Introduction
Physical activity is essential for everyone, but when there is a motor disability, finding a form of exercise that is accessible, motivating and can fit into everyday life is not always easy. And that is where riding a bike can become much more than physical activity.
Pedalling allows repetitive, active work while something much more important happens: we are going somewhere. There is a destination, a direction, a speed and surroundings to explore. We can go to the park, go along with our family, ride with our brothers and sisters or friends, or simply enjoy the feeling of moving under our own steam.
That is why, when we talk about adapted bikes and tricycles, we should not think only about their possible therapeutic benefits. Riding a bike is exercise, but it is also autonomy, participation and fun.
The physical benefits of pedalling
Cycling is a cyclical, repetitive form of exercise in which different muscle groups of the lower limbs work together in a coordinated way. Pedalling involves repeated flexion and extension of the hip, knee and ankle, which works joint mobility, muscle activation and coordination.
Keeping this activity going for a period of time also provides significant cardiovascular work, which is particularly valuable for people whose reduced mobility can make other forms of aerobic exercise harder to access.
The repetition of the movement itself is one of the great advantages of cycling. Instead of doing a few repetitions of an exercise in a treatment session, a person who enjoys riding a bike can complete hundreds of pedal strokes while getting around and playing.
Pedalling can also help develop strength and coordination, but perhaps the most interesting thing is that all this work happens within an activity with a real purpose: moving forward.
That completely changes the experience. We do not necessarily pedal because someone has told us we need to strengthen our legs. We pedal because we want to get over there, follow our brother, do another lap of the park or catch up with our friends.
Exercising without feeling that we are exercising
For physical activity to be truly useful in the long term, it is not enough for it to be beneficial: it has to be possible to build it into everyday life.
We can design an excellent exercise programme, but if it is boring, takes too much organising or always depends on someone else to lead it, it will be hard to keep up over time.
The bike offers something different. Exercise can be a consequence of the activity rather than necessarily its main goal.
A child may pedal because they want to play. A teenager because they want to get around more independently. An adult because they enjoy being outdoors. And a family may use the bike simply because they want to do something together.
That playful, motivating element is enormously valuable. The activity stops being only “therapy” and becomes part of everyday life.
Taking part matters too
For a person with a motor disability, an adapted bike or tricycle can open up opportunities to take part that would otherwise be hard to achieve.
Going out with the family, riding with brothers, sisters or friends, getting around the park or joining in school activities are experiences that bring far more than physical benefits. They encourage autonomy, confidence and social relationships and, above all, the chance to share activities with others.
When we think about childhood and disability, it is easy for our priorities to focus on everything we want to improve: strength, balance, coordination, walking or postural control. All of that matters, but a child should not spend their childhood only preparing to do things in the future.
They also need to do them now. Riding a bike can be one of them.
And the child does not need to pedal, steer and brake completely independently for the experience to be worthwhile. There are different solutions that provide only the help that is needed and can be adjusted to each person's abilities.
Adapting the bike to the person, not the person to the bike
This is probably the most important idea when we talk about adapted cycling.
A conventional bike demands certain abilities in balance, trunk control, coordination, strength and mobility. If a person cannot meet those requirements, the conclusion should not necessarily be that they cannot ride a bike; instead, the question should be:
What can we change on the bike so that they can do it?
One of the first modifications may be to increase stability. Tricycles provide a wider base of support than a conventional bike and remove much of the balance demand needed to stay upright on two wheels.
But adaptation can go much further. The position of the saddle relative to the pedals, the distance to the handlebars, the type of seat, the gear ratio, foot support or the addition of pelvic and trunk supports can radically change a person's ability to pedal.
When pedalling is too hard
The difficulty is not always keeping balance. For some people, the main problem is generating enough force to start the pedals turning and keep them going.
In these cases, small mechanical changes can make a huge difference.
A suitable gear ratio reduces the effort needed to get the bike moving. Combining a low gear with lower resistance can make cycling possible even for people with little muscle strength.
This shows very clearly why an individual assessment is so important.
Two people of the same age and height may need completely different bikes. One may require more postural support; another, gearing that makes pedalling easier; another may need help with steering; and another may have good motor control but simply need a more stable base.
The aim is not to provide more support than necessary, but to find the balance between safety, positioning and autonomy.
Feet matter too
For pedalling to be effective, we need to be able to transfer the force of the legs to the pedals. If the foot keeps slipping, loses contact or sits in a poor position, a large part of the effort is lost.
That is why some adapted bikes have pedals with specific foot supports and straps that help keep the feet correctly positioned throughout the pedal stroke.
It is not just about “holding” the foot in place. A good position allows the person to push on the pedal more securely and make better use of the movement available.
The same goes for the rest of the body. When needed, backrests and trunk supports can be added to provide a stable enough base from which the person can use their limbs more effectively.
The amount and type of support must be individualised. A person who needs help to hold their trunk upright does not have to give up pedalling actively with their legs.
And what if they need help to steer?
Here too there are different options. Some adapted tricycles can be fitted with systems that let an adult control the steering from behind while the person keeps taking an active part in pedalling. This way we can separate two skills that a conventional bike demands at the same time: pedalling and steering.
This can be especially useful while learning, or when the person can generate the leg movement but does not yet have the control needed to steer the bike safely.
Over time, and whenever possible, that help can be adjusted as the rider's ability grows.
There are many ways to ride a bike
Pedalling completely independently is just one of them.
There are tricycles with different levels of support, bikes on which another person can help control the steering, and cycles designed for two people to ride together. Theraplay, for example, offers accompanied cycles on which both riders can pedal or on which one person can ride as a passenger.
This greatly widens the possibilities for people with higher support needs. Because taking part does not necessarily mean doing 100% of an activity without help.
A person may need assistance and still be an active part of the experience. They can pedal while someone else steers, help partly with propulsion or simply enjoy the movement and the ride alongside someone.
Independence is important, but so is participation.
Choosing the right bike
There is no perfect adapted bike for everyone.
The choice should take into account the person's physical characteristics, as well as their motor abilities, positioning needs, environment and goals.
Even sizing calls for a slightly different assessment from a conventional bike. Theraplay recommends choosing its tricycles mainly by leg length, not just age or overall height, as people of the same height can have very different body proportions.
Next comes assessing how the person sits, how far they can comfortably reach the handlebars, how they place their feet, what movement they make while pedalling, how much effort they need to set off, and how well they can steer and brake.
And, of course, there is one fundamental question we should never forget: do they enjoy it?
The bike may be perfectly adapted from a biomechanical point of view, but we need the person to want to use it.
Exercise that is part of life
Building strength, improving coordination or doing cardiovascular exercise are important goals. But so are having fun, exploring, choosing where to go and being able to share an activity as everyday as riding a bike.
Perhaps that is one of the greatest values of adapted cycling: goals that we traditionally pursue inside a treatment room can be worked on while the person is doing something that makes sense to them.
Pedalling can mean exercising. But it can also mean riding alone to the other end of the park for the first time. Following a brother or sister. Choosing the way. Feeling speed. Going out with friends. Joining in a school activity. Going for a ride as a family.
And all of those goals matter. Because the best physical activity is often the one you want to do again. And if, as well as exercising, we achieve participation, autonomy and fun, the benefit goes far beyond pedalling.
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