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

1 INTRODUCTION

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 BACKGROUND

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

performance.

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

BIOSTEC2015-DoctoralConsortium

(Thomson et al., 2006; Hari and Renvall, 2001), or

APD (Auditory Processing Disorders) (Kello, 2003)

etc.

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

skill.

3 A FUSION OF VR AND

AUDITORY STIMULATION

3.1 Research Problem and Outline of

Objectives

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

Outcome

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-

AStationaryBikeinVirtualReality-RhythmicExerciseandRehabilitation

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.

BIOSTEC2015-DoctoralConsortium

4 SUMMARY

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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