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Nov. 20-22, 2015

An Interactive Healthcare System with Personalized

Diet and Exercise Guideline Recommendation
Jerry C.C. Tseng, Bo-Hau Lin, Yu-Feng Lin,

Miin-Luen Day, Shyh-Chyi Wang, Kuen-Rong Lo

Department of Computer Science and Information Engineering,

National Cheng Kung University
Tainan City, Taiwan (R.O.C.)

Telecommunication Laboratories,
Chunghwa Telecom Co., Ltd
Taoyuan City, Taiwan (R.O.C.)

Vincent S. Tseng

Yi-Ching Yang

Department of Computer Science, National Chiao Tung University

Hsinchu City, Taiwan (R.O.C.)
vtseng@cs.nctu.edu.tw

Department of Family Medicine,

National Cheng Kung University Hospital
Tainan City, Taiwan (R.O.C.)

Abstract Recently people pay more and more attention on

how to effectively and efficiently analyze the result of regular
physical examinations to provide the most helpful information
for individual health management. In this paper, we design and
develop an interactive system of virtual healthcare assistant to
help people, especially for those who suffer from chronic diseases
(e.g., metabolic syndrome) to easily understand their health
conditions and then well manage it. This system analyzes the
result of regular physical examination to evaluate the health risk
and provide personalized healthcare services for users in terms
of diet and exercise guideline recommendations. We developed
some interactive ways for users to easily feedback their vital signs
to the system and quickly get the suggestions for health
management from the system. Besides the browser-based system,
we also developed a mobile App that can regularly remind users
to carry out the recommendations, which are provided by the
system. To prove the system is feasible in the real-world clinical
environment, we also applied the Institutional Review Board
(IRB) for a human subject research to validate this system. Other
than the functional features, there are also several important
non-functional features of the extensibility and the convenience
for use. First, we use the physical examination result as the raw
data to be analyzed. Its very convenient for users with very low
cost. Second, the system design is extendable, so it can be easily
adjusted to work for any chronic ills, even other kinds of diseases.
Moreover, it can be extended to provide other kinds of
healthcare guideline recommendations as well. These features
constitute the main contributions of this work.
Keywords Personalized healthcare services; Diet and
exercise guideline recommendation; Physical examination; Virtual
assistant system

I.

Unlike cancers, most chronic diseases can be well

controlled, even can be prevented, if people can live with a
healthy lifestyle, such as the regular sleep, balanced diet and
proper exercise. Nowadays people can easily get the
information of their glucose, blood lipids, blood pressure and
waist circumference to be aware of their own health status. As
we know, self-management is the key factor in preventing
chronic illness [1, 2, 3, 10], but only few people can keep the
healthy living style with enough exercise and good diet habits
mostly because of the very busy and high pressure modern life.
Consequently, the populations of chronic diseases are getting
more and younger than ever [1].
Now through Internet, we can easily Google all what we
want to know. People can learn all kinds of information of the
general healthcare knowledge, but its not easy to judge which
ones are helpful for themselves. Because everybody has his/her
own health status, its very common that one healthcare
guideline recommendation is very helpful to somebody, but it
may be helpless, even harmful to others. Though there are
numbers of health management systems that are provided by
medical institutions, have been developed for users to record
the daily self-measurement, but users still need to bring their
own health records to the medical institutions to ask for selfcare instructions [2, 10, 12, 13].
In our earlier research works, Lin et al. [9] proposed the
VASP (Virtual Assistant System for Personal health
management) framework that can analyze the report of regular
comprehensive physical examination, and then can provide the
personalized healthcare services for users in terms of diet and
exercise guideline recommendations. In this paper, we based
on the VASP framework to design and implement an inactive
system of virtual healthcare assistant system. As shown in Fig.
1, we illustrate the high-level conceptual diagram.

INTRODUCTION

The newest report [15] released by the Ministry of Healthy

and Welfare shows us that the major part of the top 10 causes
of death are chronic diseases, although the first cause of death
in Taiwan is still cancers. According to the report, in 2014,
more than half of the top 10 causes of death are some kinds of
chronic diseases, such as the heart diseases, hypertensions,
cerebrovascular diseases, diabetes, chronic liver diseases or
kidney diseases. In this high-tension modern life, the result
seems reasonable, but that it should not be acceptable, because

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there are many self-health management ways to make people

stay away from the chronic diseases.

Other than the basic functions offered by the VASP

framework, now the sytem provides more interactive interfaces
for users to easily feedback their vital signs to the system. On
the other side, users can quickly get the responses from the
system as well. Most of the responses are suggestions for
health management. Besides the browser-based application, we

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For these issues, many medical institutions had shared

relevant information to provide healthcare for medically
underserved populations personal health management on the
Internet [1, 2, 5, 6, 10, 11, 12]. Many companies co-working
with medical institutions designed remote monitoring systems
to help medical experts efficiently maintain their patients or
avoid the elderlies on the danger, and they also proposed selfhealth management systems in preventing chronic illness [1, 2,
3, 10].

 


 








































 








iHealth365 [10] is one of self-health management systems,

which is a platform for medical institutions or companies to
manage health of customers or employees. iHealth365 can
allow users to upload their report of regular comprehensive
physical examination and analyze the vital signs of the report,
and it also provides not only the assessment of health risk but
also the health data visualization and remind system to
supervise the users. Furthermore, the smart phone app of the
iHealth365 for the users can get an improvement plan to
maintain their health. The experts also can use this system to
help their patients in real time when the patients give the
feedbacks. The iHealth365 also provides a function for
collecting data from the wearable devices. But iHealth365
system does not automatically provide personal diet and
exercise guidelines, and it still needs medical experts to
analyze the report to suggest the personal guidelines.








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Fig. 1. Conceptual diagram of the proposed system.

also developed an interactive mobile application (now its only

for Android) that can remind users to carry out the
recommendation of diet and exercise guidelines provided by
the system, to help them keep managing their health as well as
possible.
To prove that this system is feasible to use in a clinical
environment, we successfully applied to IRB of NCKU
Hospital for a hunman subject research to validate this system.
Because the experimentation now is still in process, we cant
present the final result here in this paper, but we believe that it
will work well as we expected.

In addition, last year Lin et al. [9] proposed VASP (Virtual

Assistant System for Personal health management), a virtual
assistant system for personal health management, which can
analyze the report of regular comprehensive physical
examination result to evaluate the health risk and provide
personalized healthcare services for users in terms of diet and
exercise guideline recommendations. Furthermore, the system
also can supervise and remind users to meet the recommended
plans of personalized diet and exercise guidelines. Although
the designed system [9] provides automatic recommendations
of personalized diet and exercise guidelines according to the
analysis of the individual report of regular comprehensive
physical examination, it lacks of the instantaneity and the
interaction for users. Therefore, this paper based on the
proposed framework by Lin et al. [9] to further take seamless
and ubiquitous into account to design an interactive healthcare
system with personalized diet and exercise guideline
recommendations.

Other than the functional implementations, there are several

non-functional features of this system. These features are also
the main contributions of this work.

First, we use the physical examination result as the raw

data to be analyzed. Its very convenient for users and
with very low cost.

Second, the system design is extendable, so it can be

easily adjusted to make it apply to other chronic ills
well, or to other kinds of diseases.

Moreover, it can be also extended to provide other

kinds of healthcare guideline recommendations, no only
the diet and exercise guidelines, which we took as the
implementation in this system.

Nov. 20-22, 2015

The remainders of this paper are organized as follows. We

describe the related works in Section II. Then, the proposed
system is introduced in details in Section III, and the human
subject research is introduced in Section IV. The conclusions
and future works are given in Section V.

III.

SYSTEM DESIGN

In this section, we first describe the design of the proposed

system. In Fig. 2, we illustrate the framework of our proposed
system. Based on the system overview of our proposed system,
we will illustrate the functions.and the tree main modules,
which are named Personal Health Management, Real-time
Interaction, and Personal Health Management Report, of our
proposed system respectively. Finally, we explain the
implementation of the Reminding Application (App).

II. RELATED WORKS

Taiwan now faces an imminent issue of population aging,
and the aging trend is discovering faster than the forecast. In
addition, many people has busy and high pressure modern life
so that they cannot keep the healthy living style and tend to be
in lack of exercise with eating disorders. Consequently, it leads
that there are not enough medical resources to meet the
medical needs of all people and the populations of chronic
illness are getting more and more young [1].

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addition, the real-time interaction module can immediately

provides users the real-time healthcare recommendations when
they upload the data of the physiological measurements.
On the other hand, the healthcare service providers can
make use of our proposed system to provide service to their
patients. Our proposed system provides an interface to edit
those guidelines in database for the healthcare service
providers. For the healthcare service providers, the guideline
recommendations can be respectively adjusted for each users in
our proposed system, and the report module can provide a view
of user for healthcare service providers understanding their
patients states.
Our proposed system is composed of three major
components, namely personal health management, real-time
interaction, and personal health management summary report.
In the next sections, they will be respectively introduced in
detail.

Fig. 2. The system overview

A. System Overview
Nowadays, it is very common for people to get a report of a
comprehensive physical examination from a medical institution
or a hospital in Taiwan. The comprehensive physical
examination report states the value of the examination items
and the risk of diseases. Some risk of chronic diseases, for
example Metabolic syndrome, can be reduced by diet and
exercise. The healthcare service providers can give those
people, who has risk of some chronic diseases, some
recommendations about the diet and exercise guidelines by
their professional knowledge and past experience.

B. Personal Health Management

The personal health management component includes two
main functions, diet and exercise guideline recommendations,
supervising and reminding.
1)
Diet and Exercise Guideline Recommendation
The diet and exercise guideline recommendation function
recommends personal guidelines for users according to the
report of comprehensive physical examination, as shown in
Fig. 3. In the designs, in addition to the full guidelines that can
be automatically recommended, medical experts or healthcare
service providers can adjust the priority of guidelines in order
to more adapt to users.

Traditionally, it is hard for people to search and get the

personalized diet and exercise guidelines without the
healthcare service providers professional help. In contrast, it is
very easy for people to find many general and diverse diet or
exercise guidelines in the internet. Most of the general
guideline are right but may be not appropriate for everyones
individual status. Furthermore, people should need someone to
supervise their execution of the recommended guidelines.
However, there are no sufficient number of healthcare service
providers to recommend the diet and exercise guidelines and to
supervise the execution of recommended guidelines anytime
anywhere for people who has a risk of those kinds of diseases.
On the other hand, people who has a risk of some diseases
sometimes can measure physiological value by themselves,
such like the blood pressure.

Another main function in diet and exercise guideline

recommendations is that an interface for healthcare service
providers can edit the diet and exercise guidelines in the
database. Healthcare service providers can consult the medical
experts to update the diet and exercise information. Then, the
guidelines in the database are mapped to those collected
information by healthcare service providers. Furthermore, the
healthcare service providers can edit detail information and
weights for each guidelines.

To address those problems, we propose a system which

provides those functions: guideline recommendations,
automatic supervising and reminding, real-time interaction, and
execution record summary. The framework overview of our
proposed system is illustrated in Fig. 2. First, people get the
report of comprehensive physical examination from medical
institution. Our proposed system can recommend the diet and
exercise guidelines according to the report of comprehensive
physical examination. Then, the proposed system supervises
the status of carrying out the guideline recommendations and
reminds users to reply the execution result. Furthermore, the
report module summarizes the execution result of users. In

Fig. 3. The screenshot of Personal Health Management Module

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2)
Supervising and Reminding
This function is designed for supervising and reminding
users. In order to automatically supervise and remind users to
carry out their personal recommendations regarding diet and
exercise guidelines, an active database is utilized for achieving
this purpose. The active database is considered as an eventdriven architecture which can respond to both the conditions
those are inside and outside the database.

Nov. 20-22, 2015

2) Real-time Physiological Value Upload

This function provides users an interface to upload their
physiological measurements and makes a quick determination
of users health state. If the health state of users is not in the
health range, then the guidelines are recommended by
guideline query function.
3) Real-time Feedback
This function aims to show the result of health state
determination and appropriate message for users. As shown in
Fig. 4., we shows an example that the health status of a user is
not in the health range, and the guidelines are recommended.

This function is to supervise users to fill out the daily diet

and exercise suggestions on time. In this function, there are
several different settings of basic supervising time by general
users lifestyle. In addition, users can adjust and set the
supervising time according to their special lifestyle. The
function supervises users until the reminding time, the
reminding function is triggered. Once users forget to fill out the
daily diet and exercise suggestions for a while time, the
reminding function is triggered to automatically remind users
to fill out the daily diet and exercise suggestions.

4) Physiological Value Database Edit

This function provides an interface for the healthcare service
providers. The healthcare service providers can edit health
range of physiological value and map guideline to the
physiological value, which is abnormal.
D. Personal Health Management Report
When users carry out their recommended diet and
exercise guidelines our proposed system records their
execution log. Those records can be summarized to a health
assessment report by Personal Health Management Report
module in our proposed system. The four main functions of
Personal Health Management Report module are Assessment
Edit, and visualization of Risk Report, Guidelines, and
Assessment. Before uses get their health assessment reports,
healthcare service providers can edit those report and modify
the index of next recommended guidelines for each users.
Personal Health Management Report module shows users
risk report, list of recommended diet and exercise guidelines,
examination result after currying out their recommended diet
and exercise guidelines, new recommended diet and exercise
guidelines based on the new physical examination result,
records of execution.

C. Real-time Interaction
The real-time interaction module provides those functions
which are guideline query, real-time physiological value
upload, real-time feedback, and Physiological Value Database
Edit Function. Because physiological measuring devices are
more and more popular, people can measure their physiological
value easily. Now users hope are not just only the real-time
measuring physiological value, they also want to know what
the right healthcare actions need to take when their
physiological value is out of the healthy range. Our proposed
system can give a real-time quick determination with the
physiological value database and guideline recommendations
from guideline database on Personal Health Management
Module when users upload their physiological value. In
addition, healthcare service providers can edit the health range
of physiological value and sort the recommended guideline for
each user.

1) Assessment Report Edit

This function provides healthcare service providers an
interface to edit the health assessment report before users
getting their repot. The users can only check those reports that
are saved by the healthcare assistants. Healthcare service
providers can modify the index of next recommended diet and
exercise guidelines based on the new physical examination
result.

1) Guideline Query
This function aims to query the guidelines in database
when the specific physiological measurement is given and
selects the guidelines to recommend which are high
correlations.

2) Risk Report Visualization

This function aims to show the physical examination
results of users. The examination results include previous
physical examination and the last physical examination. The
healthcare service providers or users can make a comparison
to see the difference two physical examination result.
3) Guidelines Visualization
This function shows the guidelines for healthcare service
providers or users. Those guidelines are produced based on the
previous physical examination and the last physical
examination. The healthcare service providers can modify the
index of the new diet and exercise guideline recommendations.

Fig. 4. The screenshot of user upload his/her physiological value

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Fig. 5. The screenshot of the achievement report for user

4) Achievement Visualization
This function shows the users daily record of carrying
out diet and exercise guideline recommendations. The
proposed system can record the execution status of users in the
period between the previous examination and the next
examination. As shown in Fig. 5, a users achievement report
of daily execution is presented as a line chart.

Fig. 7. The screenshot of app login function

E. Reminding App
To promote applicability of our proposed system, we
extend the reminding function on mobile platform. Our
proposed app provides those two functions, user login and
reminding. When a user login, the app will verify the users
authority and then download his/her personal setting file of
supervising and reminding from database through web services.
The reminding app executes in the background, and it gives an
alarm as a reminder on the mobile devices according to the
users setting.

Once the user is verified, the app will download the

authorized users personal setting of reminding time list, as
shown in Fig. 8. The setting list file is transferred in XML
format, and the app execution will automatically switch to the
background mode after downloading the personal setting file.
2)

Reminding Function
Since the personal setting file is downloaded, this app has
the information of reminding time list of the user, and this
function is designed to give users an alarm as a reminder on
mobile devices. In Fig. 9, it shows that there is an alarm icon
on status bar, and that can be dropped down to see complete
message.

1) User Login Function

As shown in Fig. 6, this function is designed to let user
input their username and password. The app will verify users
authority through the web services provided by the Web
Server, and Fig. 7 shows the simple communication process
between the mobile application and web server.
 


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Fig. 6. The communicaiton process bewteen the app and server

Fig. 8. The screenshot of the reminding setting ot the reminiding app

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Have IRBs approval for this

experimentation

Choose potential
ential participants

Inform consents
ents fo
for participants

The participants do the 1st

physical examination
Fig. 9. The screenshot of background mode of the reminding app

Collect thee parti

participants 1st
physical examination result

In Fig. 10, it shows that this app will issue a message to

remind the users to reply the supervising list.
IV.

HUMAN SUBJECT RESEARCH

Generate thee diet and exercise

guidelines recommendations
by system ((VASP)

To prove that this system is feasible for the use in a clinical

environment, we conducted a human experimentation to
validate this system. We applied to the IRB of National Cheng
Kung University Hospital for this human subject research. The
human experimentation was designed to validate whether the
system can really help users manage their own health status,
and to get the comments of user interface improvement via
questionnaire.

The participants
nts sta
start the human
experimentation

  

 




 





The participants do the 2nd
physical examination

Collect the partic

participants 2nd
physical examination result

Have an intervi
interview to see
why to stop halfway

Collect users
rs fee
feedback using
questionnaires

Generate the fin

final report
for this human subject research
Fig. 11. The process flow of the human subject research

We cooperated with the Department of Family Medicine of

National Cheng Kung University Hospital for this human
subject research. The detailed process flow of this human
experimentation is illustrated in Fig.11. The doctor helped
choose the potential participants from the outpatients to
participate in this human subject research. Before the
experimentation, the participants need to do the 1st physical
examination, and then we use the examination result, including
the waist, blood pressure, fasting blood glucose, high-density

Fig. 10. The screenshot of reminding message

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We take a deeper look at the participants physical

examination data. In Fig. 13, we see that 80% of the trial
subjects waist are higher than the healthy standard, and 60%
have lower high-density lipoprotein cholesterol than the
suggested value. According to the analysis result, we learn that
most of the trial subjects may be overweighted, and we believe
it would be better for them to well control their health status
through the personalized diet and exercise guideline
recommendations.














Because this human subject research is just approved by

IRB of National Cheng Kung University Hospital in July, now
the research is still in process. According to the research plan,
the research will end in November, so we can not present the
final result in this paper now. However, we are very confident
that this system will help users to well manage their health
throgh the interactive ways to make user follow the diet and
exercise guideline recommendations.







Fig. 12. The pie chart of the participants abnormal items

lipoprotein cholesterol and the triglyceride, to generate the

daily diet and exercise guideline recommendations. In this
experimentation, the trial subjects need to log their execution
data to the system, to record what recommendations they did,
and what they didnt do. After the experimantation period of 3
months, those participants need to have the 2nd physical
examination. Then we will use the new physical examination
result to evalute the chronic diseases risk, and to check whether
the system can help them well manage their health status. After
the experimentation, we will use questionnaire to collect the
participants comments or suggestions for this system. After
all, we will conduct a final report to have a complete review of
this human subject research, and to further improve the system
design based on the participants feedback.

V.

This is an on-going research, and there exist lots of

enhancements that we could explore in the future: 1). We will
integrate the system with healthcare wearable devices, such
like the smart wristband and the smart watch; 2). We plan to
design a configurable interface for users to easily extend this
system for applying to other diseases prevention; 3). We will
keep improving the reporting module of the system to make it
more attractive to users.

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ACKNOWLEDGMENT



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CONCLUSIONS AND FUTURE WORKS

This work presents an interactive system with personalized

diet and exercise guideline recommendations baesd on VASP
[9] framework. The VSAP framework can effectively and
efficiently analyze the result of regular physical examinations
to provide the most helpful information for individual health
management, but it lacks of the instantaneity and the
interaction for users. In this work we developed an interactive
system, including the personal health management module,
real-time interaction module and the reminding app for mobile
phones, to let users easily make use of this system. Moreover,
the system has a very good extendability that it can be easily
extended to apply to other diseases, and to provide other kinds
of healthcare guideline recommendations. We also successfully
applied to the IRB for a human subject research to validate the
proposed system. Since the experimentation now is still in
process, we are sorry that we cant present the final
experimental result, but we are very confident that the
proposed system can help users do the self-management of
healthcare, to prevent from suffering the chronic diseases.

We take a quick look at the participants physical

examination data, and the result is shown in Fig. 12. As to the
five kinds of physiological measurements we collected in this
work, all the trial subjects have at least one abnormal item. In
other words, they all suffer from metabolic syndrome, a very
popular chronic diseases. Moreover, more than half of them
have at least three abnormal ones among the five physiological
items we collected in this work.

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Nov. 20-22, 2015

This research was partially supported by Chunghwa

Telecom Co., Ltd., Taiwan, Republic of China.

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Fig. 13. The normal/abnormal distribution of each item

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