Bike Labyrinth: the route to more exercise in hospitals

You might not put much thought into exercise during a hospital stay. But it makes hospitalization periods hard anyway, especially for elderly patients. That's due to uninspiring hospital environments, dependence on external care, and the bed rest associated with a hospital stay. Clearly, not getting enough exercise isn’t good for anyone, but for hospitalized seniors, it has a number of serious repercussions on their health. For example, it results in decreased physical function (muscle mass and strength are reduced, and pulmonary function degrades), and it diminishes cognition. What’s more, not enough exercise is associated with longer hospital stays and increased risk of complications and mortality. Consequently, that leads to a rise in health care costs.

To counteract those negative effects, a lot of effort goes into identifying and implementing innovative ways of keeping patients active during their hospitalization. Our Bike Labyrinth is a relevant example that can help solve this problem. Finding out what elderly hospital patients expect and experience is essential for making the most out of Bike Labyrinth in the care process. Until now, very few studies have been made on Bike Labyrinth or its use in a hospital setting. That was why geriatric physical therapist S. Heilmann (M.Sc.) conducted a qualitative study of Bike Labyrinth in the Geriatrics Wing of Apeldoorn’s Gelre Hospital. He carried his research out over three months, from January through March 2019. Obviously, we’re over the moon about the study (and its conclusions!). So, we’d like to share a brief summary of the results below.

The study population consisted of 15 patients. On average, the patients interviewed were 85 years old and had been largely independent prior to admission. An approximately equal number of men and women were interviewed. On average, the patients had been admitted to the geriatrics wing for two weeks. Some patients were interviewed twice, once before using Bike Labyrinth and another time after trying it.

The study’s main finding is that most patients had positive expectations of and experiences with Bike Labyrinth. Patients who used Bike Labyrinth once were eager to continue using it. Use-related incentives include the expected health benefits, the design and feel of the virtual cycling environment, and social factors, e.g., the opportunity to interact with fellow patients. Some of the responses included:

I can only say good things about that thing. I think it’s amazing. You see yourself biking!

Or, “You’re not here for fun or sweaty feet; it helps encourage you to do your best so that you can get back home as soon as possible.”

Barriers were clearly the depressing lack of information, encouragement, or help from health care professionals to use Bike Labyrinth. That led to misunderstandings related to use. Some participants remarked:

“I believe that you have to take the initiative to exercise; nobody is going to grab you and tell you, ‘Hey you! Get out of bed!’. However, I do think some folks need more encouragement to make the effort.” “I need to be invited to try it. I was admitted here; the personnel ought to provide some supervision and show me the ropes. Nobody ever bothered to say, ‘There’s a bike you can use’. Am I supposed to figure that out myself?”

The Bike Labyrinth’s location in the hospital also turned out to be crucial in terms of interaction with fellow patients.

Despite high patient cognitive functioning and self-sufficiency, the study population indicated that they could use significantly more support. Patients with impaired cognitive functioning and who are less independent are expected to require even more. It is essential for health care professionals to walk patients through how to use these kinds of innovations. Consequently, information and support are key, along with awareness raising and visibility of the system in geriatrics.

Lastly, the study shows that Bike Labyrinth has the potential to increase exercise among elderly hospital patients during their stay, thereby boosting their health outcomes. Follow-up research on the perspective of health care professionals and the effects of Bike Labyrinth on physical functioning during hospitalization would be two worthwhile avenues of study!

If you would like to read the full study, please send an email to

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