Keywords

1 Introduction

As living standards improve, access to healthcare expands, and people become more concerned about their health, morbidity, mortality, and life expectancy are increasing (Jang & Ham, 2014). However, unlike the development of medical technology, it is difficult for rehabilitation patients who were hospitalized to continue rehabilitation exercises in the community after leaving the hospital.

Rehabilitation has been shown to improve mobility, physical functioning, and quality of life for people with disabilities suffering from illness. Mental health improvements (Blondell et al., 2014). However, while there are many companies developing equipment for older adults and people with disabilities, many of the products developed are not clinically validated, so their use is problematic and few are actually used by older adults and people with disabilities. The Elephant Total Body Exerciser is a total body exercise device that is consistently sold to neurological and musculoskeletal patients. It is used as an upper and lower limb rehabilitation device for people with disabilities in most rehabilitation hospitals and nursing homes. In addition, a study (Shin, 2016) analyzing the design satisfaction of rehabilitation medical devices using an ergonomics perspective (Shin, 2016).

The purpose of this study is to provide a validated rehabilitation exercise service model for people with disabilities in the community through a customized rehabilitation exercise study optimized for individuals by evaluating and comparing the effects of smart elephant exercise devices and walking exercise programs with real-time monitoring on mental and physical outcomes. To this end, we will confirm the effects of exercise programs on assessment tools and vital signs through a study on non-disabled people before conducting a study on disabled people.

2 Method

2.1 Participants

To conduct this study, we used five community-dwelling, non-disabled individuals (Table 1). According to Virzi (1992) and Nielson (2000), five users are the most efficient way to identify usability and problems of a particular product, and they reported that 80% of the problems can be found arithmetically. The inclusion criteria for the study were adults aged 18 years or older, at least 3 months since the diagnosis of any type of disease, free of cognitive and psychological disorders, able to communicate, and able to understand the purpose of the study and participate in the study. Exclusion Criteria is Subjects were excluded from the study if they had neurological or musculoskeletal disorders that made it difficult for them to use a whole body exercise device, if they were participating in other organized research projects, or if they had medical problems that made it difficult for them to participate in the study, as determined by the healthcare provider.

Table 1. General characteristics of participants (n = 5)
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2.2 Smart Elephant Whole Body Exercise Machine

The upper and lower extremity rehabilitation exercise machine is a combined upper and lower extremity rehabilitation device that focuses on basic and essential rehabilitation treatments such as strengthening, preventing contractures, and increasing joint range of motion. It consists of an aluminum wheel that turns a weighted wheel that is driven evenly by a chain connected to a rotating body as the crank rotates, a brake device that stops the weighted wheel, and a load adjustment device using magnets, so it is a device. By applying healthcare monitoring technology to this device, it provides feedback to each user on the number of times, time, resistance, and intensity to enhance the effectiveness of exercise.

2.3 Study Protocol

This study used a Single Experimental Research Design, the ABC Design, to clarify the cause and effect of the intervention in five non-disabled individuals. The exercise program consisted of Intervention A (walking), Intervention B (walking and exercise machine), and Intervention C (exercise machine) for 9 weeks, with each intervention lasting 3 weeks. Each intervention was conducted twice a week for 30 min, for a total of 6 sessions, and to determine the effectiveness of the exercise program, biosignal data was measured in real time and monitored by the user through a biosignal meter called Biosignalplux Professional. An intervention evaluation tool consisting of a physical test, fall risk assessment, psychosocial test, mental health test, and satisfaction test was conducted as a pre-assessment before intervention A, a post-assessment after intervention A, a post-assessment after intervention B, and a post-assessment after intervention C. The intervention evaluation tool was administered to the participants.

2.4 Evaluation

In this study, several papers were reviewed to evaluate the effect of exercise programs on the physical and psychosocial, and among them, representative evaluation tools used for the disabled in the physical and mental domains, which are necessary factors to improve the quality of life, were used as follows.

2.4.1 Physical Function Measures

To measure physical function measures, we used the Borg Rating of Perceived Effort (RPE). This tool is roughly equivalent to heart rate per minute as an indicator of exercise intensity (Kwon et al., 2018).

2.4.2 Psychosocial, Mental and Quality of Life Health Outcomes

To measure psychosocial, mental and quality of life health care outcomes, we used the Korean version of the WHOQOL-BREF, which was developed by the World Health Organization to measure quality of life for use in all cultures and standardized by Min (2000).

2.4.3 Participants’ Feedback and Satisfaction Surveys

To evaluate participants’ feedback and satisfaction surveys, we used the Self Efficacy for exercise (SEE) instrument, which assesses self-efficacy for exercise and is self-reported. Self-efficacy has been cited as an important factor influencing physical activity (Lee et al., 2007).

2.4.4 Biosignal Acquisition Applications

Measure biosignals in real time while performing a task. The tool used is the Biosignalplux Professional. It can provide up to 10 h of continuous signal streaming wirelessly at 16-bit resolution per channel at a sampling rate of up to 3.000 Hz with eight specialized sensors of your choice, and it can record eight data simultaneously. The vital signs to be measured by this tool.

2.4.4.1 Electromyography (EMG).

Measuring muscle activation by bioelectricity. In this study, surface electromyography was used to quantitatively measure maximal voluntary contraction values. The sampling rate was 1000 Hz and the notch filter was 60 Hz. The measurement site was selected for the externsor muscles, which are the most used muscles when using the whole body exercise device, and the sensor Ch.1 was measured for the left biceps brachi, Ch.2 for the right biceps brachi, Ch.3 for the left quadriceps, and Ch.4 for the right quadriceps.

2.4.4.2 Electrodermal Activity (EDA).

By measuring the change in sweat secretion, the sweat glands are active and the sympathetic nervous system is active. In this study, sensors were attached to the 2nd and 3rd fingers, and changes in the average value of skin conductance were measured in the signal parameters of each intervention.

2.4.4.3 Temperature (TEMP).

It is used to measure physical or ambient temperature and provides an analog output of temperature change, with a short response time and high accuracy. In this study, the temperature was measured immediately after the intervention to check the body temperature and to measure the change between each intervention.

2.4.4.4 Oxygen Saturation (SpO2).

The SpO2 sensor is designed to estimate the oxygen saturation level in the finger using two LEDs, and the reflected light from each of these LEDs is absorbed by a photodiode that converts the current into a digital value, from which the blood oxygen saturation can be derived. In this study, the average oxygen saturation value was measured to determine changes in the intervention.

3 Result

3.1 Physical Function Measures

The results of the paried t-test for within-group comparison of PRE at pre test, post test 1, post test 2, post test 3, and post test 4 are shown in Table 2. In RPE, the score was 7.2 ± 0.44 at pre test and 9.6 ± 1.14 at post test 1, which was a statistically significant improvement (P < .05). In post test 2, the score was 11.6 ± 1.14, a statistically significant improvement compared to post test 1 (P < .05). In post test 3, the score was 14.4 ± 2.07, a statistically significant improvement compared to post test 2 (P < .05). There was also a statistically significant improvement when comparing pre test to post test 3 (P < .05).

Table 2. Characteristic of the RPE Test of Total Score
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3.2 Psychosocial, Mental and Quality of Life Health Outcomes

The results of the Wilcoxon signed rank test for within-group comparisons of WHOQOL-BREF at pretest, post test 1, post test 2, and post test 3 are shown in Table 3. The WHOQOL-BREF showed a statistically significant improvement from 79.8 ± 8.31 at pretest to 81.8 ± 8.58 at posttest 1 (P < .05). In post test 2, the score was 81.8 ± 10.47, which was not statistically significant compared to post test 1 (P > .05). In post test 3, the score was 85.0 ± 9.82, which was not a statistically significant difference compared to post test 2 (P > .05). There was a statistically significant improvement when comparing pre test to post test 3 (P < .05).

Table 3. Characteristic of the WHOQOL-BREF Test of Total Score
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3.3 Participants’ Feedback and Satisfaction Surveys

The results of Wilcoxon signed rank test for within-group comparison of SEE in pre test, post test 1, post test 2, and post test 3 are shown in Table 4. SEE scored 782.0 ± 213.23 in pre test and 878.0 ± 182.67 in post test 1, which is not a statistically significant difference (P > .05). In post test 2, the score was 878.0 ± 182.67, a statistically significant improvement compared to post test 1 (P < .05). There was no significant difference in post test 3, with a score of 880.0 ± 275.77, compared to post test 2 (P > .05). There was also no statistically significant difference when comparing pre test to post test 3 (P > .05).

Table 4. Characteristic of the SEE Test of Total Score
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3.4 Electromyography (EMG)

The results of the Wilcoxon signed rank test for within-group comparison of EMG in interventions A, B, and C are shown in Table 5. In EMG, it was 0.74 ± 0.43 in A and 0.72 ± 0.35 in B, a statistically significant improvement (P < .05). In C, there was no statistically significant difference compared to B at 0.80 ± 0.31 (P > .05). There was also no statistically significant difference when comparing A and C (P > .05).

Table 5. Characteristic of the EMG Test of Total Score
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3.5 Electrodermal Activity (EDA)

The results of the Wilcoxon signed rank test for within-group comparison of EDA in interventions A, B, and C are shown in Table 6. EDA was 4.22 ± 1.82 in A and 4.27 ± 2.23 in B, which was not statistically significant (P > .05). In C, the score was 5.76 ± 1.33, a statistically significant improvement compared to B (P < .05). When comparing A and C, there was a statistically significant improvement (P < .05).

Table 6. Characteristic of the Electrodermal Activity of Total Score
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3.6 Temperature (TEMP)

The results of Wilcoxon signed rank test for within-group comparison of Temporature in A, B, and C interventions are shown in Table 7. Temporature was 36.53 ± 0.22 in A and 36.55 ± 0.11 in B, which was not statistically significant (P > .05). In C, it was 36.57 ± 0.09, which is not a statistically significant difference compared to B (P > .05). There was also no statistically significant difference when comparing A and C (P > .05).

Table 7. Characteristic of the Temperature of Total Score
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3.7 Oxygen Saturation (SpO2)

The results of Wilcoxon signed rank test for intra-group comparison of oxygen saturation in A, B, and C interventions are shown in Table 8. The oxygen saturation was 98.50 ± 0.68 in A and 98.56 ± 0.50 in B, which was not statistically significant (P > .05). In C, it was 98.50 ± 0.50, which was not statistically significant compared to B (P > .05). There was also no statistically significant difference when comparing A and C (P > .05).

Table 8. Characteristic of the oxygen saturation of Total Score
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4 Discussion

The purpose of this study was to evaluate and compare the effects of real-time monitoring smart elephant whole body exercise device and walking exercise program on mental and physical outcomes, and to study customized rehabilitation exercise optimized for people with disabilities. To this end, we evaluated and compared the effects of using the smart elephant whole body exercise device and walking exercise programs on mental and physical outcomes in five non-disabled people in the community. The results showed that the physical function measures, PRE assessment, showed a significant improvement between each intervention from pre test to post test 3, and the WHOQOL-BREF of psychosocial, mental and quality of life health outcomes showed that walking exercise affected the psychosocial, mental and quality of life health outcomes more than before exercise, and the elephant whole body exercise device affected the psychosocial, mental and quality of life health outcomes more than before exercise. In other words, the effects of exercise on psychosocial, mental and quality of life health outcomes could be seen, but there were no differences between each exercise program. In the SEE, which examined participants’ feedback and satisfaction surveys, there was no difference between pre- and post-exercise, but the combined walking and elephant exercise program had a impact on participants than the walking program. In other words, The study results indicate promising improvements in physical function measures, psychosocial and mental health outcomes, as well as participants’ feedback and satisfaction. The observed statistically significant improvements in the Borg Rating of Perceived Effort (RPE) and the WHOQOL-BREF scores support the effectiveness of the exercise interventions. The findings suggest that the Smart Elephant Whole Body Exercise Machine and walking exercises have a positive impact on the physical and mental well-being of individuals with disabilities.

The biosignal data showed that the walking plus elephant exercise program had a significant improvement in EMG compared to walking, and the elephant exercise program had a significant effect on EDA compared to walking and walking plus elephant exercise. However, there were no statistically significant differences between the interventions in temperature and oxygen saturation.

5 Conclusion

It was necessary to standardize the effects of the exercise program by conducting a study on non-disabled people before conducting a study on people with disabilities. Also, a study on non-disabled people was conducted before the mid- to long-term project for people with disabilities to identify deficiencies in safety and operation. A limitation of the study is that it is difficult to generalize the results because the experiment was conducted only with women in their early twenties. Therefore, in future studies, an appropriate number of sampling and balanced sex subjects are needed to increase statistical significance. In addition, since it was conducted for non-disabled people, not the disabled, it was not possible to use the initially set evaluation tools. Evaluations in the areas of daily living and falls were excluded from the results because it is difficult to compare and evaluate the functions of people with disabilities because their functions are perfect and do not change. In addition, we tried to check the electrocardiography (ECG) of vital signs, but the sensor generated a lot of noise during exercise, so we could not extract accurate data, so it was excluded from the results.

Due to the improvement of living standards, expanding access to medical services, and increasing interest in people’s health, disease-related mortality and life expectancy are gradually increasing, but unlike the development of medical technology, it is difficult for rehabilitation patients who were hospitalized to continue to perform rehabilitation exercises in the community after leaving the hospital. This is because various exercise programs that are not medically proven do not reflect individual specificity and are performed collectively due to administrative and financial convenience (Bae et al., 2010). This study will be used as a basis for customized rehabilitation exercises that provide a proven rehabilitation exercise service model for people with disabilities in the community, and it is hoped that the lives of people with disabilities will become health.