Outdoor bicycle training following stroke: protocol development, feasibility testing and application guidelines

The benefits of cycling on health have been extensively shown and indoor cycling is increasingly used as physical activity in stroke rehabilitation. However, standardized protocols and guidelines for outdoor bicycle training are still lacking for this population.

To develop a structured, group-based training protocol for outdoor cycling skills in individuals with post-stroke hemiparesis and to test the feasibility of the training protocol in individuals with stroke.

Based on existing literature, guidelines for other populations and the team's expertise, a training protocol and progression criteria were generated.

Subsequently, five stroke participants engaged in the three-week bicycle training program that involved nine sessions (three sessions/week). Feasibility was assessed by documenting adherence, progression, adverse events, acceptability of the intervention, as well as the limited efficacy of the intervention on participant's cycling goals [Goal Attainment Scale (GAS)], self-reported confidence in cycling skills (CCS), participation in leisure (Nottingham Leisure Questionnaire) and other balance and mobility outcomes.

A detailed intervention protocol initially comprising of three modules of increasing complexity and that was extended to four modules to accommodate participants' rapid progression was developed. Participants completed two to four modules, showed high intervention adherence and acceptability, and minimal adverse events. Post-intervention, significant improvements in GAS (p = 0.009) and CCS (p = 0.015) were observed, but marginal or no differences were found for all other outcomes.

This manuscript presents the first, openly available stroke-specific training protocol for outdoor cycling. Findings suggest that the intervention is feasible and acceptable, and that it improves outdoor cycling proficiency.