2 State of the Art¶

2.1 Apps in Healthcare¶

As of 2022, there were around 6.4 billion of smartphone mobile network subscriptions (https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide/), which is equivalent to around 79% of the world's population. Besides that, the average number of hours spent on mobile phones ranges from 3-4 hours a day (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685243/) up to even 5-7 hours (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9368281/). These habits are becoming detrimental to the well-being of people all around the globe, as it is shown in various studies (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9368281/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491487/). Since this problem is here to stay, at least from now, we can use this problem to our advantage, namely in health care.

In the past several years, health care professionals have begun using mobile devices, transforming many aspects of clinical practice and allowing the rapid emerge of medical software applications (apps).(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/) They help professionals with many important tasks, such as: patient management and monitoring; information and time management; communications and consulting; reference and information gathering; clinical decision-making; medical education and training; and even time management. [[[1. Wallace S, Clark M, White J. ‘It’s on my iPhone’: attitudes to the use of mobile computing devices in medical education, a mixed-methods study. BMJ Open. 2012 Aug;2:e001099.
4. Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res. 2012;14(5):e128.
7. Mosa AS, Yoo I, Sheets L. A systematic review of health care apps for smartphones. BMC Med Inform Dec Mak. 2012 Jul;12:67.
8. Divali P, Camosso-Stefinovic J, Baker R. Use of personal digital assistants in clinical decision making by health care professionals: a systematic review. Health Informatics J. 2013;19(1):16–28.]]] There are already many apps in this field, making the emerge of many legislations (https://www.sciencedirect.com/science/article/pii/S1386505623001594)and definitions (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664324/) around these topics.

With that in mind, it is important to develop new apps for many devices and clinical problems, such as the app we developed for step counting and health monitoring, using the Vital Jacket (https://ieeexplore.ieee.org/document/5482268)

2.2 Vital Jacket¶

https://www.biodevices.pt/en/sdk-2/
https://ieeexplore.ieee.org/document/5482268
https://www.biodevices.pt/en/vitaljacket-holter-2/

2.3 3-axis accelerometer and step counting¶

https://www.vertexknowledge.com/post/how-does-a-smart-watch-count-steps-tech-knowledge
https://arxiv.org/ftp/arxiv/papers/1801/1801.02336.pdf

2.4 Step Counter as a health indicator¶

In the world we live today, a sedentary lifestyle is very common, leading to 5 million deaths a year that could be avoided if a more active lifestyle was adopted and prioritized. Besides promoting physical well-being, physical activity also contributes to mental health. (https://www.who.int/news/item/25-11-2020-every-move-counts-towards-better-health-says-who). As Dr. Ruediger Krech, the Director of Health Promotion of the World Health Organization stated, “Physical activity of any type, and any duration can improve health and wellbeing” (https://www.who.int/news/item/25-11-2020-every-move-counts-towards-better-health-says-who), meaning that walking, that is free and requires no special training, is an easy way of promoting a healthier lifestyle (https://www.sciencedirect.com/science/article/pii/S2095254621001010).

The Centers for Disease Control and Prevention (CDC) recommends taking 10 000 steps daily, which is approximately equivalent to 8 kilometers. Lower than half of this value is a sign of a sedentary lifestyle (https://www.medicalnewstoday.com/articles/how-many-steps-should-you-take-a-day#by-age).

Step counter devices have been widely used since they encourage the individuals to meet their daily step goals by turning physical activity into a challenge, motivating them to choose the stairs instead of the elevator, for example (https://www.medicalnewstoday.com/articles/how-many-steps-should-you-take-a-day#by-age).

Nowadays, with the development of technology, most smartphones and wearables allow controlling the number of steps taken as a health indicator (https://www.sciencedirect.com/science/article/pii/S2095254621001010). Step counting devices are based on accelerometry motion sensing. These record a step when the acceleration surpasses a defined threshold value, allowing an immediate response. Examples of step counters are Fitbit devices, which are wearable inertial measurement units (IMUs) that besides recording steps, also acquire other data such as plethysmography to measure heart rate. These data are stored in smartphone apps, and can be viewed by the user (https://www.nature.com/articles/s41746-022-00696-5). There are already various applications that help with step counting that will be approached in the next section.

Several studies regarding step counters have been performed that proved that a higher step count is associated with reduced risk of health problems, such as cardiovascular diseases https://www.sciencedirect.com/science/article/pii/S2095254621001010, chronic obstructive pulmonary disease (https://pubmed.ncbi.nlm.nih.gov/36775005/) and overall mortality (https://www.ajconline.org/article/S0002-9149(22)00729-9/fulltext). Step counters are also used in rehabilitation, helping individuals to recover from injuries or surgeries by gradually increasing their activity levels (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246942/).

Although the use of step counting devices brings several benefits, they have some limitations concerning the steps count or the traveled distance. It is also essential that these devices are used together with other forms of exercise besides walking, and healthcare professionals, so that the individuals are able to adjust goals according to their health needs (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488109/).

https://www.sciencedirect.com/science/article/pii/S2095254621001010
https://pubmed.ncbi.nlm.nih.gov/10993418/
https://pubmed.ncbi.nlm.nih.gov/36775005/
https://www.nature.com/articles/s41746-022-00696-5
https://www.ajconline.org/article/S0002-9149(22)00729-9/fulltext
https://www.who.int/news/item/25-11-2020-every-move-counts-towards-better-health-says-who
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488109/

2.5 Similar Apps¶

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488109/
https://www.mdpi.com/2227-7080/9/3/55
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010703/
https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-01020-8
https://www.goodhousekeeping.com/health-products/g28778836/best-step-counter-pedometer-apps/