United States Patent [19]
`Amano et al.
`
`[54] HEALTH MANAGEMENT DEVICE AND
`EXERCISE SUPPORT DEVICE
`
`[75] Inventors: Kazuhiko Amano, SuWa; Kazuo
`Uebaba, Yokohama; Hitoshi Ishiyama,
`Toride, all of Japan
`
`[73] Assignee: Seiko Epson Corporation, Tokyo,
`Japan
`[21] Appl. No.1
`08/894,457
`[22] PCT Filed:
`Dec. 18, 1996
`
`USOO5941837A
`[11] Patent Number:
`[45] Date of Patent:
`
`5,941,837
`Aug. 24, 1999
`
`FOREIGN PATENT DOCUMENTS
`
`57-93036
`63-212327
`2-3927
`2-55035
`6-105829
`7-88092
`7-213499
`8-10234
`
`6/1982
`9/1988
`1/1990
`2/1990
`4/1994
`4/1995
`8/1995
`1/1996
`
`Japan .
`Japan .
`Japan .
`Japan .
`Japan .
`Japan .
`Japan .
`Japan .
`
`Primary Examiner—Max Hindenburg
`Attorney, Agent, or Firm—Eric B. J anofsky
`
`[86] PCT No.1
`
`PCT/JP96/03674
`
`[57]
`
`ABSTRACT
`
`§ 371 Date:
`
`Oct. 14, 1997
`
`§ 102(e) Date: Oct. 14, 1997
`
`[87] PCT Pub. No.1 WO97/22295
`
`PCT Pub. Date: Jun. 26, 1997
`Foreign Application Priority Data
`
`[30]
`
`Dec. 18, 1995
`Mar. 12, 1996
`
`[JP]
`[JP]
`
`Japan .................................. .. 7-329232
`Japan .................................... .. 8-55115
`
`[51] Int. Cl.6 ...................................................... .. A61B 5/00
`[52] US. Cl. ........................................... .. 600/595; 600/503
`[58] Field of Search ................................... .. 600/502, 503,
`600/587, 595
`
`[56]
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`Ahealth management device is provided, Which enables the
`user himself to make a determination of the quality of his
`state of health, Without the presence of a physician or nurse
`specialist. HoWever, this device may of course be employed
`to receive measurement directives from, or provide noti?
`cation to, a third party. Pulse sensor 4 measures the user’s
`?ngertip pulse Wave. Acceleration sensor calculates an
`acceleration value from the user’s body. These outputs are
`converted to digital signals at sensor interface 6. CPU1
`determines Whether or not the user is exercising based on the
`acceleration value read out from sensor interface 6. Based on
`this result, CPU1 takes up the user’s pulse Waves before and
`after exercise, and determines the acceleration pulse Wave.
`CPU1 then calculates the amplitude ratio of in?ection points
`included in the acceleration pulse Waveform, evaluates the
`exercise performed by the user based on the pre-exercise and
`post-exercise amplitude ratios, and displays this result on
`display device 7.
`
`4,432,374
`5,479,939
`
`128/694
`2/1984 Osani
`1/1996 Ogino .................................... .. 128/782
`
`21 Claims, 27 Drawing Sheets
`
`/ 601
`
`603
`
`604 /
`
`MEMORY MEANS
`
`605 /
`
`CONTROL MEANS
`
`608 f
`
`WAVEFORM MEASURING MEANS
`
`V
`
`BODY MOVEMENT MEASURING MEANS
`
`CALCULATING
`MEANS
`
`NOT I FY ING
`MEANS
`
`7 EVALUATION MEANS —>
`
`607
`WAVEFORM MEASUREMENT j
`DIRECTIVE DETECTION MEANS
`
`\BOB
`
`1 of 54
`
`FITBIT EXHIBIT 1006
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 1 0f 27
`
`5,941,837
`
`N
`
`
`
`mu_>ma 2.3m;
`
`F GE
`
`\ m
`
`Q :5 2
`
`m AH 55m
`
`:32; 5:; H 55 /
`
`/N
`
`N m
`
`:85 E
`358 5&5 A“ m
`
`AHV M E
`
`m’
`
`LO f
`
`H Al
`
`m
`
`v /
`
`
`
`All mowzmw zc _ 2x552
`
`
`
`'mowzmw m5; wwiE
`
`2 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 2 0f 27
`
`5,941,837
`
`FIG. 2A
`
`GOOD HEALTH
`STATE
`
`(f
`HEALTH STATE
`BEGINNING TO
`DETERIORATE
`
`HEALTH STATE
`INSUFFICIENT
`
`FIG. 25
`
`WITHIN 10~35% 35~e0% 60~I00% s0~100% 60~100%
`
`d
`a
`
`WITHIN
`
`WITHIN
`
`N
`
`OVER
`
`3 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 3 0f 27
`
`5,941,837
`
`FIG. 3A
`
`4 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 4 0f 27
`
`5,941,837
`
`5 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 5 0f 27
`
`5,941,837
`
`FIG. 5A
`
`FIG. 5B
`
`6 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 6 0f 27
`
`5,941,837
`
`FIG. 6
`
`7 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 7 0f 27
`
`5,941,837
`
`FIG. 7
`
`8 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 8 0f 27
`
`5,941,837
`
`FIG. 8
`
`g
`
`w
`
`_
`
`,
`
`+
`
`"10
`
`Q A _ 5
`5
`Z
`_
`m
`0
`9
`0'
`g _5_
`
`N -5
`
`I
`
`H
`
`L5
`LLI
`LE
`
`a:
`
`_10_
`
`—15-
`
`_
`
`.
`
`LESS <=> MORE
`EXERCISE AMOUNT
`
`__10
`
`"'5
`
`9 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 9 0f 27
`
`5,941,837
`
`mm 5 E
`L X .Y‘ Y
`
`@ Tim‘ 2 p7, m?
`
`a .GE
`
`E3 E2 _ h 2 MN pm m; E w my
`
`
`
`#532,324 2355322 32 _ @5255
`
`8:
`
`$5
`
`2::
`
`
`
`2: ._<>$;__ g
`
`10 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 10 0f 27
`
`5,941,837
`
`:2 mg;
`
`
`
`‘2: a: E
`
`E _ p m _ b p
`
`C
`
`
`
`
`
`........ .. $33M”: 83m
`
`3 .GE
`
`é:
`
`..
`
`2502250583
`
`11 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 11 0f 27
`
`5,941,837
`
`FREQUENCY (HZ)
`N .o.
`
`P .01
`
`o .o
`
`m .?
`
`m P _. .UE
`
`is $2552
`2:: 2:
`
`e :5 m2:
`
`E5 #255 mm
`com?
`
`g:
`
`com
`
`2::
`
`12 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 12 0f 27
`
`5,941,837
`
`A
`
`F'
`
`LU
`D:
`
`5’,
`33
`FIG. 12A 5
`5
`5'
`
`m 4.
`gj
`Q
`FIG. 12B 9
`%
`
`'1‘
`
`.
`
`LU
`
`é
`33
`FIG. 12C '35
`Q
`0
`‘3
`[D
`
`P1
`
`P3
`p2 P5
`P4
`TIIME
`
`P1
`
`P2
`
`P5
`
`P3 P4
`
`,
`
`TIME
`
`P1P2
`P3
`
`P4 P5
`
`T I'ME
`
`‘’
`
`13 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 13 0f 27
`
`5,941,837
`
`PRIOR ART
`
`FIG. 14AM
`FIG. 148 W PRIOR ART
`
`PRIOR ART
`
`14 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 14 0f 27
`
`5,941,837
`
`I
`
`I‘
`I'll
`
`Il
`
`I,‘
`III
`
`I
`I
`I
`
`‘ll-I“
`
`FIG. 16
`
`207
`206
`208
`\
`
`202 I OPERATIONAL AMPLIFIER
`:
`=
`I
`I
`
`I %W
`
`205
`
`201 I PRE-AMPLIFIER
`1%
`
`2042 OSCILLOGRAPH
`
`203: CHARACTER I STIC
`EXTRACTION CIRCUIT
`
`FIG. 17
`
`BASE LINE
`0 KJ
`
`15 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 15 of 27
`
`5,941,837
`
`
`
`
`
`__=um_uuz_o_>_omo<H4o>Hflmm
`
`
`
`
`
`nunxmN>4<z<H:o_m:mm4=m
`
`
`
`Aazafim~<o
`
`p_=um_o
`
`
`
`
`
`m=4<>2:=_x<24<_Hzm=amm><4mo
`2%.?GE?
`
`Jompzoo
`
`»_=um_u
`
`m_m
`
`mm_¢_4m:<
`
`
`
`4<_pzmmm¢¢_o“Now
`
`p_=om_uuz_hum¢moom_mfinmm
`
`
`
`Emo¢m><gHm_m;
`
`
`
`hoIm-mzo”~_m
`
`
`
`xoh<mm_>_H4==__mo_mac”momwow
`
`
`
`mw_.mV_“.
`
`am
`
`Eob>§!Sm -EEEEE:85u_,_EmE8$:_:_EAamIIuz_:_:§m_&_o
`
`
`
`
`
`mam/_
`
`16 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`72f0614|.eeh__S
`
`5,941,837
`
`7
`
`
`
`Joxpzoo><4¢m_o_mo_>wa.nh_:um_u_><4¢m_Q
`
`~
`
`
`
`
`
`395
`
`
`
`
`
`
`
`m_,_o:.<o__,5_2_28M6.momZBEQzfiétl.11:35,.._<zo_::_m_n_o
`
`zo_:252.8_:5H27,
`
`5
`
`25¢9|:_§__o§zsnaa.5528::m:_
`
`
`
`
`
`
`
`ma<..:Ez_._<zmm_._.xmI
`
`17 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 17 0f 27
`
`5,941,837
`
`FIG. 20
`
`TARGET VALUE FOR MAXIMAL OXYGEN UPTAKE (ml/kg/min)
`
`20~29 3U~39 40~49 50~59 60~69
`
`MALE
`
`FEMALE
`
`41
`
`35
`
`40
`
`34
`
`39
`
`33
`
`38
`
`32
`
`37
`
`31
`
`FIG. 21
`
`REQUIRED AMOUNT OF EXERCISE
`TO CREATE A STATE OF HEALTH
`
`AGE
`
`20~29 30~39 40~49 50~59 60~69
`
`OF MINUTES
`
`-
`
`.
`
`TOTAL NUMBER
`0F EXERCISE 180mm 170"" " 160mm 150mm 140mm
`PER WEEK
`
`_
`
`_
`
`_
`
`TARGET
`HEART RATE
`(beats/min)
`
`130
`
`1 25
`
`120
`
`1 15
`
`1 10
`
`18 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 18 0f 27
`
`5,941,837
`
`(RELATIVE EXERCISE
`INTENSITY)
`
`VOZmaX/Wt
`(ENDURANCE)
`
`‘y 7% TRAINING INTENSITY
`(RELATIVE EXERCISE
`\ % INTENSITY)
`.20
`30
`40
`50
`(weeks)
`
`r. __.___
`
`l
`l
`I
`
`0
`
`I0
`
`n
`
`——--- TARGET VALUE
`
`_
`
`25
`
`20 -
`
`I5
`
`IO
`
`
`
`
`
`EXERCISE DURATION (min)
`
`0
`
`2
`
`10 (weeks)
`8
`6
`4
`TRAINING PERIOD
`
`19 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 19 0f 27
`
`5,941,837
`
`FIG. 24
`
`CB: COMMUNICATIONS
`CABLE
`
`_~_. g
`
`20 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 20 of 27
`
`5,941,837
`
`21 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 21 of 27
`
`5,941,837
`
`22 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 22 of 27
`
`5,941,837
`
`FIG. 27A
`
`230
`
`/
`266
`
`23 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 23 of 27
`
`5,941,837
`
`FIG. 28A
`
`260
`/
`
`/(Q
`
`24 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 24 of 27
`
`5,941,837
`
`FIG. 29A
`
`280
`
`./
`
`/,o
`
`25 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 25 of 27
`
`5,941,837
`
`FIG. 30A
`
`503
`
`'/ / Q
`
`26 of 54
`
`

`
`U.S. Patent
`
`Aug. 24, 1999
`
`Sheet 26 of 27
`
`5,941,837
`
`27 of 54
`
`

`
`U.S. Patent
`
`UA
`
`99914:22.
`
`Sheet 27 of 27
`
`5,941,837
`
`
`
`momgxvow
`
`
`
`mz<m2Aomhzoumz<mz>mo:mz
`
`
`
`
`
`
`
`mz<m2mz<m2
`
`
`
`uz_>¢_Hozoz_p<4=u4<u
`
`
`
`
`
`mz<m2oz_z=m<mssmomm><;
`
`
`
`
`
`m2<m2zo_H<:4<>mmz<m2oz_m=m<m2pzm2m>o2>oom
`
`
`
`
`
`
`
`
`
`kzm2mm:m<m22mo¢m><g
`
`
`
`
`
`mz<m2zo_»um~mom>_Homm_o
`
`28 of 54
`
`

`
`5,941,837
`
`1
`HEALTH MANAGEMENT DEVICE AND
`EXERCISE SUPPORT DEVICE
`
`BACKGROUND OF THE INVENTION
`1. Technical Field
`
`The present invention relates to a device for measuring
`physical state in a patient based on the condition of circu-
`latio11. More specifically, the present invention relates to a
`health management device for monitoring the user’s state of
`health based on information obtained from the condition of
`circulation in the user’s body, and to a11 exercise support
`device which provides appropriate suggestions and guidance
`to the user, or provides an exercise plan deemed appropriate
`to create a state of health in the user.
`
`2. Background of the Invention
`With the rapid aging of society in recent years, the health
`issues of middle aged and elderly persons, geriatric diseases
`being chief among these, have been a topic of much dis-
`cussion. Various factors have been cited as causes of such
`diseases. As one example of these factors, evidence has been
`found which suggests that insufficient circulation can cause
`health problems. When circulation is insufficient, cells and
`tissues do not receive the necessary amount of oxygen and
`nutrients. When this situation persists for a long period of
`time, organic pathological changes begin to occur ir1 organs
`and tissues. Once these changes have progressed to a certain
`extent, symptoms can appear quite suddenly.
`Accordingly, various attempts have been made to prevent
`such diseases before there is significant progression in
`organic pathological change, by determining the quality of
`circulation,
`the basis for
`these pathological changes.
`Accordingly, it has been the practice until now to determine
`the quality of circulation by focusing on risk factors such as
`blood pressure, changes in the electrocardiogram, blood
`cholesterol, neutral fat concentration, and the like.
`However,
`in reality,
`it is not uncommon for cerebral
`apoplexy or heart failure to occur even in an individual with
`low blood pressure, while there are examples of elderly
`persons who have high blood pressure but still are in good
`health. Similarly,
`there are numerous instances where a
`substantial organic pathological change has occurred, but
`nothing is observed ir1 the electrocardiogram, etc. While
`examination equipment may discover this change if it
`progresses further,
`this is not acceptable because of the ,
`additional delay.
`Accordingly, the discovery that acceleration pulse wave-
`forms can be useful as an indicator of the quality of
`circulation has gained attention in recent years. A brief
`explanation of acceleration pulse wave as a measure of _
`circulation will now be provided. Namely, as is well known,
`circulation basically involves the heart pumping out blood,
`which flows through the arteries to the capillaries of the
`tissues and organs, and then returns through the veins.
`The supply of oxygen and nutrients takes place at the
`capillaries, so that the quality of circulation is correlated to
`the behavior of the blood in the smallest vessels.
`Accordingly, transitions in the amount of blood contained in
`the capillaries may be viewed to serve as a good measure of
`circulation. Namely, a slight difference ir1 arterial and venal
`blood pressure give rise to fine differences in nutrient supply
`and gas exchange at the capillary level. It is for this reason
`that it is believed that organic pathological changes may
`occur in tissues and organs if the difference in arterial and
`venal blood pressure expands over a long period of time.
`Accordingly, one widely used method for observing
`changes over time ir1 the amount of blood contained ir1 the
`
`2
`capillaries is the examination of the fingertip plethysmo—
`gram. However, the fingertip plethysmogram itself displays
`a gently undulating waveform. Accordingly, it was consid-
`ered diflicult to interpret very fine changes in the waveform.
`Further, there l1as also been the problem that changes in
`circulation are very small, and are sensitive to changes in the
`organism s environment.
`However, if the second derivative of the fingertip plethys-
`mogram waveform is obtained, to convert the waveform to
`a double di ‘erential plethysmogram (i.e., the acceleration
`plethysmogram waveform),
`it
`then becomes possible to
`enlarge and extract the information on circulation, and to
`display the circulation condition in a form which is easy to
`understand. FIG. 14(a)
`is one example of the original
`waveform obtained at
`the fingertip plethysmogram; FIG.
`14(b) shows the waveform of the velocity plethysmogram
`obtained by taking the first derivative of the waveform
`shown in FIG. 14(a); FIG. 14(c) shows the waveform of the
`acceleration plethysmogram obtained by taking the second
`derivative of the waveform shown in FIG. 14(a).
`FIG. 15 shows an example in which one waveform of a
`typical acceleration plethysmogram has been extracted. As
`shown in this figure, there are three peaks and two valleys
`in one waveform of an acceleration plethysmogram.
`Namely, there is an initial peak a, followed by valley b, peak
`c, valley (1, and peak e. The waveform is roughly flat fron1
`peak e until the next peak a. Further, if peak a is excluded,
`then each point does not form a peak or valley, but rather
`simply becomes a point of inflection.
`The significance of the amplitudes of each of the afore-
`mentioned peaks and valleys will now be described. To
`begin with, peak a is a signal that the blood pumped out from
`the heart has reached the capillaries in the fingertip. Valley
`b relates to the heart’s stroke volume. The larger the stroke
`volume the deeper valley b falls.
`Peak c is related to venal return, and, from the View of
`circulation,
`indicates whether or not
`there is excessive
`pooling of blood by appropriate contraction of venules.
`When the venal return is good, peak c is near or above the
`base line. In contrast, when blood pooling in venules is
`increasing, peak c ceases to rise, but rather falls below valley
`b
`
`Valley d is related to the load on the heart. When the load
`on the heart is increasing, valley d falls sharply. Peak e
`corresponds to the position of the rise in the fingertip
`plethysmogram after a contraction, however the concrete
`significance of this is not yet understood.
`It is known that poor circulation as ascertained from
`acceleration plethysmograms as described above can be
`improved by jogging or other forms of endurance training.
`A temporary improvement may be noted from just a single
`training session, while a sustained improvement can be
`confirmed if training is continued. On the other hand, if
`training is suspended, circulation again deteriorates.
`Accordingly, it is possible to know the degree of improve-
`ment ir1 circulation by analyzing the acceleration pletl1ys-
`mogram.
`I-Iei
`Japanese Patent Application First Publication No.
`8—10234 (Title: Device for Measuring Exercise Quantity)
`may be cited as one example of a technology which applies
`the above-described acceleration plethysmograms in exer-
`cise. This reference cites the use of a treadmill or bicycle
`ergometer for performing exercise to increase the health of
`the patient, with the exercise’s effect on the patient mea-
`sured. For this purpose, information referred to as “wave-
`form representative values”, which are calculated from the
`
`29 of 54
`
`

`
`5,941,837
`
`3
`acceleration plethysmogram waveform, are measured before
`and after exercise, and the di ‘erence in these waveform
`representative values is displayed. Further, during exercise,
`the waveform representative values at each point in time are
`compared to predetermined waveform representative values.
`When the difference in the measured and predetermined
`waveform representative values reaches a value which is the
`patient’s load limit, for example, then exercise is halted.
`Japanese Patent Application First Publication No.
`57-93036 may be cited as one example of an invention
`which attempts to determine circulation quality iii a patient
`by analyzing the acceleration plethysmograms. Various sites
`such as the fingertip, earlobe, and the like may be considered
`for measuring the plethysmogram. However, the aforemen-
`tioned reference specifically measures the fingertip plethys-
`mogram. This is because the movement of blood from the
`arteries to the veins can be obtained at the fingertip, and
`because this is the site where the capillaries are most
`developed and the amount of blood contained therein is
`great. Moreover, the fingertip is ordinarily exposed, so that
`it may be freely brought near the plethysmogram measure-
`ment device. Accordingly, this enables a more simplified
`structure for the device.
`
`The structure of the acceleration plethysmograph accord-
`ing to the invention in the above—cited reference is shown in
`FIG. 16. This device is formed by means of the cascade
`connection of a fingertip plethysmogram pick-up 200, pre-
`amplifier 201, operational amplifier 202, characteristic
`extraction circuit 203 which has two analog differentiating
`circuits utilizing CR circuits, and an oscillograph 204.
`Fingertip plethysmogram pick-up 200 is comprised of an
`opening 206 into which the patient inserts his finger, a light
`source 207, and a photoelectric element 208.
`Three types of plethysmogram waveform graphs are
`displayed on oscillograph 204:
`the plethysmogram waveform, and the first and second
`derivative waveforms of the plethysmogram which are
`calculated by characteristic extraction circuit 203.
`Accordingly, based on the acceleration plethysmo-
`grams shown on oscillograph 204,
`it is possible to
`determine the quality of circulation in the patient.
`To begin with, as a first method for this determination, the
`acceleration plethysmogram waveform is typed according to
`the depths of valleys b and d into three categories: valley
`b>valley d, valley bssvalley d, or valley b<valley d. Next, the /
`thus-type patterns are further typed into three categories
`based on the height of peak c relative to the base line. The
`measured acceleration plethysmogram waveform is then set
`to whichever of these patterns it most closely resembles.
`A second method of determination makes use of the .
`height of peak c and the depth of peak d from the base line.
`As shown in FIG. 17, the depth of valley b is divided into
`four equal parts, for example, with the each partitioned area
`assigned a number 0, 1,
`.
`.
`. 5, in order from the base line.
`The number of points corresponding to the height of peak c,
`the depth of peak d, etc., are then determined from the
`positions thereof. In this way, the quality of circulation in the
`patient can be rendered as a numeric value.
`This reference provides several working examples,
`including: 1) a device wherein, in place of a CR circuit, the
`measured value of the plethysmogram is digitalized using an
`A/D converter, and the acceleration plethysmogram is cal-
`culated by means of digital processing using a microcom-
`puter, 2) a device wherein the third derivative waveform is
`obtained by taking the derivative of the acceleration plethys-
`mogram waveform, and a microcomputer is used to obtain
`the position of the valleys and peaks, and 3) a device which
`
`4
`corrects for fluctuations in the time interval of the plethys—
`mogram due to respiratory action, by carrying out statistical
`processing, such as obtaining the arithmetic average for
`pairs of corresponding peaks and valleys, on the repeating
`waveform of a plurality of individual pletliysmograms.
`Japanese Patent Application First Publication No.: IIei
`2-55035 discloses an invention which develops the above-
`described technology. The structure of the acceleration
`plethysmograph according to this reference is shown in FIG.
`18. As shown in this figure, plethysmogram detector 300
`includes a lamp 301 which is provided opposite the center of
`a concavity into which the fingertip is inserted, and a light
`detector comprising a photoelectric element 302. Photoelec-
`tric element 302 is formed of resistors 303 to 306 and a
`bridge circuit. The output from this bridge circuit is ampli-
`fied by differential amplifier 307. Further, the brightness of
`lamp 301 can be adjusted with a switch S so that the bridge
`circuit is balanced. In this figure, the symbol V is the voltage
`of the electric source.
`The output of differential amplifier 307 is amplified
`further by amplifier 308. Waveform correcting circuit 309
`then modifies the amplified output to a rectangular wave-
`form by clipping voltages which exceed a prefixed standard
`voltage. This output is differentiated at differentiating circuit
`310, with micropulses generated in the negative direction by
`rectifier 311 to trigger one-shot multivibrator 312. As a
`result, a rectangular wave of duration To is obtained in the
`output of one-shot multivibrator 312.
`In addition, the output of differential amplifier 307 passes
`through gate circuit 313 during an interval of the aforemen-
`tioned duration TU. The output signal of gate circuit 313
`passes through differentiating circuits 314, 315, with the
`output of the second derivative of the plethysmogram sigial
`obtained in the output of differential circuit 315. Waveform
`correcting circuit 316 generates a sampling pulse for the
`output at each point in time where a valley b, peak c, and
`valley d appear. In accordance with this sampling pulse,
`sampling circuit 317 samples the output from differential
`circuit 315, which has passed through delay circuit 318, and
`stores the result in successive recording circuit 319. Maxi-
`mum value detection circuit 320 reads out the contents of
`successive recording circuit 319, and records the maximum
`value from among the amplitudes for valley b, peak c, and
`valley d. The output of maximum value detection circuit 320
`is divided at voltage dividing circuit 321, with each divided
`voltage then output.
`Control circuit 322 successively outputs the voltages of
`valley b, peak c, and valley d, which are the output of
`successive recording circuit 319. This output is input into
`pulse height analyzer 323 which employs the output value of
`the voltage dividing circuit 321 as a comparison voltage,
`and, based on the voltages of valley b, peak c, and valley (1,
`outputs values in which these voltages have been standard-
`ized (for example, ratios c/b, d/b, or ratios b/a, c/a, d/a, etc.)
`to output terminal OP.
`A microcomputer or similar device determines which
`waveform pattern from among the pre-typed acceleration
`plethysmogram waveforms the waveform output at output
`terminal OP is associated with, and displays this result.
`When making this determination of the waveform pattern,
`a determination is first made as to which of the voltage zones
`classified by voltage dividing circuit 321,
`the levels of
`standardized valley b, peak c, and valley d are associated
`with. For each of the separate voltage zones with which
`valley b, peak c, and valley d are associated, the measured
`plethysmogram is typed as one of the aforementioned
`patterns, based on the respective size relationship, and on the
`
`30 of 54
`
`

`
`5,941,837
`
`5
`vertical relationship with respect to the base line of valley b,
`peak c, and valley (1, to n1ake a determination of the quality
`of circulation.
`As explained above, maintaining good circulation is nec-
`essary to create a state of health. One important factor to
`accomplishing this is performing the appropriate level of
`exercise, to maintain a good circulation state for as long a
`period as possible. However, use of devices such as dis-
`closed in the above-cited references present a problem.
`Namely, it is known to be extremely diflicult to accurately
`measure plethysmogram waveforms during exercise.
`Accordingly, using acceleration plethysmograms measured
`during exercise as a basis for controlling the exercise
`performed by a patient is not very successful, so that, as a
`result,
`the goal of carrying out
`the appropriate level of
`exercise is not achieved. Moreover, the present inventors
`carried out experiments using devices having the structures
`disclosed in the aforementioned references, and confirmed
`that plethysmograms could not be correctly measured. The
`san1e conclusion was reached even in the case where a
`sensor was attached to a patient’s hand and the hand was
`held in place while the subject exercised on a tread mill, for
`example.
`information
`In devices such as those described above,
`extracted from the acceleration plethysmogram is simply
`displayed to the patient. Thus, a doctor or nurse with specia
`training is required to interpret these results. However, if
`numerous patients are exercising each day, and doctors anc
`nurses must analyze the results and then direct the nex
`exercise plan for each patient, then this creates a consider-
`able burden on hospital personnel, and does not benefit the
`patient’s treatment.
`However, it is extremely troublesome and inconvenien
`for the user of the device himself to make a determination of
`the quality of circulation, without the assistance of a doctor
`or nurse. Moreover,
`there is no assurance that a patien
`exercising without a doctor present will be able to perform
`exercise of the same quality as would have been carried on
`if a doctor were present to provide guidance. Accordingly,
`when carrying out
`interval
`training or physica
`rehabilitation, various problems may occur, such as the
`exercise proving ineffective because it was too mild, or the
`exercise having an effect opposite that desired because it was
`overly strenuous.
`On the other hand, guidance could be provided to the /
`patient once every two or three weeks, but this is bothersome
`since it necessitates a visit to the doctor’s office. Moreover,
`exercise of the same quality as if regular guidance were
`being provided still may not be carried out in this case.
`Accordingly, there have been grave doubts that e ective
`exercise guidance could be carried out in the case where
`conventional devices were employed.
`SUMMARY OF THE INVENTION
`
`The present invention was conceived in consideration of
`the aforementioned circumstances, and has as its first objec-
`tive the provision of a device for accurately measuring
`conditions in a patient based on the circulation state and
`body movement.
`It is a second objective of the present invention to provide
`a health management device which monitors the user’s state
`of health based on the state of circulation which is obtained
`from pulse waveforms, and provides appropriate sugges-
`tions and guidance to the user, this device moreover being
`easy to use.
`It is a third objective of the present invention to provide
`a health management device which has a simple structure
`
`6
`and which can proscribe an exercise plan deemed appropri-
`ate for creating a state of health in the user after taking the
`user’s physical condition into consideration.
`the
`In order to achieve the above-stated objectives,
`present invention is characterized in the provision of a pulse
`wave measuring means which measures the user’s pulse
`waves, and a body movement measuring means which
`measurers the movement of the user’s body.
`As one preferred embodiment, the present invention con1-
`poses a pulse wave measuring means for measuring the
`user’s pulse waves, a body movement measuring means
`which measures the user’s body movement, a calculating
`means which obtains an indicator showing the state of
`circulation in the user from the pulse waveform when the
`measured results of the body movement measuring means
`are below a prespecified value, and a notifying means which
`notifies the user of the aforementioned indicator.
`
`this embodiment composes a pulse
`More specifically,
`wave measuring means for measuring the user’s pulse
`waveforms, a pulse wave measurement directive detection
`means which detects a directive by the user to measure pulse
`waves, a calculating means which obtains an indicator
`showing the state of circulation in the user from the pulse
`waveform during the time that a plethysmogram measure-
`ment directive is being output, and a notifying means which
`notifies the user of the aforementioned indicator.
`
`The aforementioned calculating means obtains the accel-
`eration plethysmogram pulse waveform, selects two peaks
`and valleys from among the plurality of peaks and valleys
`appearing in the acceleration plethysmogram, obtains an
`amplitude ratio for the selected peaks and valleys, and
`defines this ratio as the aforementioned indicator.
`In this embodiment, notification of the state of circulation
`is provided to the user based on the measurement of his
`pulse waves. Accordingly it is possible for the user to know
`the state of his own circulation at all
`times, with the
`exception of during exercise. Thus, advanced notice of such
`diseases as ischemic he art disease or cerebrovascular disease
`can be obtained.
`
`The following four arrangements may be considered for
`the aforementioned calculating means.
`(1) The aforementioned indicator is defined as the value
`obtained by dividing the amplitude value of the second
`valley by the amplitude value of the first peak in the
`acceleration pulse waves.
`In this arrangement, the amplitude value of the spectral
`component obtained from a spectral analysis of change
`across the time period of adjacent pulse waves is defined as
`the indicator. As a result,
`it
`is possible to ascertain and
`manage the state of health based on an indicator which well
`displays the activity of the sympathetic and parasympathetic
`nervous systems.
`(2) The time interval between adjacent pulse waves is
`calculated, spectral analysis is conducted on change over
`this time interval, and the amplitude value of the spectral
`component which is obtained from this analysis is defined
`as the aforementioned indicator.
`In this arrangement, the ratio of the amplitudes of the low
`frequency and high frequency spectral components which
`are obtained from spectral analysis on changes over the time
`interval between adjacent pulse waves is defined as the
`indicator. Therefore, variation in the indicator which arises
`due to differences between individuals can be eliminated.
`Thus,
`in addition to managing the state of health,
`it
`is
`possible to provide objective data for determination.
`(3) The time interval between adjacent pulse waves is
`calculated, spectral analysis is conducted on change over
`
`31 of 54
`
`

`
`5,941,837
`
`5
`
`7
`this time interval, the ratio of the amplitude of the low
`frequency spectral component and tl1e l1igl1 frequency
`spectral component obtained from this analysis is
`calculated, and defined as the indicator.
`Ir1 this arrangement, the number of times the amount of
`change in the time interval between adjacent pulse waves
`exceeds a prespecified time is set as the indicator. Thus,
`health state can be ascertained and managed based on a
`indicator which well expresses conditions of arousal or
`sedation in the body.
`(4) The time interval between adjacent pulse waves is
`calculated, and the number of time in which the amount
`of change in continuous time intervals exceeds a prespeci—
`fied time is defined as the indicator.
`In another embodiment, the health management device
`has a pulse measurement means for measuring the pulse rate
`of the user. VVhen the measured result of the body movement
`measuring means exceeds a prespecified value, the notifying
`means notifies the user of the measured pulse rate.
`This health management device is provided with an
`evaluation means which measures an indicator when the
`measured result of the body movement measuring means is
`below a prespecified value, and measures the indicator again
`after the measured result of the body movement measuring
`means exceeds the prespecified value and then again returns
`below that prespecified val11e. The evaluation means then
`carries out an evaluation of the exercise performed by the
`user based on the difference in these indicators. Thereafter,
`the notifying means notifies the user of the results of this
`evaluation.
`In this embodiment, the user is informed of his pulse rate
`while he is exercising. Thus, even during exercise,
`it is
`possible to adjust the amount of exercise appropriately, so
`that a more desirable training e eet can be achieved.
`In another embodiment, a pulse measuring means for
`measuring the user’s pulse rate, and a pulse measurement
`directive detection means, for de ecting a directive from the
`user to measure pulse rate, are provided. As a result, the
`notifying means notifies the user of the pulse rate measure-
`ment result during the time that a pulse measurement
`directive is being output.
`In this embodiment, an evaluation means is provided
`which takes up the indicator obtained when the user issued
`a pulse measurement directive prior to the start of exercise,
`and the indicator obtained when the user issued a pulse /
`measurement directive after the completion of exercise, and
`then carries out an evaluation of the exercise performed by
`the user based on the difference in these indicator values.
`Thereafter,
`the notifying means notifies the user of the
`results of this evaluation.
`Since the exercise evaluation is made