BRAIN article on using e-bikes for rehabilitation

[Dewey]

E-rehab market growing along with e-bike popularity

IRVINE, Calif. (BRAIN) — Don DiCostanzo has heard the stories. The 14-year-old with bone cancer regenerated leg movement riding an e-bike after having surgery. A woman who began e-biking to recover from a heart transplant. Another battling a muscular disease now is able to maintain mobility with...

www.bicycleretailer.com

Article from Bicycle Retailer News discussing the opportunities and challenges in the US of e-bikes as rehabilitation tools, the upshot of which is e-bikes are currently not recognized by US health insurers as a reimbursable medical device, mobility device, or piece of durable medical equipment, in the same way as an electric wheelchair or mobility scooter.

 

[m@Robertson]

Its worked wonders to increase my cardiovascular strength, not to mention overall fitness. My cardiologist is all for it. I even wrote up a plan for him for distribution to his other patients, and also described why torque sensing is potentially catastrophic for heart patients whereas cadence sensing and a throttle is a requirement.

 

[PedalUma]

Point taken. I make the same allowance for people with health issues even though I am not into throttles. I know there are definitely mental health benefits, small motor and balance benefits. And there are plenty of videos on Parkinson's and bikes. See Video 2 at 50 second in.

 

[Ang1sgt]

I am recovering from a Brain Tumor that I had removed back in 2016. I have had some issues with balance and for 2 years needed to walk with a cane to assist me. I walked more in the next few years because my Doctor and fellow cyclist wanted to make sure my plate was healed and solid. There were issues with the wound track that took 9 months in the Wound Clinic every 3 days. Back in early 2020 My Doctor cleared me to get back on the bikes. He stated that I needed a MIPS compliant helmet to add some added protection for me. I tried, but I had issues trying to get good again on my recumbent. And then the PANDEMIC. Being partially Service connected disabled, I stayed home and just sat around basically. Riding the trainer indoors just was not doing it and I almost needed a boost to get up on it.

Now that I am in my late 60’s my conditioning is not what it could or should be. That is why I am looking at an E-Bike. I want one with a good pedal assist, and one that feels natural to me. I have test ridden a few and I know what I want. I just have to sell off a few bikes that I have so I can afford one of these new bikes. I wish I could talk the VA into something like this!

 

[Bicyclista]

Its worked wonders to increase my cardiovascular strength, not to mention overall fitness. My cardiologist is all for it. I even wrote up a plan for him for distribution to his other patients, and also described why torque sensing is potentially catastrophic for heart patients whereas cadence sensing and a throttle is a requirement.

Pray tell. Why is torque sensing dangerous for heart patients? Both my ebikes have torque as well as cadence sensing. I wear a pacemaker and did not know I was in danger. My pacemaker was installed in February, I ride 3 or 4 times a week 20 to 40 miles per ride, and so far no problems. Don't tell me I have to stop!

 

[fooferdoggie]

Could see a throttle but cadence is just throttle controlled by rotation. you can work as little or as hard with torque sensing. but you are limited to models that would have a throttle too.

 

[PedalUma]

I normally create bikes that are torque sensing and have the option of a throttle. Either way the handlebar throttle is not needed if you are willing and able to pedal, which is what riding a bike is all about. It is like playing an acoustic instrument that can be amplified to the extent desired. It feels like a natural bike but enhanced. Here is one. Yes, it is electric.

 

[m@Robertson]

Pray tell. Why is torque sensing dangerous for heart patients? Both my ebikes have torque as well as cadence sensing. I wear a pacemaker and did not know I was in danger. My pacemaker was installed in February, I ride 3 or 4 times a week 20 to 40 miles per ride, and so far no problems. Don't tell me I have to stop!

From what little I know of the job a pacemaker does, what follows may not apply to your condition. It does to someone who has had heart attacks and now has reduced heart function as a result, where exercise strains a permanently damaged heart muscle.

I laid out the long version here.

I Hate Ebike Torque-Sensing (maybe you should too)

Well, I don’t actually hate it, but it is a technology rooted in cycling’s past, whose existence was created to market a product to legacy riders.

talesontwowheels.com

In short, torque sensing requires physical effort - forced pressure on the pedals - to produce assist. That is its nature. If your exercise regimen reaches a point where physical effort needs to be dialed back, then torque sensing also dials back the bike's assist at the time when you need it the most. Cadence sensing is an assist mechanism independent of physical force applied to the pedals, so the rider can dial in the assist level they require at a given moment, rather than taking what the bicycle decides it will let them have. Torque sensing was for me something of a disaster, although that is over-dramatic. It meant the difference between having to physically stop versus a couple of button clicks to let the bike take more of the burden, then click the assist back down when I was ready to take on more. Essentially it turned the bike into an analog bike experience. The torque-sensor'd ebike just let me go faster during the times when I could pedal it.

 

[pxpaulx]

From what little I know of the job a pacemaker does, what follows may not apply to your condition. It does to someone who has had heart attacks and now has reduced heart function as a result, where exercise strains a permanently damaged heart muscle.

I laid out the long version here.

I Hate Ebike Torque-Sensing (maybe you should too)

Well, I don’t actually hate it, but it is a technology rooted in cycling’s past, whose existence was created to market a product to legacy riders.

talesontwowheels.com

In short, torque sensing requires physical effort - forced pressure on the pedals - to produce assist. That is its nature. If your exercise regimen reaches a point where physical effort needs to be dialed back, then torque sensing also dials back the bike's assist at the time when you need it the most. Cadence sensing is an assist mechanism independent of physical force applied to the pedals, so the rider can dial in the assist level they require at a given moment, rather than taking what the bicycle decides it will let them have. Torque sensing was for me something of a disaster, although that is over-dramatic. It meant the difference between having to physically stop versus a couple of button clicks to let the bike take more of the burden, then click the assist back down when I was ready to take on more. Essentially it turned the bike into an analog bike experience. The torque-sensor'd ebike just let me go faster during the times when I could pedal it.

I feel like this is an oversimplification. The concept of torque sensing as described suggests that torque sensing bikes have no assist 'levels' - that you simply get on and ride, and the bike will compute a predetermined output based on the rider's input. Any half decent bike we've owned with a torque sensor has multiple levels of assist - when you put them into the highest/boost option, the amount of rider input is typically doubled, tripled or even quadrupled. The result is that even though it is still torque-assist based, the motor output for the vast majority of users far outweighs even the lightest input, requiring next to no real effort - and I'm a 300+lb dude.

My point being, if the level of assist provided by a torque-assist ebike is not enough at a bike's highest boost setting, the rider is not ready to manage a 50+lb bike in terms of weight, handling, mounting or just generally riding in the first place. At that level of fitness, well, the most apt analogy I can think of would be struggling to get out of bed to do basic physical tasks - at that point e-bikes just wouldn't be in scope for potential rehabilitation yet.

Edit - I did read your linked post, and it makes a lot of sense. low speed Ebikes as EV/Transport I sincerely hope are the future (an uphill battle in the US to be sure!), and agree there are different use cases for cadence vs torque (and of course other aspects such as throttle/no throttle). Ultimately more people on ebikes of any kind is a good thing!

 

[fooferdoggie]

when I first started riding and I could not put effort into it. both my mid drives would let me keep my heart rate at around 90 and just spin and go 20mph. alsmot no effort at all less then walking. unless you had steeper hills to climb.

 

[PedalUma]

A tri-athlete around here says that there are some 'cheaters' who have bikes tuned to their heart rate. She says without proof that assist kicks in when the hart starts beating faster at some threshold. And that there is a worm gear in the downtube to the BB.

 

[Mulezen]

I am recovering from a Brain Tumor that I had removed back in 2016. I have had some issues with balance and for 2 years needed to walk with a cane to assist me. I walked more in the next few years because my Doctor and fellow cyclist wanted to make sure my plate was healed and solid. There were issues with the wound track that took 9 months in the Wound Clinic every 3 days. Back in early 2020 My Doctor cleared me to get back on the bikes. He stated that I needed a MIPS compliant helmet to add some added protection for me. I tried, but I had issues trying to get good again on my recumbent. And then the PANDEMIC. Being partially Service connected disabled, I stayed home and just sat around basically. Riding the trainer indoors just was not doing it and I almost needed a boost to get up on it.

Now that I am in my late 60’s my conditioning is not what it could or should be. That is why I am looking at an E-Bike. I want one with a good pedal assist, and one that feels natural to me. I have test ridden a few and I know what I want. I just have to sell off a few bikes that I have so I can afford one of these new bikes. I wish I could talk the VA into something like this!

I mentioned the subject of ebikes to both my to my neurosurgeon and Physical therapist at the VA I go to…McGuire Hospital in Richmond. Both happened to be avid cyclists. I’m unsure funds are available at the moment. The PT thought that with the wider tires and greater weight the bikes would be more stable. A mid-drive should be on your menu. Check the reviews and threads here for leads towards a reputable brand…though you with your background in bikes you probably already have an idea.

 

[Bicyclista]

From what little I know of the job a pacemaker does, what follows may not apply to your condition. It does to someone who has had heart attacks and now has reduced heart function as a result, where exercise strains a permanently damaged heart muscle.

I laid out the long version here.

I Hate Ebike Torque-Sensing (maybe you should too)

Well, I don’t actually hate it, but it is a technology rooted in cycling’s past, whose existence was created to market a product to legacy riders.

talesontwowheels.com

In short, torque sensing requires physical effort - forced pressure on the pedals - to produce assist. That is its nature. If your exercise regimen reaches a point where physical effort needs to be dialed back, then torque sensing also dials back the bike's assist at the time when you need it the most. Cadence sensing is an assist mechanism independent of physical force applied to the pedals, so the rider can dial in the assist level they require at a given moment, rather than taking what the bicycle decides it will let them have. Torque sensing was for me something of a disaster, although that is over-dramatic. It meant the difference between having to physically stop versus a couple of button clicks to let the bike take more of the burden, then click the assist back down when I was ready to take on more. Essentially it turned the bike into an analog bike experience. The torque-sensor'd ebike just let me go faster during the times when I could pedal it.

Thank you for the clarification and for the link to the long version, which I read. I am sorry your heart condition sets some limitations.

With regard to torque sensing, I'm afraid we will have to agree to disagree. I like torque sensing precisely because it makes riding ebikes more natural, i.e. more like a conventional bicycle. Both my ebikes have torque and cadence sensing and they make me feel like I have Superman legs, a very powerful feeling! I would not trade that wonderful feeling for buttons or a twist throttle.

As for your effort in trying to redefine the word bicycle in your linked article, I would object to that as well. The definition of bicycle is "a vehicle with two wheels in tandem." To say that ebikes are not bicycles is simply wrong.

@m@Robertson, despite our differences of opinion, I enjoy your knowledgable posts and your civil manner. You are a "right honorable gentleman opposite," as they say in the British Parliament.

 

[m@Robertson]

I feel like this is an oversimplification. The concept of torque sensing as described suggests that torque sensing bikes have no assist 'levels' - that you simply get on and ride, and the bike will compute a predetermined output based on the rider's input. Any half decent bike we've owned with a torque sensor has multiple levels of assist - when you put them into the highest/boost option, the amount of rider input is typically doubled, tripled or even quadrupled. The result is that even though it is still torque-assist based, the motor output for the vast majority of users far outweighs even the lightest input, requiring next to no real effort - and I'm a 300+lb dude.

Well, the majority of my personal experience with torque sensing is with that 39 lb ebike I showed in that article, which I purchased and owned. As I said there, one of the things I wanted to verify by buying it was whether what I had heard about torque sensing held up to the actual experience. Unfortunately, it did. While that bike had five separate assist levels, it was not capable of providing the amount of assist you are describing (i.e. up to almost zero pedal effort). Part of this is no doubt because it is a low-power bike, peaking at around 400w. Torque sensing behaved exactly as advertised: Output was proportional to input. Meaning more force on the pedals was required to get more force back out of the motor, and if you took it easy, the bike essentially said screw you work for it or you get nothing back. Going to a higher level of assist increased the output level increments, but the core tenet of the system was it took hard(er) effort to get the bike to give you a result. Light effort yielded minimal assist regardless of the PAS output level.

Just as cadence based systems are not all on/off switches, I am sure there are more sophisticated torque sensing systems (and lets bear in mind I wrote that article in 2019), but the bike I purchased was not one of them... and it behaved exactly true to form in the sense that what people tell you is torque sensing is what I got.

With regard to torque sensing, I'm afraid we will have to agree to disagree. I like torque sensing precisely because it makes riding ebikes more natural, i.e. more like a conventional bicycle. Both my ebikes have torque and cadence sensing and they make me feel like I have Superman legs, a very powerful feeling!

OK, but as a philosophical exercise I have to ask why is this conventional bicycle experience considered to be desirable? And I'm asking this as a lifelong cyclist myself before going over to the dark side.

I think its part of a work-ethic and a function of personal pride. It is tied to a bicycle being a difficult-to-master, workout/exercise tool that is beyond the ability of mundane mortals. Thats good for the rider's self esteem, but does it make a bike a better tool more usable to a broader spectrum of the population? I don't think it does, and to bolster that argument I would point to the Far East where cycling as a sport is effectively nonexistent, but riding a bicycle is a daily transportation tool (i.e. 'slog') and in that world, where literally an order of magnitude of bicycles exist in use over the entire rest of the planet, there is effectively zero demand for torque sensing. The reason for this, I'd argue, is not that Far Easterners are unable to build bikes with the feature. Its because they are not using bikes for recreation. Their bikes have a job to do and torque sensing's purpose is to fulfill the work ethic demanded by the analog-era Western recreational cyclist.

I expect torque sensing preference to fade away just like resistance to the derailleur did starting about 100 years ago. Today your typical rider cannot even imagine why a lack of a derailleur can even be considered a positive thing, and over time as electric assist becomes the norm rather than the exception, we'll see the same sort of attitude change.

This all goes straight into my position that an ebike should not be looked at as a bicycle (with the shining exception being how they are treated within the vehicle code and traffic laws). Of course we all understand the dictionary definition, but thats not the point of making the differentiation. From my first few rides on my first ebike, where I was actively trying to use the bike as a fitness tool as well as get back into daily commuting, I realized almost immediately that what I was riding - as a system - was almost nothing like bicycles after decades of daily riding. I had to treat the ebike as an entirely new system, with different rules to learn and master (certain things carry over, of course, but a lot less than you'd think just looking at one vs. the other). I'm not the one who came up with calling an ebike a 'bicycle-shaped object' but the differentiation is an apt one. Some of the worst ebike advice you can come across is from a cyclist who treats an ebike like a bicycle (I am not lumping anyone here into this category; just saying it exists).

I would not trade that wonderful feeling for buttons or a twist throttle.

Just to be sure I didn't give the wrong idea: I am using cadence-based sensing to work out - using pedal assist. Not a throttle. I'm happy to use a throttle on occasion - especially when carrying cargo and I need to start up from a stoplight - but we're both pushing on pedals to make things happen. I'm just doing it in a different way. And also I am using a mid drive motor (BBSHD) with a highly configurable pedal assist system that I have - to oversimplify - dialed back significantly so it can never run away from me. I do have buttons in the mix but thats just to dial up or down the assist increment. Back in 2019 when that article was written I was still using my dual hub AWD commuter bike which was less configurable, but it worked just as well by simply using the 2x5 assist levels as a 10-level system, along with the occasional downshift in intense wind (its a flat-land commute so no other reason to shift; especially with a hub motor).

 

[Bicyclista]

OK, but as a philosophical exercise I have to ask why is this conventional bicycle experience considered to be desirable? And I'm asking this as a lifelong cyclist myself before going over to the dark side.

...It is tied to a bicycle being a difficult-to-master, workout/exercise tool that is beyond the ability of mundane mortals.

This all goes straight into my position that an ebike should not be looked at as a bicycle...

I will just answer the three points quoted above.

The conventional bicycle riding experience is desirable because it is such a good experience. I too come from being a lifelong cyclist, with around 70 years of experience. I learned to ride when I was a kid. When I ride I feel exhilaration and joy, a sense of freedom and happiness. This comes from not only the obvious fact that I can travel farther and faster than walking, but also from the feeling of control, of being one with the machine. My connection with my bicycle is not only through the handlebars and the saddle, but also via the pedals. I can spin the pedals fast or slow, I can coast, and I can stand on the pedals when going over a bump. I can push on the pedals harder to accelerate or to climb a hill.

Clearly, for me, not having torque sensing would remove an important control over my bike. I like the way my bike responds with a surge of power when I push hard on my pedals. My 2016 Haibike AllMtn has a Yamaha motor. Yamaha ebike motors feature "instant torque." The motor responds as soon as I apply light pressure on my pedals. The bike feels alive and I like that. My other bike, a Yuba Spicy Curry AT, has a Bosch motor that requires a bit more pressure to respond, but it feels like it's ready to carry any load, fitting for a cargo bike.)

Having only cadence sensing does not give me that feeling. I owned a Magnum Ui5 six years ago. It only had cadence sensing and a wimpy throttle. I hated the lag between applying pressure to the pedals and the surge of power from the motor. The cranks had to go half a turn (at least) before the motor would wake up. It felt very unnatural. I sold the bike within six months.

Last year I rented a Pedego Stretch while my Yamaha motor was being overhauled for preventive maintenance. The Pedego Stretch also has only cadence sensing. The lag between pedal rotation and motor awakening was even worse than the Magnum Ui5. It seemed to require almost two full revolutions of the crank before I felt any power! I had to resort to the throttle to get going after a stop at intersections, and the throttle had such poor modulation that I got underway in a very jerky manner. Needless to say, I eliminated the Pedego Stretch from my list of potential cargo bikes. I eventually bought the Yuba Spicy Curry AT with both torque and cadence sensing.

I don't think riding a bike is beyond the ability of mundane mortals. Learning to ride a bike is like learning a language. If you start as a kid, it's easy. If you start as an adult it can be hard. But even if it's hard for some adults, it's certainly not beyond the ability of most people. Many of my friends who biked as kids and only recently took up riding again found that they never really forgot how to do it. It was a matter of riding more to shake off the rust.

Isn't saying "ebike" vs "conventional bike" a good differentiation? Saying an ebike should not be regarded as a bicycle but as a "transportation vehicle" muddies things because a conventional bicycle is also a transportation vehicle.

 

[m@Robertson]

The conventional bicycle riding experience is desirable because it is such a good experience.

I wasn't questioning the quality of your experience (or mine for that matter as we both have the same decades-long analog cyclist background). But our mutual respective experiences are colored indelibly by the fact that we only had an analog bike to ride. So neither of us knew any better. So we learned one thing one way and we learned to love that thing. Thats what I have been getting at with regard to the ebike being a different animal that needs to be treated as such: It can provide the same (or different but equally gratifying) benefits so long as the development of the experience is a new one not hindered by preconceived notions about what a satisfying cycling experience is, or how to achieve it. It can be an entirely new learning experience but... this is unlikely to happen when stacked up against a population of paying Western customers who tell bicycle manufacturers who cater to their market that they want an analog riding experience.. For this reason I think its going to take some time for a shift to happen as it will require a new generation of 'bicyclists'.

It would not surprise me to see analog and analog-oriented cyclists in the future become what fixie riders are today in terms of the cycling population. Given the influence of the Far East and their colossally larger riding population, I don't think that is much of a stretch as - taking riders as a whole across the world - the vast majority of electric riders are, right now, already riding these bikes without concern or complaint (as evidenced by regional global sales numbers). Couple this to the desire of Western non-cyclists to buy in at a low price point and you have a market primed for a steady progression in this direction. I have already seen it happen in ebike discussion groups whose membership is almost exclusively new ebike riders. They get bitten by the bug, upgrade to a 'nicer' bike and when torque sensing reality hits them you hear a 'wtf' online and a concern on 'how do I fix this?' It is far from a universal reaction but its there in the kind of numbers that you have to believe at least a noticeable portion of the market is on board right now with cadence sensing, and this is still an early stage of market development for this product.

Clearly, for me, not having torque sensing would remove an important control over my bike. I like the way my bike responds with a surge of power when I push hard on my pedals.

See, right there I can point to that and say we're after entirely different things even as analog cyclists. I dabbled in MTBs but my main background is in road bikes, and I absolutely do not want any 'surge of power' because that does me about zero good on a long stretch of deserted road. I am instead all about developing and maintaining a precise cadence. Doing a long ride in the countryside, you need to establish a rhythm, then laser-focus and maintain it. Lets say you are happy at about 70 rpms. Hit a gentle incline and the goal is to shift a close-ratio cluster so you can stay at 70. Gets a little steeper and you shift again to achieve the same purpose. Gets real steep and 70 rpm goes out the window and instead you grind out a slower but rock-steady pace at a much higher effort level, just hard enough so you do not damage your muscles (since once we get to the end point we still have to turn around and make it home) but you are pouring on a barely tolerable strain. This is nothing like singletrack riding but cycling on a road bike for miles on end, you want to keep that ideal rhythm.

I don't think riding a bike is beyond the ability of mundane mortals.

Well, taken in context I actually didn't say it was. What I was trying to say, at least, was the perception among cyclists is that cycling defines what they are (superior physically) and other people are not. Its a point of personal pride, and the arrogant spandex-clad cyclist is a topic so well understood it doesn't need a lot of introduction... especially on an ebike forum where the targets of that disdain are everywhere to be found here. This Them vs. Us mentality is magnified by the fact that cycling in the USA is not a sport that gets respect, and often reaps outright hostility from the general, car-driving public. Here again I am coming at this as a road rider and a (former) part of that community. I have a pretty good idea of how it goes with singletrack riders but little direct experience.

Interestingly, while I have a variety of ebikes, I actually get support and a friendly reaction from cyclists when riding a cargo bike. Riding a truck seems to erase the prejudices against the motor (with the shining exception being analog cargo bike riders).

 

[Mike_V]

E-rehab market growing along with e-bike popularity

IRVINE, Calif. (BRAIN) — Don DiCostanzo has heard the stories. The 14-year-old with bone cancer regenerated leg movement riding an e-bike after having surgery. A woman who began e-biking to recover from a heart transplant. Another battling a muscular disease now is able to maintain mobility with...

www.bicycleretailer.com

Article from Bicycle Retailer News discussing the opportunities and challenges in the US of e-bikes as rehabilitation tools, the upshot of which is e-bikes are currently not recognized by US health insurers as a reimbursable medical device, mobility device, or piece of durable medical equipment, in the same way as an electric wheelchair or mobility scooter.

Thanks Dewey these will be great for some deserving bicyclists.
I can imagine someone special thrilled by riding for the first time just by pushing the throttle with their right thumb.
Because it's all they could do.
I see several special bikes on craigslist in CT & MA

 

[scottsdalecommuter]

A tri-athlete around here says that there are some 'cheaters' who have bikes tuned to their heart rate. She says without proof that assist kicks in when the hart starts beating faster at some threshold. And that there is a worm gear in the downtube to the BB.

That was my first thought when I read this was a heart-rate sensor could do the trick, peg it at something like Maffetone method of 180-age-another 10 for recovering from heart situation (ie: 180-65-10=105 HR), interesting idea for sure.

 

[PedalUma]

I like to joke. The idea is great until someone hacks your Bluetooth!
It would be cool to have it with progressive assistance based on heart rate. You would also want to include cadence. So even with a high heart rate assistance drops as cadence drops. And assistance increases as cadence increases with a moderate heart rate on the curve. As you ask for it you get it. That would be a great physical therapy bike. And so much fun to ride.