A Smart Wearable Sensor System for Counter-Fighting Overweight in Teenagers

Transcription

1 sensors Article A Smart Wearable Sensor System for Counter-Fighting Overweight in Teenagers Carlo Emilio Stoli 1, *, Maria Renata Guarneri 1, Paolo Perego 1, Marco Mazzola 2, Alessra Mazzola 1 Giuseppe Andreoni 1 1 Politecnico di Milano, Dipartimento di Design, via Giovanni Duro, 38/A, Milano, Italy; mariarenata.guarneri@polimi.it (M.R.G.); paolo.perego@polimi.it (P.P.); alessra.mazzola@polimi.it (A.M.); giuseppe.reoni@polimi.it (G.A.) 2 Neosperience S.p.a, Corso Indipendenza 5, Milano, Italy; marco.mazzola@neosperience.com * Correspondence: carloemilio.stoli@polimi.it; Tel.: Academic Editor: Thomas B. Messervey Received: 31 March 2016; Accepted: 26 July 2016; Published: 10 August 2016 Abstract: PEGASO is a FP7-funded project whose goal is to develop an ICT mobile-based platform toger with an appropriate strategy to tackle diffusion of obesity or lifestyle-related illnesses among teenagers. Indeed, design of an engaging strategy, leveraging a complementary set of technologies, is approach proposed by project to promote adoption of healthy habits such as active lifestyle balanced nutrition to effectively counter-fight emergence of overweight obesity in younger population. A technological key element of such a strategy sees adoption of wearable sensors to monitor teenagers activities, which is at basis of developing awareness about current lifestyle. This paper describes experience carried out in framework of PEGASO project in developing evaluating wearable monitoring systems addressed to adolescents. The paper describes methodological approach based on co-designing of such a wearable system main results that, in first phase, involved a total of 407 adolescents across Europe in a series of focus groups conducted in three countries for requirements definition phase. Moreover, it describes an evaluation process of signal reliability during usage of wearable system. The main results described here are: (a) a prototype of stardized experimental protocol that has been developed applied to test signal reliability in smart garments; (b) requirements definition methodology through a co-design activity approach to address user requirements preferences not only technological specifications. Such co-design approach is able to support a higher system acceptance usability toger with a sustained adoption of solution with respect to traditional technology push system development strategy. Keywords: wearable sensors; smart garment design; lifestyle monitoring; teenagers; co-design 1. Introduction The rapidly increasing prevalence of overweight obesity among children adolescents reflects a global epidemic worldwide. Due to associated serious medical conditions, it is estimated that obesity already accounts for up to 7% of health care costs in EU, as well as costs to wider economy associated with lower productivity, lost output premature death. Obesity in younger age has been recognized as an alarming key predictor for obesity in adulthood, but also entails a number of short-term health complications at juvenile age [1]. Obesity overweight also have economic, social environmental dimensions, implying direct indirect costs. The former are connected with personal hospital health care, health services drugs, whereas latter is mainly related to reduced productivity of obese Sensors 2016, 16, 1220; doi: /s

2 Sensors 2016, 16, of 12 workers. At social level, it has been studied that obese person often has very low self-esteem, is depressed tends to stay on his/her own: he/she is most of time mocked by his/her peers. Therefore, overweight people may have serious relational problems. The environment has a significant impact on development of obesity. Many factors contribute to sedentary lifestyle of young people adults. As an example, urbanization trend, rise in number of vehicles lack of cycle paths discourage parents from letting ir children walk or cycle to school. This situation is no longer sustainable: it is urgent to begin with prevention programs. Placing preventive care at heart of health systems is of paramount importance. Advances in understing of health risk factors design of effective interventions to prevent illness are way forward. Measuring evaluating quality of prevention strategies is important in order to gain a better understing of ir mechanisms of action potential benefits risks; to measure ir impact appropriateness; to monitor ir relevance in terms of tackling health inequalities [2]. In consideration of above, PEGASO [3] an FP7 project funded by European Union (EU) tackles prevention, focusing on obesity related co-morbidities, in which lifestyle coaching plays a very important role. This objective is achieved by developing a platform that leveraging mobile ICT technologies through wearable sensors mobile apps supports young people in becoming aware of risks motivates m in a behaviour change path towards healthy lifestyles. PEGASO gives guidance towards developing good habits provides a social platform to stimulate young people s willingness to engage actively in ir health management. The challenge of PEGASO is to develop a system that meets requirements of users by adopting a user-centred design (UCD) methodology [4]. The approach is useful to motivate engage adolescents, which is an essential requirement for systems acceptance efficacy, rar than forcing people to accommodate technologies, products, or services. It should also be underlined that PEGASO, as a solution for prevention, is addressed to all people, independently of presence or lack of pathology. As a matter of fact, prevention specifically means tackling risk factors that are recognized in scientific community as probability multipliers in directly or indirectly causing specific pathology. This is a very difficult challenge because it is addressed to people who do not have a specific disease or even a minimal sign of it. Indeed, preventative actions are aiming at, e.g., introducing healthy habits in nutrition, adopting an active lifestyle, minimizing use of smoking, alcohol or or substances, i.e., reducing all possible factors that in short or long term can contribute to development of cardiovascular or metabolic diseases. This action is recognized as key strategy for future health care, not only to minimize diffusion of se illnesses but above all to assure a good, long active life for people to reduce costs of health care systems, contributing to overall economic sustainability of welfare systems. Preventative actions can be undertaken at different levels: (a) education; (b) monitoring; (c) awareness. As a voluntary action, prevention is to be induced by an engagement strategy: in this sense, UCD is a winning method. By addressing user needs preferences, it is easier for products systems to be adopted by same people contributing to ir design. This is an application pull approach that represents or side of innovation strategy. Usually in sensor development, technology-driven approach (also called technology push method) is followed: it means starting from technology its requirements to design final system. Instead, UCD starts from users needs preferences to define functional technological specifications that system has to meet. The main advantage of this methodology is high user acceptance usability of final product. In se types of applications, such as prevention, this issue is fundamental for long-term adoption of se systems. Lifestyle monitoring solutions [5] ir integration into wearable accessories smart clothing has emerged as ICT solutions, able to capitalize on latest advances in sensing, signal analysis communications [6 12]. This has generated a number of commercial products experimental prototypes, demonstrating important advances achieved in enabling ICT technologies.

3 Sensors 2016, 16, of 12 Nowadays, wearable sensors smart textiles have become key elements of lifestyle coaching service in an ecological monitoring setting for a single user responsive system. Neverless, available commercial products often offer limited functionality accuracy in representing reliable monitoring solutions, while experimental prototypes are obstructive, conspicuous, require skilled users, or only apply to specific populations. In both cases, a step forward has to be done to fulfil mobility ergonomic requirements crucial for ir public acceptation commercial exploitation. Individual monitoring represents a key point in PEGASO strategy. In PEGASO frame, main purpose of sensing component of platform is to collect data about teenagers physical activity behavioural habits. The adoption of an active lifestyle monitoring of its related physical parameters in an engaging, social platform is one of objectives of technological platform of project [3]. In this view, design of a dedicated wearable platform represents a specific challenge goal. As a matter of fact, some statistics affirm that re is a lack of continued utilization of se products, namely sports activity monitors, limited to six months of use. To strengn acceptance continued use of wearable devices by users is a key aim of PEGASO. This objective could be reached by involving users from beginning of device s development, using a UCD approach. The PEGASO system architecture is based on a mobile platform that collects integrates data coming from physical parameters, healthy behaviour environmental feedback. These data are collected using three levels of sensors (Figure 1). The first one is smartphone, which represents central main important part of system. Teens usually have use smartphones. If PEGASO apps are installed, smartphone allows functionality of system it is able to provide minimum level of information that guarantees system operability. A smart wristb could be considered second level of PEGASO sensors. This smart bracelet consists of an activity tracker that measures physical activities (thanks to a three-axis accelerometer) during day calculates energy expenditure. Users could wear it all data acquired are transferred to a dedicated app via Bluetooth. The wearable electronic system smart garments constitute third level of PEGASO sensor system. The wearable system is addressed to short-term monitoring of physiological parameters during sport activities. The electronic module measures cardiac activity (with an I-lead ECG), physical activity (thanks to a three-axis accelerometer) energy expenditure. The device is connected to garments using a two-press stud it sends data acquired via Bluetooth. The smart garment is equipped with textile electrodes at chest level it allows a continuous monitoring of physiological parameters in an unobtrusive comfortable way [6 11]. The textile electrodes are made of a 3D conductive textile, in which a silver yarn is mixed with a 3D static filament. This textile was chosen after several laboratory tests among different conductive textiles [13]. The tested textiles differ in composite mixture of conductive non-conductive yarns, which means a substantial change in terms of conductivity, elasticity properties decay after usage washing cycles. Among different samples of conductive textiles, 3D textile kept its properties after laboratory test [13]. This paper presents discusses development of wearable monitoring system of co-design activities conducted with teenagers, to define requirements specifications at functional, technical aestic levels, to increase its acceptance compliance. Secondly, paper focuses on functional validation of smart garments through proposal of a first stardized protocol to verify signal reliability with respect to some activities of daily living.

4 activity behavioural habits. The adoption of an active lifestyle monitoring of its related physical parameters in an engaging, social platform is one of objectives of technological platform of project [3]. In this view, design of a dedicated wearable platform represents a specific challenge goal. As a matter of fact, some statistics affirm that re is a lack of continued utilization of se products, namely sports activity monitors, limited to six months of use. To strengn acceptance continued use of wearable devices by users is a key aim of Sensors 2016, PEGASO. 16, 1220 This objective could be reached by involving users from beginning of device s 4 of 12 development, using a UCD approach. Figure 1. PEGASO sensors system. Figure 1. PEGASO sensors system. The PEGASO system architecture is based on a mobile platform that collects integrates data 2. Materials coming from Methods physical parameters, healthy behaviour environmental feedback. These data are collected using three levels of sensors (Figure 1). The first one is smartphone, which represents We recruited central cooperated main important with part potential of system. users Teens in usually design have use development smartphones. of If devices PEGASO apps are installed, smartphone allows functionality of system it is able to technologies, pointing out features functional advantages that system offers. The use of provide minimum level of information that guarantees system operability. A smart wristb a co-design could activity be considered represented second an important level of PEGASO stepsensors. in This approach smart bracelet adopted consists in PEGASO of an activity because by making tracker final that usermeasures activelyphysical participate activities in (thanks design to a three-axis process, accelerometer) final acceptance during day compliance of systemcalculates could have energy more expenditure. successusers value. could wear Thisit was all done by data means acquired ofare co-design transferred focus to a groups in dedicated app via Bluetooth. The wearable electronic system smart garments constitute first year of project. third level of PEGASO sensor system. The wearable system is addressed to short-term monitoring of physiological parameters during sport activities. The electronic module measures 2.1. Co-Design Focus Groups cardiac activity (with an I-lead ECG), physical activity (thanks to a three-axis accelerometer) Sinceenergy beginning expenditure. ofthe PEGASO, device is connected teens were to involved garments through using a two-press focus stud groups it insends Italy, Spain, data acquired via Bluetooth. The smart garment is equipped with textile electrodes at chest UK to elicit underst ir opinion about health, importance of a healthy active level it allows a continuous monitoring of physiological parameters in an unobtrusive lifestyle, comfortable use of mobile way [6 11]. The social textile media electrodes for health are made purposes of a 3D conductive textile, monitoring in which of a silver ir activities physiological yarn is mixed parameters with a 3D static through filament. wearable This textile devices. was chosen Teenagers after several were laboratory recruited tests through among schools, focusing on fostering communities of interest (i.e., all students in a class), rar than students with identified risk factors. Focus groups were methodologically organized into three phases. In total 407 European adolescents participated in focus groups. Table 1 below shows distribution of teenagers per country per phase. Before recruitment, a dedicated informed consent was approved by each school institution signed by parents. Table 1. Number of participants 1 in focus groups in three phases in each country. Phase Italy Spain United Kingdom Total per Country Total per Project Adolescents (male female) aged During first phase or focus group, PEGASO Project was presented to teens, investigating ir level of awareness about use of technology for health purposes. The second phase was addressed to exploration of sensors wearable technologies for health management. Each participant tested one commercial life tracker for one week; different models were proposed, some stressing design aspects hiding functionality (i.e., Misfit Shine), some more

5 Sensors 2016, 16, of 12 evidently showing functionality technology behind (i.e., Withings Pulse). Figure 2 shows devices used for experiment. The goal was to collect participants opinions about use of wearable sensors ir features. Sensors 2016, 16, of 12 Sensors 2016, 16, of 12 (a) (b) Figure 2. The commercial life trackers given to users: (a) Misfit Shine; (b) Withings Pulse O2. Figure 2. The commercial life trackers given to users: (a) Misfit Shine; (b) Withings Pulse O 2. (a) (b) In addition, some design samples of PEGASO garments (two sport t-shirts two sport bras) were In addition, Figure shown, 2. The some to commercial investigate designlife samples trackers most of given important PEGASO to users: features garments (a) Misfit that (two Shine; teenagers sport (b) Withings t-shirts consider Pulse O2. relevant two sport to bras) wereimprove shown, to investigate acceptance of most wearable important apparel. features The that third phase teenagers was consider specifically relevant dedicated to improve to In addition, some design samples of PEGASO garments (two sport t-shirts two sport bras) acceptance co-design activities of as wearable will be explained apparel. in The detail third in phase next paragraphs. was specifically dedicated to co-design were shown, to investigate most important features that teenagers consider relevant to activitiesfor second phase, as a function of some preliminary preferences expressed by a sample of improve as will be acceptance explained of in detail wearable in apparel. next paragraphs. The third phase was specifically dedicated to subjects interviewed at beginning of project in first focus group phase, an initial set of co-design For second activities phase, will as be aexplained functionin ofdetail somein preliminary next paragraphs. preferences expressed by a sample of sensing garments was proposed. The main issue underlined by teenagers is willingness to show subjects interviewed For second atphase, beginning as a function of of some project preliminary in first preferences focus group expressed phase, by a an sample initial of set of or to hide sensing technology: some of m are technology addicted so y like to show to sensing subjects garments interviewed was proposed. at beginning The main of issue project underlined first by teenagers focus group is phase, willingness an initial set to show of or ors that y are up to date with most recent systems. Instead, a second group of adolescents to hide sensing indicated sensing garments that y technology: was proposed. would like some The to wear ofmain a missue normal are t-shirt technology underlined by equipped addicted teenagers is with sensing so capabilities; y willingness like to this show to show means to ors that y or to that are hide sensors up tosensing date have with technology: to be embedded mostsome recent of into systems. m are technology t-shirt Instead, a sensing second addicted group so y device of has adolescents like to show to be fixed indicated to that y ors hidden would that y by clos likeare toup items. wear to date According a normal with to t-shirt most se equipped recent systems. suggestions, withinstead, two sensinga different capabilities; second group samples of this of adolescents garments means were that indicated that y would like to wear a normal t-shirt equipped with sensing capabilities; this means sensors developed have to be presented embedded in into first focus t-shirt group: one sensing set of garment devicewas has made to be with fixed visible hidden by that sensors have to be embedded into t-shirt sensing device has to be fixed clos sensors items. concept, According or to se one suggestions, following two hidden different sensors samples vision. offigures garments 3 were 4 compare developed hidden by clos items. According to se suggestions, two different samples of garments were presented male in female first versions focus group: of two oneprototypes. developed presented in first focus set of group: garment one was set of made garment with was made visible with sensors visible concept, or sensors oneconcept, following or hidden one following sensors hidden vision. Figures sensors 3vision. 4Figures compare 3 4 male compare female versions male of female two prototypes. versions of two prototypes. (a) (b) Figure 3. The comparison of two male versions of first set of sensorized t-shirts: (a) style with technical textile (a) visible device to be attached to two snap buttons; (b) (b) style with a more fashionable colour sensing device hidden into pocket where two connecting Figure 3. The comparison of two male versions of first set of sensorized t-shirts: (a) style Figure snap 3. buttons The comparison are placed. of two male versions of first set of sensorized t-shirts: (a) style with technical textile visible device to be attached to two snap buttons; (b) style with with technical textile visible device to be attached to two snap buttons; (b) style with a a more fashionable colour sensing device hidden into pocket where two connecting more snap fashionable buttons are colour placed. sensing device hidden into pocket where two connecting snap buttons are placed.

6 Sensors 2016, 16, of 12 Sensors Sensors 2016, 2016, 16, 16, of 6 of (a) (a) (b) (b) Figure Figure The The comparison of of two two female female versions versions of of first first set set of of sensorized bras: bras: (a) (a) style style Figure 4. The comparison of two female versions of first set of sensorized bras: (a) style with with technical technical textile textile visible visible device device to to be be attached attached to to two two snap snap buttons; buttons; (b) (b) style style with with with technical textile visible device to be attached to two snap buttons; (b) style with a a a more more fashionable colour colour sensing sensing device device hidden hidden into into pocket pocket where where two two connecting more fashionable colour sensing device hidden into pocket where two connecting snap snap snap buttons buttons are are placed. placed. buttons are placed. The The Visible Sensor Sensor Line Line was was made made of of a a technical textile, textile, used used for for professional sport sport activities, in in order order The to to Visible be be comfortable Sensor Line guarantee was made skin skin of a perspiration. technical textile, High High used elasticity for professional assures assures sport proper proper activities, sensor sensor stability in order over over to be comfortable skin skin of of adolescent. guarantee The The skin Hidden perspiration. Sensor Sensor High Line Line elasticity was was made made assures of of jersey jersey proper cotton, cotton, sensor in in order order stability to to look look over like like skin everyday of garments. adolescent. The The The device device Hidden was was Sensor hidden hidden Line by by a a was pocket pocket made on on of jersey chest, chest, cotton, laterally in order as as in in to look male male like version version everyday or or centrally garments. as as in in The device bra bra version. was hidden Two Two textile textile by a pocket electrodes on are are chest, embedded laterally in in both both as in smart smart male version garments: or centrally as in bra version. Two textile electrodes are embedded in both smart y y allow allow recording of of I-leading ECG ECG signal, signal, toger with with respiration; garments: y allow recording of I-leading ECG signal, toger with respiration; sensing sensing device device also also mounts a a three-axis Inertial Inertial Monitoring Unit Unit (IMU) (IMU) to to detect detect measure activity activity device also mounts a three-axis Inertial Monitoring Unit (IMU) to detect measure activity movements. The The textile textile electrodes are are made made of of silver-based yarn yarn that that demonstrated high high movements. The textile electrodes are made of silver-based yarn that demonstrated high electrical electrical conductivity, stability of of sensors sensors with with respect respect to to repeated washings signal signal quality quality conductivity, stability of sensors with respect to repeated washings signal quality comparable comparable to to one one obtained through stard silver/silver chloride adhesive medical to one obtained through stard silver/silver chloride adhesive medical electrodes. The smart electrodes. The The smart smart garments are are n n connected with with electronic wearable device device by by means means of of garments are n connected with electronic wearable device by means of two snap buttons. two two snap snap buttons. In of in In In third third phase phase of of co-design activity, in in a a dedicated focus focus group, group, users users were were provided with with to a a co-design template, asked asked to to sketch sketch new new PEGASO smart smart garments. Some Some guidelines to colours or for driving proper sensors positioning for suggestions were were given, given, related related to to materials, colours colours or or for for driving driving proper proper sensors positioning physiological measurements; y were n asked to design t-shirts, bras or vests (Figure 5). for for physiological measurements; y y were were n n asked asked to to design design t-shirts, bras bras or or vests vests (Figure (Figure 5). 5). (a) (a) (b) (b) Figure Figure Figure The 5. The The co-design co-design co-design rules rules rules related related related suggestions suggestions to to comply comply to comply with with basic with basic basic requirements: requirements: (a) (a) threestestep (a) three- three-step development development design design activity design activity activity explained explained explained to to to teenagers; teenagers; (b) (b) (b) three three fixed three fixed points fixed points points imposed imposed imposed by by bytechnical technical technical functional functional requirements requirements for for signal signal for signal monitoring monitoring project project project dissemination. dissemination Overall Overall System System Raw Raw Signal Signal Reliability Protocol Following aestic suggestions/requirements that that emerged from from three three focus focus group group phases, phases, final final garment prototypes were were made. made. These These prototypes were were shown shown to to users, users, to to get get ir ir comments opinion about about fabrics, fabrics, design design aestic aspects. The The smart smart garments were were

7 Sensors 2016, 16, of Overall System Raw Signal Reliability Protocol Following aestic suggestions/requirements that emerged from three focus group of of These prototypes were shown to users, to77get ir comments opinion about fabrics, design aestic aspects. The smart garments were also tested also tested tested in order order to to evaluate evaluate signal signal reliability reliability with with respect respect to to skin skin motion motion artefacts. artefacts. Ten Ten healthy healthy also in orderin to evaluate signal reliability with respect to skin motion artefacts. Ten healthy volunteers volunteers (five males five females) were recruited. They were asked to wear smart garment (five males five females) were recruited. They were asked to wear smart garment (proper size (proper size size version male/female for version male/female for each each subject) to to connect connect PEGASO PEGASO wearable wearable (proper version male/female for each subject) subject) to connect PEGASO wearable electronic device electronic device device (WES). (WES). After After that, y y were asked asked to to do do some some physical physical exercises exercises repeat repeat three three electronic (WES). After that, y werethat, asked to were do some physical exercises repeat three times each of times each each of of following following experimental experimental procedures. procedures. Table Table 2 below below shows shows phases phases of of testing testing times following experimental procedures. Table 2 below shows 2 phases of testing protocol. protocol. protocol. Sensors 2016, 16, 16, 1220 Sensors 2016, phases, 1220 final garment prototypes were made. Table 2. Overall system raw signal reliability protocol. Table 2. Overall system raw signal reliability protocol. Description Figure Description Figure Phase Phase Description 0 Rest for 20 Rest for 20arms s withatarms sides 0 s with at sides 0 Rest for 20 s with arms at sides times:20flexion/extension arms arms times: flexion/extension 1 20 times: flexion/extension arms movements + 10 right) movements (10 left ( left right) times: inside/outside arms 20 times: times:20 inside/outside arms movements movements 20 inside/outside arms 3 movements on horizontal plane on horizontal plane (10 left + 10 right) (10 left + 10 right) times: times:10 elevation depression depression of of 10 elevation of times: elevation depression 4 shoulders shoulders shoulders times:20 abduction/adduction arms arms times: abduction/adduction movements (10 left + 10 right) movements (10 left + 10 right) movements (10 left + 10 right) 10 times: times: retro/anteposition retro/anteposition of of shoulders shoulders 10 from back to front Figure

8 Sensors 2016, 16, of 12 Table 2. Cont. Phase Description Figure 10 times: retro/anteposition of 5 Sensors 2016, 16, 1220 shoulders from back to front 8 of 12 Sensors 2016, 16, of 12 Sensors 2016, 16, of times: rotation of torso from left to right 10 times: rotation of torso from left to 10 times: 10 rotation times: rotation of torso of from torso left fromto right left right to right times: flexion/extension of torso from back to front (10 front + 10 back) 10 times: 10 flexion/extension times: flexion/extension of torso of from torso 10 times: from flexion/extension back to front (10of front + torso 10 back) from back to front (10 front + 10 back) back to front (10 front + 10 back) times: 10 right times: right left lateral left lateral flexion flexion of of torso from left to right torso from left to right (10 left + 10 right) 10 times: (10 right left + 10 left right) lateral flexion of 10 times: right left lateral flexion of torso from left to right (10 left + 10 right) torso from left to right (10 left + 10 right) 3. Results Discussion 3. Results Discussion 3.1. Focus Group Results 3. Results Discussion 3.1. Results Focus Group Discussion Results The focus groups gave chance to explore user attitude towards introduction of 3.1. wearable Focus The focus Group monitoring groups Results gave technologies chance into to one s explore life. Given user attitude available towards technologies introduction future of 3.1. wearable Focus Group Results perspectives, monitoring The focus groups all technologies participantsinto gave chance demonstrated one s life. to explore agiven great user interest available attitude in wearable technologies towards sensors, introduction considering future of m perspectives, The focus groups gave chance explore user attitude towards introduction of wearable comfortable all monitoring participants useful technologies for demonstrated monitoringa into one s life. of great irinterest Given lifestyle. in wearable available Some of technologies m sensors, said considering y would m future prefer wearable comfortable monitoring technologies into one s life. Given available technologies future perspectives, to use se all garments useful for participants only monitoring during demonstrated exercises, of ir a great instead lifestyle. interest of Some duringof in wearable m entire said sensors, day y considering would in place prefer m ofto ir perspectives, use comfortable clos se garments ( If all I wanted only useful participants for something during exercises, monitoring demonstrated in my clos instead of ir a great Iof would during lifestyle. interest rar in entire Some wearable day of m a wristb sensors, in place said y that considering of would is ir moreclos prefer discrete ). m to comfortable ( If useful for monitoring of ir lifestyle. Some of m said y would prefer to use They I wanted se demonstrated something garments only interest my clos during in exercises, garments I would rar instead price, wear of during ira availability wristb that entire day on is more in market, discrete ). place of ir information They clos use demonstrated se garments only during exercises, instead of during entire day in place of ir clos ( If about I wanted something design, interest materials in garments in my clos colours. price, ir I would Theyavailability rar were wear very a wristb curious on market, about that is which information more data discrete ). were about detected They ( If I wanted something in my clos I would rar wear a wristb that is more discrete ). They demonstrated using design, materials garments, interest in especially colours. They garments during were price, ir very ir sport curious availability activities, about on sowhich that market, y data could were monitor detected information performance using about demonstrated garments, interest garments price, ir availability on market, information about improvement. especially design, materials Anor during colours. strong ir They point sport were wasactivities, very comfort so curious inthat about use y which of could data garments monitor were detected withperformance using embedded improvement. design, materials colours. They were very curious about which data were detected using garments, smart textileanor especially during strong during sports activities point was ir sport compared comfort activities, with in so bracelets. use of that y Subjects, garments could indeed, with monitor said performance y embedded would be garments, smart especially during ir sport activities, so that y could monitor performance improvement. allowed textile toduring use Anor se sports strong garments activities point while compared was playingwith comfort sports bracelets. in (e.g., use during Subjects, of garments volleyball indeed, said with training y embedded sessions would be y improvement. allowed smart cannot to textile wear use during Anor se anything garments sports strong such while activities point as bracelets was playing compared orsports comfort necklaces, (e.g., with bracelets. in but during use y Subjects, of are volleyball allowed garments training indeed, to wear with said smart y sessions embedded y would garments). be smart cannot textile wear anything during sports such activities as bracelets compared or necklaces, with but bracelets. y are Subjects, allowed indeed, to wear said smart y garments). would be allowed to use se garments while playing sports (e.g., during volleyball training sessions y allowed Two to models use se achieved garments resounding while playing success sports among (e.g., during 173 users volleyball interviewed: training most sessions rated y (42 cannot wear anything such as bracelets or necklaces, but y are allowed to wear smart garments). cannot of 173) was wear anything black, waisted-shaped such as bracelets model; or necklaces, this t-shirt but has y a sporty are allowed design to wear tightens smart in garments). waist, Two models achieved resounding success among 173 users interviewed: most rated (42 with Two green models seams. achieved The second resounding one (voted success by 38 of among 173 users) 173 was users a white interviewed: t-shirt, with a smooth most rated design, (42 of 173) was black, waisted-shaped model; this t-shirt has a sporty design tightens in waist, of short 173) was blue sleeves black, waisted-shaped a small purple model; pocket this t-shirt on has left a side sporty of design chest. tightens in waist, with green seams. The second one (voted by 38 of 173 users) was a white t-shirt, with a smooth design, with As green result seams. of The third second focus one group, (voted teens by 38 gave of 173 feedback users) was on a white garments t-shirt, features with a smooth produced design,

9 as a point to take into high consideration, recommending us to collaborate with fashion designers. The aestics of PEGASO system drive its acceptability. Based on results of focus groups, second generation of smart garments was developed tested in pre-pilot phase (i.e., a three-step validation period in preparation for full pilot): Sensors 2016, 16, of 12 in this phase, potential users could experience a real interaction with PEGASO technologies. The pre-pilot is made of three steps, addressed to evaluation of devices apps. The first step was related Two to testing models achieved evaluating resounding PEGASO success among system in 173 a controlled users interviewed: environment; most mock-ups rated of PEGASO (42 of 173) apps waswere black, installed waisted-shaped in users model; devices this t-shirt tested has a sporty design game was tightens shown in in demo waist, with green seams. The second one (voted by 38 of 173 users) was a white t-shirt, with a smooth mode. Feedback was collected this led to an adjusted design graphics. The second step design, short blue sleeves a small purple pocket on left side of chest. consisted of real use of PEGASO system. For one week, a group of users tested devices (a As result of third focus group, teens gave feedback on garments features produced wristb some sketches. a monitoring They had to sensor), choose among garments several templates of apps. t-shirts, The bras last pre-pilot vests is design still ongoing ir at time favourite of writing one. As in of this previous paper. phases, re was no unanimity on sensor placement: some of m preferred visible one, ors hidden (Figure 6). Figure 6. One example of sketches produced by Italian teenagers for co-design focus: bra Figure version 6. One according example to of vision sketches of a 15-year-old produced female by Italian student. teenagers for co-design focus: bra version according to vision of a 15-year-old female student. Concerning co-design sketches, users outlined three different t-shirt models: males drew As very result colourful of se models, two testing with symbols steps, such three as main peace sign outcomes or irfrom favourite s users bfeedback, logo; somein of terms of usability those wereacceptability, singlet models, are ors following were t-shirts ones. with(a) short Users sleeves. prefer Females to wear sketched garments solid colour, just during sports in particular training black rar than white, during bras toir put under usual any daily t-shirt. activities. All interviewed The participants users stated liked ir shirts preference hidden sensors, embedded in t-shirt not visible to or people. Most of found m comfortable to wear, though y expressed opinion that design needs to be subjects indicated that y would prefer light technical fabrics, such as ones already used for improved made more fashionable; (b) They liked that t-shirts were stretchy that y fit sport clos. all of m. Users Some were of veryparticipants interested inexpressed monitoring that features y would but y have indicated preferred garments or fabrics design instead of those as presented; a point to take (c) into Short highsleeves consideration, tank recommending top-style shirts us to collaborate were preferred. with fashion While designers. wearing sensors, The participants aestics of did PEGASO not feel system restricted drivein its ir acceptability. movements/activities at all did not notice m. Based on results of focus groups, second generation of smart garments was developed tested in pre-pilot phase (i.e., a three-step validation period in preparation for full pilot): in this phase, potential users could experience a real interaction with PEGASO technologies. The pre-pilot is made of three steps, addressed to evaluation of devices apps. The first step was related to testing evaluating PEGASO system in a controlled environment; mock-ups of PEGASO apps were installed in users devices tested game was shown in demo mode. Feedback was collected this led to an adjusted design graphics. The second step consisted of

10 Sensors 2016, 16, of 12 real use of PEGASO system. For one week, a group of users tested devices (a wristb a monitoring sensor), garments apps. The last pre-pilot is still ongoing at time of writing of this paper. As result of se two testing steps, three main outcomes from users feedback, in terms of usability acceptability, are following ones. (a) Users prefer to wear garments just during sports training rar than during ir usual daily activities. The participants liked shirts found m comfortable to wear, though y expressed opinion that design needs to be improved made more fashionable; (b) They liked that t-shirts were stretchy that y fit all of m. Some of participants expressed that y would have preferred or fabrics instead of those presented; (c) Short sleeves tank top-style shirts were preferred. While wearing sensors, participants did not feel restricted in ir movements/activities at all did not notice m System Reliability Results Ten healthy volunteers tested smart garment signal reliability with respect to skin motion artefacts while performing movements of activities of daily living; data are reported in Table 3. Users were asked to wear smart garment, to connect WES to start performing a stardized set of defined exercises (as shown in Table 2 above). The data signals acquired during test were processed to compute quality of signal during each step according to following criteria: Criterion 1: ECG signal is suitable for processing to compute main parameter (beat-to-beat heart rate related secondary parameters, e.g., heart rate variability); scoring system: 0 = N, 1 = Y; Criterion 2: percentage time of a high quality signal; scoring system: from 0 = 0% to 1 = 100%; Total score in each step for each subject = Criterion 1 * Criterion 2. The test can be considered as successful if overall score is equal or greater than 0.8 after complete test. The recruited subjects are described in following table. Table 3. Participants characteristics. Subject ID H (cm) W (kg) Age (Years) Sex M F F F F M M F M M As shown by results in Table 4, most critical activity is demonstrated to be flexion/extension arm movements because y produce severe skin motion artefacts affecting signal quality.

11 Sensors 2016, 16, of 12 Table 4. Signal reliability scores. Phase Subject Total s s s s s s s s s s avg sd Conclusions The results of this part of study concern methodology to develop innovative wearable sensors not simply from technological point of view but, above all, in relation to users feedback compliance. The case study was PEGASO system technologies (garments, apps, game), which is one aspect of entire project s outcome. Preliminary findings are related to vision judgments provided by adolescents about new wearable monitoring technologies. The main interesting elements of data collected during focus groups related analysis raised that life shortness of activity trackers is a common topic in literature phenomenon is particularly widespread among teens. As a matter of fact, teens revealed y were interested in monitoring ir activity wearing smart clos. The outcome is that designing devices answering ir desiderata is really challenge, aforementioned involvement strategy could be key. In fact, UCD approach was demonstrated to be effective reliable in providing solutions that match users requirements preferences. This would increase actual daily use of se wearable devices for implementing prevention strategies adopted by project in promoting healthy habits into selected teenager cohort. Moreover, an evaluation protocol for smart garment its signal reliability with respect to skin motion artefacts was defined. Thanks to different exercises performed, wearable system functionality can be tested in real usage. The system developed proves its reliability good quality of signal acquired during usage. The PEGASO framework will be validated by secondary school students during pilot test phase. Four validation studies will be carried out in Italy (Lombardy), Spain (Catalonia) United Kingdom (Engl/Scotl), involving about 400 students. The validation of PEGASO platform will first assess system technology acceptance, usability long-term use. These factors will be assumed also as a secondary assessment of motivation engagement of teenagers in adoption of prevention strategies. From a technology perspective, pilot tests will also evaluate reliability in assessing teenagers lifestyles ir changes (with a focus on eating habits on physical activities) related efficacy on sensors network system. Also, at end of project we will be able to have a complete assessment of efficiency of system in encouraging lifestyle change. Acknowledgments: This paper is partly based on work performed within context of PEGASO project. The PEGASO project is co-funded by European Commission under 7th Framework Programme FP7-ICT Grant Agreement n PEGASO is part of cluster of projects in ICT for health area; it started in December 2013 will run for 42 months. The author wishes to thank all project partners for ir contribution to activities.

12 Sensors 2016, 16, of 12 Author Contributions: C.E.S. M.R.G. were in charge of original idea of paper: y revised related literature started proposing, discussing reviewing issues of PEGASO wearable system. They contributed in writing first draft of paper y revised final version. G.A. contributed in proposing, discussing reviewing technological ethical aspects of wearable monitoring system. He contributed in writing related parts of paper he revised final version. A.M. was in charge of analysis of focus groups. She contributed in writing related parts of paper she revised final version. M.M. P.P. contributed in proposing, discussing reviewing technological issues of PEGASO wearable system. They contributed in writing related parts of paper y revised final version. Conflicts of Interest: The authors declare no conflict of interest. Abbreviations The following abbreviations are used in this manuscript: UCD ICT ECG ICT IMU EU FP7 WES References User-Centred Design Information Communication Technologies Electrocardiogram Information Communication Technologies Inertial Monitoring Unit European Union 7th Framework Programme Wearable Electronic System 1. Sassi, F. Obesity Economics of Prevention: Fit Not Fat; OECD Report; OECD: Paris, France, Starfield, B.; Hyde, J.; Gérvas, J.; Heath, I. The Concept of Prevention: A Good Idea Gone Astray? J. Epidemiol. Community Health 2008, 62, [CrossRef] [PubMed] 3. Pegaso Fit for Future. Available online: (accessed on 31 March 2016). 4. Sers, E.B. From User-Centered to Participatory Design Approaches. In Design Social Sciences; Frascara, J., Ed.; Taylor & Francis Books Limited: London, UK, 2002; pp Bonato, P. Wearable Sensors Systems. IEEE Eng. Med. Biol. Mag. 2010, 29, [CrossRef] [PubMed] 6. Ledger, D.; McCaffrey, D. Inside Wearables How Science of Human Behavior Change Offers Secret to Long-Term Engagement Part 1; Endeavour Partners LLC: Boston, MA, USA, Available online: (accessed on 31 March 2016). 7. Lymberis, A.; Gatzoulis, L. Wearable Health Systems: From smart technologies to real applications. In Proceedings of 28th Annual International Conference of IEEE Engineering in Medicine Biology Society, New York, NY, USA, 31 August 3 September 2006; pp De Rossi, D.; Lymberis, A. New generation of smart wearable health systems applications. IEEE Trans. Inf. Technol. Biomed. 2005, 9, [CrossRef] [PubMed] 9. Cho, G. Smart Clothing: Technology Applications; CRC Press: Boca Raton, FL, USA, Perego, P.; Moltani, A.; Andreoni, G. Sport monitoring with Smart Wearable System. In Studies in health Technology Informatics, phealth In Proceedings of 9th International Conference on Wearable Micro Nano Technologies for Personalized Health, Porto, Portugal, June 2012; Blobel, B., Pharow, P., Sousa, F., Eds.; IOS Press: Amsterdam, The Nerls, 2012; pp Webster, J.G. Medical Instrumentation Application Design, 4th ed.; John Wiley & Sons: New York, NY, USA, Andreoni, G. Il Fattore Uomo nel Design; Aracne Editrice: Roma, Italy, Perego, P.; Andreoni, G.; Tarabini, M. Textile Performance Assessment for Smart T-Shirt Development. In Proceedings of etelemed 2016: The Eighth International Conference on ehealth, Telemedicine, Social Medicine (with DIGITAL HEALTHY LIVING 2016/MATH), Venice, Italy, April 2016; pp by authors; licensee MDPI, Basel, Switzerl. This article is an open access article distributed under terms conditions of Creative Commons Attribution (CC-BY) license (