A Stationary Bike in Virtual Reality
Rhythmic Exercise and Rehabilitation
Justyna Maculewicz, Stefania Serafin and Lise Busk Kofoed
Department of Architecture, Design and Media Technology, Aalborg University Copenhagen, Copenhagen, Denmark
A stationary bicycle is a powerful rehabilitation and
exercising device, due to its natural rhythmic compo-
nent. Our goal in this paper is to discuss benefits of a
stationary bike usage supplemented with augmented
feedback, music and virtual reality (VR). In addition,
we present some of the existing applications, which
disabilities it might help, the role of VR in rehabilita-
tion and the bases of rhythmic rehabilitation.
Indoor exercising on the stationary bike might be
a monotonous activity if not supported with some vi-
sual or auditory stimulation. Technology inclusive of
different types of sensors and interfaces provides us
with opportunity to make the stationary bike much
more efficient and enjoyable tool. Our goal is to in-
troduce a system which will serve for elderly people
in retirement home, whom are not able or it is very
difficult for them to train outdoor. The system will be
adjusted to their needs and preferences.
The stationary bike based exercises are recom-
mended for a wide group of medical conditions (see
section 2.3). Adding VR to the stationary bike
might give psychological and physiological benefits.
Holden (2005) in her review of research of motor re-
habilitation in VR punctuated four major benefits of
this approach: (1) people with disabilities appear ca-
pable of motor learning within virtual environments;
(2) movements learned by people with disabilities in
VR transfer to real world equivalent motor tasks in
most cases, and in some cases even generalize to other
untrained tasks; (3) in the few studies (n = 5) that have
compared motor learning in real versus virtual envi-
ronments, some advantage for VR training has been
found in all cases; and (4) no occurrences of cyber-
sickness in impaired populations have been reported
to date in experiments where VR has been used to
train motor abilities".
2.1 Existing Systems
Commercially available systems using a stationary
bike augmented with VR have both fitness and reha-
bilitation applications. Most of them are concentrated
on the visual aspects of VR. Systems like Holdings
(2014), Sports (2014) and Mokka et al. (2003) are for
active individuals to make their fitness more demand-
ing and enjoyable. Also several rehabilitation appli-
cations were made with the stationary bike as a core
of the system. Ranky et al. (2010) introduced Vir-
tual Reality Augmented Cycling Kit (VRACK). It is
a combination of a stationary bike and specific hard-
ware and sensors, which allows for data acquisition
(e.g. physiological) and stimulation by visual, audio
and haptic feedback. Chen et al. (2009) has proposed
rehabilitation system with only visual feedback for re-
habilitation of spinal-cord injury. Chuchnowska and
Sekala (2011) developed system for interactive reha-
bilitation of children under the age of three.
2.2 A Stationary Bike in Virtual Reality
One of the main features of VR, which makes it ben-
eficial for exercise and rehabilitation is its ability to
provide immersion (a feeling of being enveloped by,
included in, and interacting with the virtual environ-
ment (Witmer and Singer, 1998)), sense of presence
and control over the simulated environment. Ijssel-
steijn et al. (2004) indicate that higher feeling of im-
mersion and presence generate more fun thus higher
motivation to exercise. If a person enjoys exercising
it is more likely she or he will exercise and therefore
accelerate rehabilitation process. Below, we present
studies where a stationary bike was used in VR. The
goal is to show how this fusion is already used and
what more can be done.
Chuang et al. (2003) compared biking with and
without VR. Results show that in VR participants can
bike longer and over longer distances. Huang et al.
Maculewicz J., Serafin S. and Kofoed L..
A Stationary Bike in Virtual Reality - Rhythmic Exercise and Rehabilitation.
2015 SCITEPRESS (Science and Technology Publications, Lda.)
(2008) compared different visual displays and con-
cluded that that participants can exercise longer with
head-mounted display (HMD) than without any dis-
play. Ijsselsteijn et al. (2004) indicate that higher im-
mersion is correlated with faster cycling. The use of
VR in motor rehabilitation might be justified by the
fact that there is better transfer of the function to the
real when exercising on robotic device with VR than
these devices alone (Mirelman et al., 2009).
On the other hand Mestre et al. (2011) report that
video feedback does not have any significant effect
on performance, while video feedback joint with mu-
sic clearly increased performance. This effect might
be explained by higher immersion and participant’s
diverted attention when music was presented. Similar
results were collected by MacRae (2003). To achieve
greater commitment to the tasks executed in VR it
seems necessary to add music to the video feedback
(Mestre et al., 2011).
VR with exercising is used to get participants
more immersed in a stimulating environment (Smith
et al., 1998). Combining it with the stationary bike
may enhance the psychological benefits of exercise
e.g. motivation, enjoyment, fun, decrease the per-
ceived exertion etc. In general, VR equipment was
introduced to increase users’ involvement and adher-
ence at training sessions (Mestre et al., 2011). VR
has a power to divert users’ attention from unpleas-
ant bodily sensation and hence delays the onset of
boredom and fatigue (Annesi and Mazas, 1997). An-
nesi and Mazas (1997) noted the higher attendance at
training with VR than stationary bike alone. Promis-
ing results were collected by Chuang et al. (2003)
showing that VR might be the reason of decreased
rating of perceived exertion (RPE). Similar thing was
presented by Huang et al. (2008), where wearing
HMD gave lower RPE in comparison to no-display
conditions. In the study of Ijsselsteijn et al. (2004)
participants using VR showed more interest, enjoy-
ment and perceived more competence in exercise. In
general VR gives opportunity to have enjoying and
rewarding experience (Sveistrup, 2004; Grealy et al.,
1999). Apart from the enjoyment and motivation,
Chen et al. (2009) wrote, that use of VR in reha-
bilitation of patients with spinal cord injury can ease
patients’ tension and induce calm.
Among all the physical and psychological bene-
fits shown above there is also a need for improvement.
Adding music seems crucial to get even more engag-
ing and efficient experience.
2.3 A Stationary Bike in Rehabilitation
A stationary bike has been used in rehabilitation
of cognitive and physical skills in several disabili-
ties and diseases such as a stroke (Ambrosini et al.,
2011; Ranky et al., 2010; Chuchnowska and S˛ekala,
2011), multiple sclerosis (Mostert and Kesselring,
2002; Beier et al., 2014), spinal cord paresis (Chuch-
nowska and S˛ekala, 2011; Chen et al., 2009), and
balance disorders (Chuchnowska and S˛ekala, 2011;
Kim et al., 1999; Kim et al., 2001) and traumatic
brain injury (Grealy et al., 1999). It also serves as a
help for post-surgical population (Ranky et al., 2010).
Specific functions, which might benefit from cycling
therapy are a motoric activity, a circulatory system,
breathing (Chuchnowska and S˛ekala, 2011), and bal-
ance control (Kim et al., 2001).
Based on the effect of transfer of function to walk-
ing (Ranky et al., 2014) bike exercise can be used
in walking rehabilitation. Phadke et al. (2009) in-
dicates that bicycle training normalizes reflex depres-
sion, which is a shared function with walking, while
Snijders et al. (2011) writes that biking may regulate
timing and amplitude of limb movement, which can
be helpful for the rehabilitation of freeze of gait - a
phenomenon observed in Parkinson’s disease (PD).
2.4 Rhythmic Rehabilitation
Recent evidence suggests that auditory feedback can
facilitate rehabilitation process (Sigrist et al., 2013).
Rhythmic exercises with the use of a metronome help
to improve both cognitive and physical skills. Sig-
nificant improvement was observed among others, in
gait rehabilitation in PD (Thaut et al., 1997) and after
stroke (Thaut et al., 1997).
A project called Interactive Metronome (Koomar
et al., 2001) revealed how the rhythm exercises can
improve both physical and cognitive skills in hu-
mans. This program is directed towards young and
adults with neurological problems, but also healthy
patients for enhancement of cognitive and athletic
Connection between 1) time, 2) cognitive and 3)
physical skills are widely described in literature. Tim-
ing is crucial for: attention (Miyake et al., 2004; Taub
et al., 2007), intelligence (Fink and Neubauer, 2005;
Helmbold et al., 2006), working memory (Fink and
Neubauer, 2005; Baudouin et al., 2006), processing
speed (Wearden, 2008; Penton-Voak et al., 1996), mo-
tor skills (Bengtsson et al., 2009; Jantzen et al., 2007)
etc. Its disorders are observed in ADHD (Houghton
et al., 2011; Gilden and Marusich, 2009), autism
(Wimpory et al., 2002; Nicholas et al., 2007), dyslexia
(Thomson et al., 2006; Hari and Renvall, 2001), or
APD (Auditory Processing Disorders) (Kello, 2003)
Cognitive rehabilitation must be ordered in layers,
beginning with the most basic skills such as attention
and concentration, then progressing to more complex
skills such as memory, verbal, language, visuospa-
tial, executive function, and social behavior (Gordon
and Hibbard, 1992). The foundation skill is atten-
tion. It is necessary for good memory, executive func-
tion, communication, and executive control (Bennett
et al., 1998). Attention training appears to generalize
to other tasks (Rimmele and Hester, 1987). Thus, our
program will be mostly concentrated on this cognitive
3.1 Research Problem and Outline of
In this project we aim to incorporate VR and auditory
feedback in a stationary bike platform.The possible
benefits of this approach would involve not only phys-
ical exercise but increment in cognitive skills. We see
it at as a powerful rehabilitation and also exercising
system for people who can not perform difficult and
power demanding exercises, but they still want and
should exercise (e.g. elderly).
Based on the gathered evidence we know that bik-
ing performance and exercise enjoyment can change
as a function of VR’s elements (e.g. type of display,
additional music, level of immersion etc.). Therefore
we aim to explore of the idea of introducing music
and soundscape in VR.
As soundscape we understand ‘an environment
of sound (sonic environment) with emphasis on the
way it is perceived and understood by the individual,
or by a society. It thus depends on the relationship
between the individual and any such environment
(Truax, 1978). To the best of our knowledge, there
is no research that tested the effect of the soundscape
on exercise performance in VR. We hypothesize that
higher immersion produced by a more consistent vir-
tual environment will be beneficial for both physical
and psychocological effects of VR on exercise. Our
experience taught us that visual events are accompa-
nied by auditory experience. Thus, natural sounds
placed in VR can increase perceived level of congru-
ence and be necessary for the sense of presence. An-
other important aspect of each action is the auditory
feedback generated by the movement. Getting not
only visual but also auditory feedback of the expe-
rienced environment can increase the perceived level
of control.
In our opinion is worth to consider feedback in a
form of (1) ecologically valid sounds, which simu-
late real life sounds and build soundscape and (2) a
synthetic rhythmic feedback, which can help to lower
variability of performance while biking.
In general, this work will help us to analyze how
the audio feedback, music and soundscape sounds in-
crease or decrease the performance score during bik-
ing, to identify the properties of audio signals which
constitute understandable and efficient feedback, to
find humans preferences for synthesised or natural
sounds accompanying their exercise.
The results of our investigation should help to im-
prove the elderly exercising and facilitate understand-
ing of the exercises procedures and aims, provide
knowledge for designing proper feedback signal and
support elderly with intuitive, comfortable, not stress-
ful and even relaxing way of exercising.
3.2 Stage of the Research and Expected
In one of our basic experiments (Maculewicz et al.,
2013) we checked how people follow the tempo on
an exercising bike in several conditions. We had four
main goals in this experiment. We wanted to inves-
tigate: If auditory feedback can help to keep guid-
ing tempo? Should we use single or double feed-
back sound in cyclic movements? When, within one
round of pedals, should be feedback produced (differ-
ence between two points)? Does the change of guid-
ing sound change the influence of auditory feedback?
Figure 1 visualizes the setup used in the experiment.
Whenever participants was passing with pedal one of
the magnet sensors, he or she heard sound coming
from the headphones.
The results of our experiment showed that audi-
tory feedback helps to keep a guiding tempo. It was
proved that for this type of cyclic movement single
feedback helps much better than double feedback.
Moment of presenting feedback does not change ac-
curacy of performance. Our results also showed that
participants followed better tempo presented by drum
sound than music at the same level of the tempo. Fig-
ure 2 shows in details those results. Presented mea-
sure is an absolute value of the difference between
participant’s results and presented tempo. The lower
value, the participant’s tempo was closer to the guid-
ing tempo.
Based on the results of our rhythmic walking ex-
Figure 1: Presentation of the experimental setup. The red
dots indicate placement of the magnet sensors, which was
responsible for detecting participants’ tempo. Feedback
was presented when person was passing the magnet sensor
with a pedal.
Figure 2: Presentation of the results of the experiment. X-
axis presents type of guiding stimulus and Y-axis presents
average absolute value of the difference between partici-
pants’ results and presented tempo.
periment (Maculewicz et al., 2014) we hypothesize
that different types of feedback can change preferred
pedaling rate and therefore make users bike faster. If
we find feedback which makes users bike faster but
still in their preferred cadence we could motivate par-
ticipants to exercise harder without change in RPE.
Our second aim of this research program is to con-
sider use of the music in VR exercises. People lis-
ten to the music during exercising for many reasons.
They use it as a distraction from discomfort, for re-
duction of tension, or to block repetitive noises made
during exercise (Stevens and Lane, 2001). Music can
be also used as a cue for synchronization of their mo-
tion. Well-selected tracks may contribute to increase
in motivation. They are adjusted to preferred tempo
and presents desired energy level for exercise. We
suggest to add music into VR can incorporate all of
above mentioned benefits to the biking exercise expe-
rience. Music added in VR increases performance and
commitment to the task in VR (Mestre et al., 2011).
We are mostly interested in its rhythmic quality and
therefore ability to induce rhythmic and stable exer-
cise pace in motivational environment. As we wrote
before, all of those components together can serve as
a promising tool for improving cognitive and physi-
cal skills. Figure 3 presents a visual part of the VR
environment which will be used in the future experi-
ments. Incorporated elements (e.g. visualization of
birds, trees in the wind etc.), which are associated
with sounds, give opportunity for building rich sound-
scape. A visual part of VR will be built in Unity
(Unity Technologies) and a sound part will be pre-
pared in Max/MSP (Cycling’74) software.
Figure 3: Presentation of the visual part of VR which will
be used in the forthcoming experiments.
3.3 Methodology
All formulated hypothesis will be tested by subjects
in an experimental setting (in the laboratory and
the real environment - retirement home). Quantita-
tive and qualitative data acquired during experiments
will be analysed with appropriate statistical methods
(ANOVA, t-test etc.) selected based on the experi-
mental and theoretical requirements. Mathematical
methods will help to establish models of the effi-
ciently working feedback systems.
Every specific experiment within this project will
require consideration of the appropriate methods. Par-
ticipants exertion and, in general, exercise experience
might be measured with a few different tests (e.g.
Perceived Exertion Scale (PES) (Borg, 1982) and
The Subjective Exercise Experiences Scale (SEES)
(McAuley and Courneya, 1994)). For their perfor-
mance and efficiency we will measure biking tempo,
distance, length of exercising session, heart beat etc.
This paper presented a new, exploratory approach
to augment stationary bike with VR platform with
acoustic stimuli (music or soundscape). Based on the
presented evidence we will follow two lines of re-
search. One is to investigate impact of soundscape
and/or music display on increasing the immersion VR
experience while cycling. The second, to further in-
vestigate how auditory feedback can modulate pace
of exercise and RPE of person exercising. This work
is currently in progress.
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