# Expectation vs. Reality: Attitudes Towards a Socially Assistive Robot in Cardiac Rehabilitation
## 2 Background
### Cardiac Rehabilitation Context  
Cardiovascular diseases (CVD) are considered one of the most critical causes of death worldwide. In 2017, it was reported that a total of 17.5 millions of deaths caused by CVDs, representing 31% of all deaths in the world [19]. Aiming to reduce this problematic, different clinics and rehabilitation centers provide cardiac rehabilitation (CR) programs. These programs are designed to help people that have suffered a cardiovascular event to reduce the possibility of suffering a second event [20]. Conventional CR programs are structured in three phases (i.e., Phase I: inpatient; Phase II: outpatient; and Phase III: reinforcement) [21]. This research is focused on providing assistance to patients that completed the Phase I, and who are starting the Phase II or outpatient phase. This phase considers a twice-weekly program that takes an average of 18 weeks of physical exercise (treadmill-based physical activity), as well as an education program covering the prevention of risk factors and adoption of healthy habits,such as controlling blood pressure, cholesterol, weight, and stress management [22]. Prior to the intervention, an observation of the conventional therapy at the local clinic was performed. During this phase, the structure and stages of the therapy were identified. As illustrated in Figure 1, the session is divided in three stages: the first stage comprises the initial measurements and warming during the first 10 to 15 min of the session. The second stage is the exercise that is performed on a treadmill during 15 to 20 min. Finally, after the physical activity, patients perform a 10 to 20 min cooldown together with the final measurements. Table 1 summarizes the measurements that are registered during each stage of the therapy. Pre-exercise and postexercise variables are meant to evaluate the patient's health condition before and after exercise (considering primarily their heart rate and blood pressure levels). During the exercise, the heart rate and intensity perception (i.e., Borg scale defined as a qualitative scale to estimate exertion during performing physical activity [23]), as well as the exercise conditions (speed and treadmill inclination) are considered. Considering the important role that CR plays in the recovery and reduction of risk factors that could generate cardiovascular events, it is relevant to explore different approaches that can positively impact this service, improving program efficiency and quality. In this work, it is presented the development of socially assistive robot companions that can supervise training while motivating and keeping the patient engaged during the exercise. The research conducted by the authors was carried out in three stages: as illustrated in Figure 2a, an observation of conventional CR therapy was performed to identify relevant variables and parameters that the system should consider. Subsequently, a sensor interface, designed to measure multiple parameters (observed in the previous stage) during therapy, was integrated to a humanoid robot NAO (Softbank Robotics, France). This system was first evaluated under laboratory conditions with one healthy user (see Figure 2b) [20]. Finally, the system's performance was assessed under clinical conditions in a pilot study conducted with four patients during their first four therapy sessions (see Figure 2c), where the potential of the system was evidenced in [6]. This preliminary work has served to evaluate the reliability of the system, as well as the robustness in a real CR scenario. However, a long-term intervention assessment is required to identify users' perception and attitudes towards the social assistive robot. For this reason, this work focuses on evaluating these aspects on patients who finished the Phase II of the rehabilitation program and  
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