Project Fizzyo!

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About Fizzyo

Cystic Fibrosis is a chronic, life-limiting condition affecting sufferers from birth. Approximately 1 in 2500 babies are born with CF.

With improved prevention and treatment life expectancy for patients has slowly increased and currently stands at an average of 41 years of age.

Project Fizzyo is about trying to improve physiotherapy care for children with Cystic Fibrosis. Airway clearance techniques (ACTs), physical activity and exercise can mitigate the progression of Cystic Fibrosis (CF) lung disease, but routine physiotherapy treatments are burdensome and adherence is low. Traditional research methods (RCTs) have failed to produce credible evidence to guide practice, partly because ‘blinding’ isn’t possible and patient preference can confound results.

We have worked with engineers and designers and UCL computer science students through the Industry Exchange Network (IXN) to develop electronically chipped ACT devices and wearable activity trackers to facilitate automatic data transmission from the homes of children with CF to the clinicians and researchers caring for them. Industry partners (Microsoft) and UCL computer science experts and students have also helped us develop computer games driven by breathing through an ACT device (to enhance treatment enjoyment and adherence).

The project will use this technology for passive remote capture and transmission of longitudinal data during ACTs, physical activity and exercise daily in 160 children over 18 months. A data scientist will use this data, reconciled with individual demographic and longitudinal clinical records, to identify positive and negative clinical outcome predictors. Computer gaming will be introduced and removed (interrupted time series design) to evaluate the effect of gaming on ACT adherence and clinical outcomes during the study.

This exciting remote monitoring platform has the potential in future to guide personalised physiotherapy prescription based on individual treatment responses, generate accurate, sustainable population-based physiotherapy registry data, and provide a template for remote monitoring of other interventions in CF across the NHS.

The Fizzyo device is a wireless sensor that connects to existing CF Physiotherapy equipment, turning breaths into controls for video games.

Winner of Tech for Good Ability.Net Digital Health Award 2017.

CF Trust

Ability.Net Awards Winner

Unity3d Framework

Start Hacking! There’s a lot you can do with the resources below. There are some getting started guides for starting on your Fizzyo game development Journey.
Project Fizzyo Unity3d Resources
Understand how to get started with the Project Fizzyo Unity3d Framework Project Fizzyo.


Innovative big data analysis methods will be used to address the primary research questions below:

  • What is the proportionate impact of adherence with prescribed ACTs and exercise on clinical outcomes in children with CF?
  • What is the specific impact of feedback or gaming technology during ACTs and exercise on adherence over time and the impact of this adherence on clinical outcomes?
  • Which particular ACT technique is associated with the best clinical outcomes in children with CF, aged 6-16 years? (and at what ages or stages of disease are different ACTs most effective)
  • What is the minimum effective dose of ACTs, physical activity or exercise and the proportionate benefits of each to sustain optimal lung function and exercise capacity, and reduce hospital admissions?
  • Can any improvements in adherence to ACTs from feedback or computer gaming be sustained over long periods of time?
  • Can remote monitoring and big data analysis help identify sensitive composite outcome measures for children with mild signs and symptoms.

  • Social

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    Project Fizzyo.


    “Technology such as this is not currently available and we believe has the potential to really change the way these children are cared for in the NHS.” Professor Eleanor Main, University College London, Physiotherapy.

    Great Ormond Street Institute of Child Health

    Fizzyo Team

    Professor Eleanor Main, University College London, Professor Physiotherapy

    Timur Kuzhagaliyev, University College London, UCL Student Team Lead,

    Dr Yun Fu, University College London, UG Student Supervisor

    Dr Harriet Shannon, University College London, PhD Supervisor

    Emma Raywood, University College London, PhD Fellow

    Sarah Rand, University College London, Physiotherapist

    Helen Douglas, University College London, Physiotherapist

    Kunal Kapoor, University College London, Data Science Machine Learning

    Dr Colin Wallis, University College London, GOSH CF Consultant

    Rachel O'Connor, Royal London Hospital, Physiotherapist

    Nicky Murray, Royal Brompton Hospital, Physiotherapist

    Haiyan Zhang, Microsoft Research, Cambridge, Director of Innovation

    Nicolas Villar, Microsoft Research, Redmond, Senior Researcher

    Lee Stott, Microsoft, Software Engineer

    Anita Ramanan, Microsoft, Software Engineer

    Mason Cusack, Microsoft, Software Engineer

    Simon Jackson, MVP, Microsoft Valued Professional, UK

    Jude Pullen, Maker

    Ryan White, Maker

    Greg Saul, Creative Design Technologist

    Konglomerate Games, Abertay University


    News and Updates

    11th June 2020

    Update on Research Paper and Conference Proposals Research Paper Profile on Research Gate

    Type Submitted to (conference) Published in (journal) Date of conference/Publication   1st Author Title
    Conference Poster ECFS 2020 Journal of CF Jun-20 Accepted ROC Use of the Polar™H10 Heart Rate Sensor during the Modified Shuttle Walk Test in children with cystic fibrosis: can we demonstrate maximal response?
    Conference Poster ERS 2020 ERJ Sep-20 Accepted HD Identifying heart rate threshold for moderate to vigorous physical activity in children and young people wearing activity monitors

    19th Oct 2019

    Update on Conference Papers and Poster Proposals Research Paper Profile on Research Gate

    Type Submitted to (conference) Published in (journal) Date of conference/Publication   1st Author Title
    Conference Poster NACFC 2019 Pediatric Pulmonology Oct-19 Accepted HD 613: Establishing valid wear-time of activity trackers for the assessment of daily physical activity in children and young people with CF
    Conference Poster NACFC 2019 Pediatric Pulmonology Oct-19 Accepted ER 612: Can brass or wind instruments facilitate airway clearance in people with CF?
    Conference Poster NACFC 2019 Pediatric Pulmonology Oct-19 Accepted NF 212: A multivariable composite outcome to define disease severity in children with cystic fibrosis

    11th Jan 2020

    We have now a Project Fizzyo Research Project Profile on Research Gate

    The Goal of Project Fizzyo: Remote monitoring and gaming technology for improving physiotherapy prescriptions, adherence of clinical outcomes in children with cystic fibrosis.

    5th Oct 2019

    Yesterday the @TrudellMed team came from Canada to present us with our beautiful (and very heavy) #ACTNow award 🏆, recognising our work to improve airway clearance for children and young people with CF.

    2nd Oct 2019

    Excited that our paper was accepted to @NeurIPSConf @WiMLworkshop: “Identification of Patterns in Cystic Fibrosis Physiotherapy with Unsupervised Learning”! The data science aspect of @FizzyoCF is just one piece of a huge project, thank you to all involved! #MicrosoftCSElife

    1st Oct 2019

    Thanks to #Microsoft for inviting me to talk at #FutureDecoded about my passion for @FizzyoCF and gamifiying healthcare

    29th Sept 2019

    Congratulations Kunal Kapoor @uclphysio @FizzyoCF for excellent delivery of your first ever conference presentation!! Take home: Use Mean of lowest 5 HR minutes to calculate Resting Heart Rate for MVPA threshold. read more about the project here

    Kunal Kapoor and Eleanor Main presented physical activity monitoring data from @FizzyoCF @uclphysio this morning @EuroRespSoc #ers2019. We believe there’s a balance to be achieved between purist research instruments and what children will wear! read more about the project here

    27th Sept 2019

    @KonolomerateG amazing work are so happy to announce that we have been selected as finalists in the Converge Impact Challenge! We can’t wait to show the judges how we can help 😁

    19th Sept 2019

    Update on Research Papers

    Type Submitted to (conference) Published in (journal) Date of conference/Publication   1st Author Title
    Conference Poster ERS 2019 ERJ Sep-19 Accepted HD Assessment of activity tracker wear-time in longitudinal measurement of physical activity in children and young people with CF
    Conference Poster ERS 2019 ERJ Sep-19 Accepted KK Determining resting heart rate in children using wearable activity monitors

    10th Sept 2019

    Today it is exactly 1 year since we recruited our first Fizzyo participant. What a year!

    9th Sept 2019

    Well done for your hard work, to the @uclphysio MSc. students who presented their dissertation projects today (especially to our 3 Fizzyo MSc. students!) and good luck to those who are still waiting to present tomorrow!

    15th July 2019

    @KonolomerateG amazing work we are thrilled to announce that Archipelayo has won the gold medal at the Serious Play Awards 2019!! Thanks to all the judges and everyone who has supported us or played the game. We are so excited for the future 🎉🎉 #SeriousPlay #cysticfibrosis #physiotherapy

    9th July 2019

    Hackfest AI and ML, we are so lucky all these data science geniuses have come to work with us from all over the world, to help us get the most out of the Fizzyo data

    8th July 2019

    Our games programming team @KonolomerateG @jamie_b818 from Abertay University is heading out to the Serious Play Conference in Montreal! He’ll be showing off how gamification can be used for physiotherapy for cystic fibrosis 💪 #seriousplay19 #cysticfibrosis #gamification @SeriousPlayConf

    2nd July 2019

    We are now fully recruited at all sites! ✅ @GreatOrmondSt
    ✅ @RBandH ✅ @RoyalLondonHosp Thanks to everyone who is onboard for the next (up to) 16months of data

    20th June 2019

    Update on Research papers

    Type Submitted to (conference) Published in (journal) Date of conference/Publication   1st Author Title
    Conference ePoster ECFS 2019 Journal of CF Jun-19 Accepted ER The complexity of defining adherence to airway clearance treatments in clinical trials
    Conference Presentation ECFS 2019 Journal of CF Jun-19 Accepted GD Multi-professional expertise and high performance informatics infrastructure supports innovative health technology research and clinical care in CF: Project Fizzyo
    Conference Poster ECFS 2019 Journal of CF Jun-19 Accepted ER Technical support requirements for remote monitoring of physiotherapy in children with cystic fibrosis​
    Conference ePoster ECFS 2019 Journal of CF Jun-19 Accepted HD Quantifying moderate to vigorous physical activityusing heart ratein children and young people with CF

    19th June 2019

    We can measure every single breath, of every single treatment, of every single day, while playing a game. It’s a miracle that data is pouring in, the likes of which we’ve never seen before. Eleanor Main: Professor of Physiotherapy, University College London

    Project Fizzyo is changing the way that physiotherapy is done for children with Cystic Fibrosis. Eleanor Main, Professor of Physiotherapy at University College London says, “We can measure every single breath, of every single treatment, of every single day, while playing a game. It’s a miracle that data is pouring in, the likes of which we’ve never seen before.”

    Data is analysed in Microsoft Azure, where data scientists apply machine learning and artificial intelligence to create highly focused advice for individual patients. Cian’s father is delighted with the project, concluding, “It’s really about motivation, making Cian see all the good things outside CF, and I think it makes life a little easier.” read more about the project and Cian here

    14th June 2019

    Back in 2017, Simon Jackson joined the Fizzyo project working in specifically on the Gaming Framework

    The aim of the project was to simply ask the following question:

    What physiotherapy treatments do children and young people with cystic fibrosis actually use, and is the frequency of doing them related to health outcomes?

    It might sound odd, but it’s not actually known if the prescribed treatment is wholly beneficial, or if regular exercise and medication is a better path. It should be, based on current evidence, but it’s not been scientifically proven.

    The Fizzyo Project’s goals

    Cystic Fibrosis causes a build-up of thick sticky mucus in the lungs, digestive system and other organs, causing a wide range of challenging symptoms affecting the entire body.

    The Fizzyo project was created to focus on the breathing exercise treatment a patient undergoes to clear the mucus from their lungs, where they blow long and hard into an airway clearance device in repeated sessions for upwards of 20 to 30 minutes at a time, several times a day. As you can imagine, for any individual this would be very boring. For a child, however, this would seem like an eternity.

    For research, the project wants to capture data and feedback to validate the effectiveness of the treatment, finally proving or disproving the effects. Or, better yet, identify ways to improve the exercises and tailor them to each patient for the best effectiveness.

    As a secondary effect, we wanted to make these time consuming and sometimes painful exercises more fun, encouraging kids to do them through gaming.

    The Fizzyo Framework

    From breath to game to analytics Sensor Inputs

    The framework takes input from a custom input module attached to an airway clearance device that vibrates the air as a patient blows through it (attempting to loosen any mucus in their lungs). This module has two inputs:

    A pressure sensor to capture how strong/long the patient is blowing A single button to drive interaction Paired with the sensor is a FitBit, to also track the patient’s pulse and other health data but this isn’t available to the games at this time. If you want to see the full details of the Fizzyo project, including the framework, future plans and details of the games themselves, you can do so by checking out the full post on Medium.

    8th June 2019

    The FizzyoCF team are Back home after a great 42nd Cystic Fibrosis Conference #ECFS2019 It was great to catch up with so many people, I’m exhausted but inspired!

    Here are a few @FizzyoCF 📸highlights

    30th May 2019

    Today we are part of line up of speakers for the respiratory led @UCL_RCCA symposium including our own @MainEleanor and @DrSamRay come along and stay for chat after @UCLchildhealth

    11th May 2019

    FizzyoCF team speaking today Developing a system to monitor adherence to airway clearance, and adding games to airway clearance (because ‘airway clearance is massively boring’) @FizzyoCF @MainEleanor @ICCRPT #GlobalPT #WCPT2019

    29th March 2019

    Today we were shooting a short film about the study, with thanks to our brilliant participants who were happy to be filmed, @MicrosoftUK, @RichInteractuk, Nicky at @RBandH, @Fizzy_Emma and @MainEleanor

    14th March 2019

    Exciting time the University of Abertay Game Development students are play testing their FizzyoCF games today with children.

    1st March 2019

    New Month, New Hub! We are really pleased to have released a new version of the #FizzyoHub last night, thanks to @gregsaul especially for working non-stop day and night to make these improvements.

    1st Jan 2019

    Happy New Year! The FizzyoCF team started off the year with a trip to east London for our first recruitment @RoyalLondonHosp with @RachelPhysio

    4th of Dec 2018

    Last week of term for the University of Abertay students they just presented their game pitch to the rest of the students in our classes. The other students were very interested with the Fizzyo device, with people asking us about it afterwards and watching us test the game #Fizzyo #gamedev #abertay #CysticFibrosis

    30th Nov 2018

    The trial is now in full swing at GOSH with over 30 patients recurited and the team have been at the Royal Brompton today onboarding new patients into the Fizzyo Trial. Exciting Time.

    28th Nov 2018

    First look at Abertay University team, @KonglomerateG as they start on FizzyoCF building games for Cystic Fibrosis patients. Check out the teams progress here

    12th Nov 2018

    Nov 2018 Updates - Creating a Game for Fizzyo We’ve made it incredibly easy to start building your Fizzyo project and registering it with the Fizzyo cloud services. To get started, you can follow these guides: Register your Game with the Fizzyo cloud services - Used to integrate your game with the Fizzyo backend. Downloading the Fizzyo Framework and integrating it with your project Adding the Fizzyo Framework to your Scene Building your Project for UWP Once your Windows 10 UWP package is created, it’s read for submitting to the Fizzyo project see more details here

    1st Nov 2018

    Project Fizzyo: improving physiotherapy care for children with Cystic Fibrosis (CF) at Microsoft Future Decoded Download the presentation

    Project Fizzyo is about using technology to transform physiotherapy healthcare for children with Cystic Fibrosis (CF). It is also about the extraordinary things that happen when experts across different industries collaborate. Lung clearance techniques and exercise can slow down the progression of CF lung disease, but these routine physiotherapy treatments are boring and burdensome. Families find it really hard to adhere to the full prescription. For Project Fizzyo, we worked with engineers and computer scientists from Microsoft, UCL and Great Ormond Street Hospital to build electronic chips for airway clearance devices and a secure and sustainable data transfer platform. We also designed computer games that are played by breathing through the chipped airway clearance device, to try and make the treatments less boring and more enjoyable. Using these innovative big data and machine learning methods, we can start to understand how sticking to prescribed treatments can improve clinical outcomes. In this session we will walk you through the project and talk about the outcomes, as well as discussing how in the future this kind of work has the potential to radically change the way we deliver and evaluate the effects of medical interventions like physiotherapy and may facilitate personalised and evolving care plans as children grow and change with life circumstances.

    30th Oct 2018

    Hello to Konglomeate Games from Abertay University who will be spending the next 12 weeks developing a game for Project Fizzyo.

    5th Oct 2018

    Fizzyo devices all ready for patients

    2nd Oct 2018

    Project Fizzyo at the GOSH Open House Event

    25th Sept 2018

    Getting all of the Fizzyo tablets with Windows 10 devices ready for the trial.

    13th Sept 2018

    The trial begins and the application forms are ready for posting

    7th Sept 2018

    Its been 18 months in preparation but its totally worth it, Fizzyo the platform for transforming physiotherapy for children with Cystic Fibrosis has the permission to GO Live! Information packs will be posted to applicants soon. We will be posting information packs over the coming days to eligable familes.

    5th Sept 2018

    Student Project Presentations Well done to our students Nils and Claudia who presented #Fizzyo preliminary work about the Fitbit physical activity and Fizzyo sensor ACT data. Vital work before we start the study, Thank you both.

    22nd Aug 2018

    Its time to move to the live environment, Tim and Greg moving the infrastructure over to its final home on Azure Cloud

    18th Aug 2018

    Getting closer to approval for the Fizzyo trial, Still a few more steps to go, but the ethics committee are happy but its great progress from the team.

    24th July 2018

    UCL Computer Science Students games showcase to Cystic Fibrosis patients at Great Ormond Street Yesterday some visitors to @GreatOrmondSt had a demo of the #Fizzyo games. BIG thanks to Tom on Leopard ward, it was brilliant to see you enjoying physio! Big thanks as well to Tiernan a @uclcs student who has been working hard to debug the games.

    13th July 2018

    Programming the Fizzyo Devices.. its a day of learning and fun for the Fizzuyo team 5th July 2018

    8th July 2018

    Project Fizzyo reaching milestone for Patient Trial Go Live

    3rd July 2018

    Data Science and device testing the devices and services, exciting times and our devcies are being now setup and tested

    1st March 2018

    UCL 1st Year Computer Science Students, are presenting their Fizzyo Game Concepts to the Fizzyo team.

    22nd May 2018

    Project Fizzyo presenting the project at Microsoft AI and Health Summit @MicrosoftUK, @GreatOrmondSt TransformativeAI for health.

    12th July 2017

    Tech4Good Winners 2017

    Project Fizzyo Announced as Winner of AbilityNet Tech4Good Award 2017 - Digital Health Award Both of Vicky Coxhead’s sons have Cystic Fibrosis and because of this they have to do regular physio to keep infections at bay. She applied to feature on a a new BBC2 documentary asking for families with a problems to get in touchand was introduced to Haiyan Zhang, who volunteered to help. Haiyan works as Innovation Director at Microsoft Research in Cambridge. She enlisted the help of Creative Technologist Greg Saul to create a device that could take the boys’ breaths and turn them into controls for a videogame. Together, with Lee Stott at Microsoft UK, they organised hackathons where volunteer designers and engineers from across the UK came along to make new video game experiences for the Coxhead boys. Tech4Good 2017 Winners

    19th June 2017

    Tech4Good Shortlisted Finalist 2017

    We are proud to announce the that Fizzyo has been shortlisted as a finalists for this year’s AbilityNet Tech4Good Awards 2017 – 32 amazing businesses, charities and individuals who use digital technology to make the world a better place. They have been shortlisted in eight categories but you can vote for your favourite to win the Tech4Good People’s Award, which will be announced at our awards ceremony on 11 July. Tech4Good 2017 Finalist Shortlist

    1st April 2017

    Understand Game Play and how patients undertake Physio during a gaming session - Example of the Qubi Game Play Project Fizzyo.

    Understand how to get started with the Project Fizzyo Project Fizzyo Source Control.

    21st March 2017

    D&AD Impact & Microsoft Present Innovative Technology For Good - Project Fizzyo

    TOWN HALL SERIES: D&AD Impact & Microsoft Present Innovative Technology For Good from AdvertisingWeek on Vimeo.

    21 Feb 2017

    How IOT and data is changing lives