensity exercise per week, and reaching this target was considered a measure of adherence. However, given the physical, cognitive, motivational, and health-related differences among patients, it cannot be assumed that a standardized approach will be equally effective for all. In particular, the functional capacities of HF patients can significantly influence their adherence levels and overall activity performance. Recent guidelines emphasize that exercise prescriptions should be tailored to patients' individual characteristics, such as age, cognitive capacity, and functional status. In line with this, the present project aims to offer an alternative solution to the commonly reported low adherence and insufficient physical activity behaviors in HF patients. The proposed system will design an IoT-based personalized physical activity monitoring intervention that tracks activity behavior, increases the duration of physical activity, strengthens adherence, and reduces sedentary time. Personalized goals will be defined for each individual based on heart rate measurements and calculated heart rate reserve, and these targets will be continuously monitored through an IoT-based server system. This approach aims to address and overcome the barriers to sustained physical activity by providing individualized solutions. Furthermore, as highlighted in current recommendations, achieving both short- and long-term physical activity targets is essential. However, these goals must take into account each patient's starting point as well as their physical, cognitive, and motivational differences. Given the variation in functional capacity among HF patients, it is expected that levels of participation in prescribed activities will differ. Therefore, unlike previous studies, this project will establish individualized physical activity goals for each patient and monitor the processes by which these goals are achieved.

The project proposal aims to establish personalized physical activity goals using IoT technology and to monitor participants in real time during their daily lives. Drawing on the findings of a prior trial, who identified factors that hinder exercise adherence in HF patients, this system has been developed to address such barriers. According to their study, factors such as fear of symptoms, environmental constraints, lack of social support, and the absence of individualized exercise pre

• Left ventricular function [Срок оценки: From enrollment to the end of the intervention at 12 months]
• Functional capacity [Срок оценки: From enrollment to the end of the intervention at 12 months]
• Brain natriuretic peptide [Срок оценки: From enrollment to the end of the intervention at 12 months]
• Quality of Life measured by the Left Ventricular Dysfunction Scale [Срок оценки: From enrollment to the end of the intervention at 12 months]
• Motion analysis and energy expenditure parameters [Срок оценки: From enrollment to the end of the intervention at 12 months]
• Hospital readmission rate [Срок оценки: From enrollment to the end of the intervention at 12 months]