Cycle your way out of hospital: In-bed cycling for critically ill patients found to reduce intensive care stays and improve physical function

As the old Victorian proverb goes (sort of), a bike ride a day keeps the doctor away. And the clear health benefits of cycling – as long as you don’t get hit by a driver – have certainly been proven over the years.

Last year, doctors and health workers were given the green light to prescribe cycling to patients to improve their physical and mental health, as part of a £13.9 million trial, while in July, research published in the British Medical Journal found that those who cycled to work were associated with a 24 per cent lower risk of hospital admission for cardiovascular disease, and a 47 per cent lower risk of death.

And it turns out that cycling won’t just help you stave off a prolonged hospital stay – it can also ensure, if you do end up ill and needing treatment, that you can get home quicker too.

A new review undertaken by researchers in Canada has discovered that specialised in-bed cycling therapy, when used in the intensive care unit with critically ill patients, leads to better physical function and shorter stays in hospital.

> Cycling your commute can lower risk of death by 47%, as long as you aren't hit by a driver

The research, titled ‘Leg Cycle Ergometry in Critically Ill Patients’ and published in NEJM Evidence this week, was carried out by a research team at McMaster University and St Joseph’s Healthcare in Hamilton, Ontario, led by recent rehabilitation science PhD graduate Heather O’Grady, and involved the assessment of data from 33 rehabilitation trials in 13 countries.

Analysing the hospital stays and recovery times of over 3,200 critically ill adults who were admitted to an intensive care unit for more than 24 hours, the researchers compared those patients who were subject to early in-bed cycle ergometry – the use of a recumbent bicycle which can be deployed when a patient is bed-bound, mechanically ventilated, and sedated – as a rehabilitation strategy and intervention, and those who weren’t.

The review found that, on average, patients who use cycle ergometry spent one day fewer in the intensive care unit compared to those who didn’t cycle, and around 1.5 days fewer in the hospital in general.

> NHS trial to prescribe cycling to patients to improve physical and mental health receives increased funding

Building on a previous study by Michelle Kho, an associate professor at McMaster’s School of Rehabilitation Science, who first highlighted the benefits of early in-bed cycling for mechanically ventilated patients, the researchers also concluded that cycling could improve physical function in patients at the time of both ICU and hospital discharge.

The review also showed that adverse events during cycling rehabilitation are uncommon and occurred in only one per cent of those who took part, compared to two per cent in the non-cycling pool, while there were also 12 fewer deaths per 1,000 in the cycling sample, suggesting in-bed cycling has no effect on ICU mortality.

“This research is a major win for patients and their families,” lead author O’Grady said following the research’s publication. “This analysis shows that cycling as part of rehabilitation in the ICU can decrease ICU and overall hospital length of stay, is safe, and perhaps most importantly for patients, leads to better physical function post-ICU discharge.”

In 2021, prosthetics expert Jim Ashworth-Beaumont, who lost his right arm and suffered massive internal injuries after being struck by an articulated lorry driver while training on his bike, told us of his own use of in-bed cycling during his painstaking recovery.

> How a prosthetics doctor who lost his arm after being hit by a lorry driver got back on the bike

Ashworth-Beaumont went out for what should have been a quick afternoon training ride in southeast London on 21 July 2020, but shortly after setting off ended up under the wheels of an articulated lorry, in a collision that cost him his right arm and meant he spent the next five weeks in a coma.

“I do remember everything about the accident,” Jim, who has spent over two decades working as a prosthetist for the NHS, told us eight months on from the collision.

“I remember getting pushed by the lorry, holding on to the lorry, flipping underneath the vehicle. The lorry turned right but the articulation turned left, and that’s what pushed me. I ended up under the wheels and got crushed. I remember the wheels of the truck rolling up my arm, and had accepted I was going to die, basically.

“It took me a couple of weeks until I came out of my coma to realise how bad things were. My liver and my kidneys were screwed because they got crushed as well, there was a lot going on.”

Being fed through tubes while he was in the coma left Jim’s body emaciated and extremely weak. As a talented triathlete who has competed internationally at age-group level, it’s something he found particularly difficult to come to terms with.

“I went to sleep a super-fit guy, and woke up as a skeleton,” he said. “That was the really hard thing to take, I had no physical ability whatsoever.

“My wife brought me a laptop, I couldn’t open the bloody lid. I couldn’t pick up a pen for a week. That was the really hard thing to come to terms with really, not so much the bits that I’d lost but that I had no physical ability.

“But I’ve improved a hell of a lot. My liver’s improving, my kidneys have improved to the point where I’m not on dialysis anymore, and my leg’s sorting itself out. Short of regrowing an arm I’m actually doing pretty good.”

The video above shows some of the earlier steps of Jim’s lengthy recovery process, including (around 3:15 into the video) using an in-bed cycling technique, which he credited with helping him mentally, as well as physically.

“I was doing 20-mile cycles flat on my back because it’s something I could do. That’s another aspect of cycling that saved me, having access to that,” he said.

“I’m stronger as a cyclist now than I ever have been because I’ve never focused on the bike. This time round it’s all been about building up the strength and co-ordination.

“I’ve also been working with a private physio twice a week and we do a lot of Wattbike stuff. It’s been really, really good, sprint sessions and high intensity training. Although I’m a runner, the cycling has really accelerated my recovery I think.

“I’m not a massive guy, and even when I had the arm I was around 59kg. Now I’m about 54. I don’t produce a lot of watts, I can probably maintain around 150 for my functional threshold power. My stamina has improved a lot as well.

“Obviously you have to look for the positives in life. I think I’ve broadened my curriculum of fitness activities which is a positive.”