RESERACH & EVIDENCE

Latest research.

Stay up to date with the latest scientific findings and clinical evidence on our THERA-Trainer products. Learn how modern therapy concepts and proven outcomes support patient recovery and functional improvement.

CYCLING

Discover the latest research and clinical evidence behind our CYCLING products.

Clinical Evidence Summaries

Pazo-Palacios et al. (2025)

Effects of in-bed cycling in critically ill adults: A systematic review and meta-analysis of randomised clinical trials

Both functional improvements and positive economic effects (LOS) are evident

Design: Meta-analysis; assessments at baseline and post-intervention (ICU discharge, hospital discharge, or follow-up up to 6 months) | 32 Publications | 3052 Patients

Population: 3,052 adults (aged 18 and older)
in intensive care units across
32 randomized controlled trials in multiple countries

Intervention: Bed-based cycling (passive, actively assisted, or active), often combined with standard rehabilitation
(e.g., physical therapy, mobilization exercises); compared to rehabilitation alone or other control groups

Intensity: Various (meta-analysis)

Outcome: Length of hospital stay (LOS), number of studies: 14 (n = 1,189); duration of mechanical ventilation (MV), number of studies: 16 (without FES n = 1,024; with FES n = 474); functional status, number of studies: 5 (n = 400)

Open original publication

Radovanović V., et al. (2025)

The Significance of Robot-Assisted Therapy on the Recovery of Motor Function in Patients After Ischemic Stroke

Robot-assisted therapy (with TT tigo) combined with conventional rehabilitation significantly improved motor function recovery after ischemic stroke compared to conventional therapy alone. The experimental group showed markedly greater improvements in both upper and lower extremity function, supporting the effectiveness of robotic-assisted rehabilitation in stroke recovery.

Design: Prospective comparative study | 40 Patients

Population: 40 patients after ischemic stroke (mean age 66.8 ± 9.1 years; both sexes)

Intervention: Robot-assisted therapy (THERA-Trainer Tigo) combined with conventional rehabilitation vs. conventional rehabilitation alone

Intensity: Mean rehabilitation duration ~16 days; no significant difference in duration between groups

Outcome: Significant improvement in motor function (Fugl-Meyer scale) in both groups, with greater improvements in the experimental group:
Upper limb improvement: 11.35 vs. 4.35
Lower limb improvement: 6.8 vs. 2.55

Open original publication

Ahmad et al. (2024)

Effect of Adding Early Bedside Cycling to Inpatient Cardiac Rehabilitation after Heart Valve Surgery

Adding early bedside bicycle training to inpatient cardiac rehabilitation following heart valve surgery leads to significantly better outcomes

Design: RCT (parallel, single-center) | 31 Patients

Population: 31 patients following heart valve surgery (median sternotomy), aged 20–40 years; IM n=16, CM n=15

Intervention: Bed cycling with a mini-bike + standard rehab vs. rehab alone

Intensity: 2 days post-op until discharge; focus on early mobilization

Outcome: Improvement in 6MWD, Barthel Index, and FVC; shorter ICU and overall length of stay

Open original publication

Bethoux, F. (2024)

Intensive Aerobic Cycling Is Feasible and Elicits Improvements in Gait Velocity in Individuals With Multiple Sclerosis

High-intensity aerobic cycling, particularly using forced-rate (FE), is feasible for individuals with MS and resulted in measurable improvements in walking speed—from 0.61 to 0.68 m/s on average (p = 0.010). FE showed a greater increase (+0.09 m/s) than VE (+0.03 m/s), although the difference was not statistically significant (p = 0.17)

Design: Pilot study | 22 Patients

Population: 22 MS patients, EDSS 2.0–6.5 (moderate mobility impairment) FE group: n=12 VE group: n=10

Intervention: Forced-rate (FE) vs Voluntary (VE) Aerobic Cycling

Intensity: 12 weeks, 2×/week, 45 min each at 60–80% HRmax, mean HR 65 ± 7%, cadence 67 ± 13 RPM

Outcome: Improvement in gait speed (0.61 → 0.70 m/s); FE: +0.09 vs VE: +0.03 m/s

Open original publication

Brookman et al. (2024)

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

The exercise program featuring gamified indoor cycling in long-term care facilities demonstrated significant improvements in the physical, mental, and social health of older adults. The combination of exercise, competition, technology, and social interaction was particularly effective.

Design: Pilot study (mixed methods) | 32 Patients

Population: 32 nursing home residents; average age 83.1 years; 45% with dementia; 50% without a walking aid

Intervention: Multimodal indoor cycling with gamification and competition

Intensity: 26 participants – daily – cycling, audiovisual route, group interaction, competition

Outcome: Improvement in functional fitness, reduced depression, increased self-efficacy, enhanced social interaction

Open original publication

Rojo et al. (2024)

Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis

In this pilot RCT, both groups (with and without VR) showed short-term improvements in range of motion, particularly in active hip flexion and passive knee extension. The use of virtual reality did not result in additional functional benefits—but VR can serve as a motivational supplement.

Design: Pilot RCT (block randomized) | 20 Patients

Population: n = 20 adults with ataxia and hemiparesis; mean age 59.9 ± 13.6 years

Intervention: Cycling training with vs. without VR support

Intensity: 3 sessions/week for 1 week; each: 2×5 min pedaling at 4, 5, and 6 km/h, 2 min rest; VR use via Oculus Quest 2

Outcome: Improved active hip flexion, improved passive knee extension

Open original publication

Abe et al. (2023)

Leg Cycling Leads to Improvement of Spasticity by Enhancement of Presynaptic Inhibition in Patients with Cerebral Palsy

A single session of rhythmic leg cycling led to a significant improvement in spinal inhibition (D1 inhibition) and a reduction in spastic reflexes (H-reflex, Hₘₐₓ/H-M wave) in adults with cerebral palsy, accompanied by increased knee MAV (greater mobility). These findings suggest plastic changes in spinal inhibitory networks and demonstrate that even a single cycling session can reduce spasticity—through targeted modulation of presynaptic inhibition.

Design: Pre-post study | 14 Patients

Population: 14 patients with spastic cerebral palsy
Age: 19–45 years
Alter: 19–45 Jahre

Intervention: A single session of passive leg cycling on a stationary bike

Intensity: 30 min single-session therapeutic leg cycling (rhythmic)

Outcome: Reduction in spasticity via increased presynaptic inhibition (neurophysiologically measurable via H-reflex analysis)

Open original publication

Linder et al. (2023)

Increased Comfortable Gait Speed Is Associated With Improved Gait Biomechanics in Persons With Chronic Stroke Completing an 8-Week Forced‑Rate Aerobic Cycling Intervention

The 8-week forced-rate cycling program led to a significant increase in walking speed (+0.09 m/s) and a marked improvement in endurance performance (6MWT +53 m) in patients with chronic stroke. “Responders” who demonstrated clinically relevant progress—including improved gait kinematics and kinetics—benefited significantly from this.

Design: Before–after study (no control group) | 14 Patients

Population: N = 14 patients with chronic stroke (<6 months post-stroke) Age: not specified 60–80% of heart rate reserve

Intervention: Forced-Rate Aerobic Cycling (Exercise bike with preset cadence)

Intensity: 24 sessions (3×/week), 60–80% heart rate reserve; 50 min per session

Outcome: Gait speed increased from 0.61 to 0.70 m/s; 6-minute walk test (6MWT): 272 → 325 m; significant improvements in spatiotemporal parameters, ground reaction force, and power output in patients reaching MCID

Open original publication

Ringenbach et al. (2023)

Assisted Cycle Therapy (ACT) Improved Self‑Efficacy and Exercise Perception in Middle‑Age Adults with Down Syndrome

Motor-assisted cycling training (ACT) significantly improved both the confidence in one’s own movement abilities and the positive perception of the training in adults with Down syndrome, whereas voluntary cycling only increased self‑efficacy. The concept is particularly promising for a population with cognitive impairments, as motivation and self-assessment can be enhanced through external support.

Design: Quasi-randomized study | 24 Patients

Population: ACT: n=12, VC: n=10, NC: n=2, mean age ~59.9 ± 13.6; mean = 36.4 years, adults with Down syndrome

Intervention: Motor-assisted cycling training (ACT) vs. voluntary cycling (VC) vs. no intervention (NC)

Intensity: 3×/week for 8 weeks, 30 min, plus 30% higher cadence

Outcome: Improvement in self-efficacy after 8 weeks

Open original publication

Shinohara et al. (2023)

The Effect of In-Bed Leg Cycling Exercises on Muscle Strength in Patients With ICU-Acquired Weakness

Ergometer training in bed led to a significantly faster recovery from ICU-AW and markedly greater gains in strength, particularly in the legs. There were no significant differences in upper extremity and functional scores (FSS, FIM, grip strength).

Design: Retrospective (historically controlled) | 23 Patients

Population: Ergometer group: n = 23; ICU patients diagnosed with ICU-acquired weakness (ICU-AW); control group: n = 33 comparable ICU-AW patients; age/demographic data not specified.

Intervention: In-Bed Leg Cycling + Early Mobilization vs. Early Mobilization Alone

Intensity: 5×/week, 20 min in-bed leg cycling + 1 mobilization per day

Outcome: Recovery from ICU-acquired weakness at ICU discharge: 87% vs. 60.6%; efficiency of muscle strength gain (MRC sum): ergometer 1.0 [0.7–2.1] vs control 0.1 [0.0–0.2]; lower limb strength efficiency: ergometer 0.6 [0.3–0.9] vs control 0.1 [0.0–0.2]

Open original publication

Lin et al. (2022)

Effects of Lower Limb Cycling Training on Different Components of Force and Fatigue in Individuals With Parkinson’s Disease

Low-resistance cycling training over 8 weeks demonstrably led to improved muscle strength (MVC), better neural activation (VA), and stronger reflexes (twitch force) in the knee extensors among patients with Parkinson’s disease—all of which were statistically significant (p < 0.05). Of particular relevance is the marked improvement in central fatigue resilience (CFI)—a centrally controlled aspect—while peripheral fatigue values remained unchanged.

Design: Randomized controlled trial | 24 Patients

Population: 24 patients with idiopathic Parkinson’s disease (13 men, 11 women), mean age: 60.6 ± 8.2 years

Intervention: Low-intensity leg cycling workout

Intensity: 8 weeks, 2–3×/week (not exactly specified), low-resistance leg cycling

Outcome: Improvement in muscle strength (MVC, VA, twitch force); reduction in central fatigue; peripheral fatigue unchanged

Open original publication

Linder et al. (2022)

An 8‑week aerobic cycling intervention elicits improved gait velocity and biomechanics in persons with Parkinson’s disease

The 8-week moderate-to-vigorous aerobic cycling program resulted in a significant increase in walking speed (+0.14 m/s) among individuals with moderate Parkinson’s disease, while walking performance in the control group deteriorated. This improvement was accompanied by a normalization of walking biomechanics—better cadence, longer strides, and an improved stance phase.

Design: Randomized controlled trial | 28 Patients

Population: N = 28 with mild to moderate idiopathic Parkinson's disease (PD) Intervention group (PDex): n = 14, control group: n = 14 Mean age not specified†

Intervention: Aerobic stationary cycling

Intensity: 8 weeks, 3× per week, moderate-to-high intensity (60–80% heart rate reserve)

Outcome: Improvement in gait speed: +0.14 m/s (0.86 → 1.00 m/s) vs. decline in control group (0.91 → 0.80 m/s)

Open original publication

Vitacca et al. (2022)

In-Patient Trajectories and Effects of Training in Survivors of COVID-19–Associated Acute Respiratory Failure

This study shows that a tailored inpatient rehabilitation program incorporating a gradual introduction of cycle ergometer training in COVID-19 ARDS survivors improves both functional performance (SPPB) and significantly increases mobility levels—regardless of the initial performance level. The 6-minute walk test improved by up to 115 m with stable oxygen saturation. The training was feasible and effective during the rehabilitation stay.

Design: Retrospective cohort study | 123 Patients

Population: n = 123 COVID-19 survivors following ARDS
Age: not specified
SPPB stages at admission:
– Stage 1 (<6): 44 (35.8%)
– Stage 2 (6–9): 50 (40.6%)
– Stage 3 (≥10): 29 (23.6%)

Intervention: Inpatient rehabilitation with gradual increase in exercise intensity, including a cycle ergometer

Intensity: 1 rehabilitation stay; SPPB-based training: passive → gait exercises → strength/balance training → cycling

Outcome: 65.8% of patients improved their SPPB by at least the MCID; proportion in stage 3 increased from 23.6% to 56.9%; 6MWD improved by median 115 m (no desaturation) / 60 m (with desaturation)

Open original publication

Barclay et al. (2019)

The Effect of Cycling Using Active-Passive Trainers on Spasticity, Cardiovascular Fitness, Function and QoL in People with Moderate to Severe MS – A Feasibility Study

Active-passive cycling training (APT) was highly feasible and safe for sedentary MS patients with moderate to severe disability. All participants in the training group completed the program in full and demonstrated significant improvements in exercise performance, spasticity, endurance, function, and quality of life.

Design: Parallel-groups RCT (feasibility) | 24 Patients

Population: n = 24 hospitalized MS patients with moderate to severe disability (EDSS ≥ 6) IG = 15, CG = 9

Intervention: Active-Passive Trainer (APT) + Standard Rehabilitation vs. Standard Rehabilitation Alone

Intensity: 4 weeks, 5×/week, 30 min each (2 min passive – 26 min active – 2 min passive)

Outcome: 100% adherence, no adverse events; increases in speed, power, and distance during training

Open original publication

Rayegani et al. (2011)

The Effect of Electrical Passive Cycling on Spasticity in War Veterans with Spinal Cord Injury

Electric-assisted cycling resulted in significant improvements in patients with spinal cord injuries who had been wounded in combat

Design: Prospective controlled intervention study | 64 Patients

Population: n = 64 SCI patients (95% male), mean age ~43 years; lesion level: 17% cervical, 34% upper thoracic, 45% lower thoracic, 3% lumbar

Intervention: Electrically assisted passive leg cycling vs. no pedaling exercise

Intensity: Single or repeated sessions (not specified)

Outcome: Marked reduction in spasticity scale; improved passive ROM in hip, knee, and ankle; neurophysiological improvements (Hmax/M ratio, F/M ratio)

Open original publication

Fowler et al. (2010)

Pediatric Endurance and Limb Strengthening (PEDALS) Using Stationary Cycling – A Randomized Controlled Trial

The PEDALS cycling training program was safe, feasible, and clinically promising for ambulatory children with spastic cerebral palsy

Design: Phase I RCT (partially blinded) | 62 Patients

Population: 62 outpatients with spastic diplegia (CP) Age: 7–18 years GMFCS I–III

Intervention: Stationary bike training (PEDALS protocol: strength + endurance)

Intensity: 12 weeks, 30 sessions, strength and endurance training

Outcome: Improvement in 600-yard test performance; improvement in GMFM-D&E; improvement in knee extensor strength (at 120°/s)

Open original publication

Clinical Evidence by Indications

Cerebral palsy

Holmes, C., et al. (2025). Home-based motorised cycling in adults with cerebral palsy: A feasibility study. Open original publication

Abe et al. (2023). Leg Cycling Leads to Improvement of Spasticity by Enhancement of Presynaptic Inhibition in Patients with Cerebral Palsy. Open original publication

Fowler et al. (2010). Pediatric Endurance and Limb Strengthening (PEDALS) Using Stationary Cycling – A Randomized Controlled Trial. Open original publication

Down syndrome

Ringenbach et al. (2023). Assisted Cycle Therapy (ACT) Improved Self‑Efficacy and Exercise Perception in Middle‑Age Adults with Down Syndrome. Open original publication

Hemodialysis

Lai, Y., et al. (2025). Intradialytic Exercise: Effects on Arterial Stiffness and Gait Speed in Patients Undergoing Hemodialysis. Open original publication

Paglialonga, F., et al. (2014). Intradialytic cycling in children and young adults on chronic hemodialysis. Open original publication

Intensive care

Pazo-Palacios et al. (2025). Effects of in-bed cycling in critically ill adults: A systematic review and meta-analysis of randomised clinical trials. Open original publication

Wi, J., et al. (2024). Feasibility and safety of in-bed cycling/stepping in critically ill patients. Open original publication

Shinohara et al. (2023). The Effect of In-Bed Leg Cycling Exercises on Muscle Strength in Patients With ICU-Acquired Weakness. Open original publication

Newman, A. N. L., et al. (2021). CardiO Cycle: a pilot feasibility study of in-bed cycling in critically ill patients post cardiac surgery. Open original publication

Nickels, M., et al. (2020). Acceptability, safety, and feasibility of in-bed cycling with critically ill patients. Open original publication

Waldauf, P., et al. (2020). Effects of Rehabilitation Interventions on Clinical Outcomes in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials*.. Open original publication

Ringdal, M., et al. (2018). In-bed cycling in the ICU; patient safety and recollections with motivational effects. Open original publication

Choong, K., et al. (2015). In-bed mobilization in critically ill children: Safety & feasibility study. Open original publication

Camargo Pires-Neto, R., et al. (2013). Very early passive cycling in mechanically ventilated critically ill patients: Physiological and Safety aspects - A case series. Open original publication

Internistic Diseases

Kammerlander, A., et al. (2025). Effect of Eccentric Cycling on Oxygen Uptake and Hemodynamics in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Crossover Trial. Open original publication

Ahmad et al. (2024). Effect of Adding Early Bedside Cycling to Inpatient Cardiac Rehabilitation after Heart Valve Surgery. Open original publication

Karatzanos, E., et al. (2021). Acute Cardiorespiratory Responses to Different Exercise Modalities in Chronic Heart Failure Patients—A Pilot Study. Open original publication

Nakaya, Y., et al. (2021). Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial. Open original publication

Pymer, S. C., et al. (2021). Considering the Feasibility, Tolerability, and Safety of High-Intensity Interval Training as a Novel Treatment for Patients With Intermittent Claudication. Open original publication

Multiple sclerosis

Bethoux, F. (2024). Intensive Aerobic Cycling Is Feasible and Elicits Improvements in Gait Velocity in Individuals With Multiple Sclerosis. Open original publication

Barclay et al. (2019). The Effect of Cycling Using Active-Passive Trainers on Spasticity, Cardiovascular Fitness, Function and QoL in People with Moderate to Severe MS – A Feasibility Study. Open original publication

Barclay, R. L., et al. (2019). The effect of cycling using active-passive trainers on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe Multiple Sclerosis: a feasibility study. Open original publication

Szecsi, J., et al. (2009). Functional electrical stimulation-assisted cycling of patients with multiple sclerosis. Open original publication

Neurological diseases

Rojo et al. (2024). Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis. Open original publication

Rabelo, M. et al. (2018). Overview of FES-Assisted Cycling Approaches and Their Benefits. Open original publication

Older adults

Brookman et al. (2024). Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care. Open original publication

Orthopedic Diseases

Philp, F., et al. (2022). A pilot study of a single intermittent arm cycling exercise programme on people affected by Facioscapulohumeral dystrophy (FSHD). Open original publication

Sanzo, R., et al. (2021). The effects of exercise and active assisted cycle ergometry in post-operative total knee arthroplasty patients - a randomized controlled trial. Open original publication

Wainwright, T., et al. (2020). A cycling and education intervention for the treatment of hip osteoarthritis. Open original publication

Keogh, J. W., et al. (2018). Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial. Open original publication

Parkinson’s disease

Palmieri, J., et al. (2024). Bicycling for Rehabilitation of Persons With Parkinson Disease. Open original publication

Lin et al. (2022). Effects of Lower Limb Cycling Training on Different Components of Force and Fatigue in Individuals With Parkinson’s Disease. Open original publication

Linder et al. (2022). An 8‑week aerobic cycling intervention elicits improved gait velocity and biomechanics in persons with Parkinson’s disease. Open original publication

Tiihonen, M., et al. (2021). Parkinson's disease patients benefit from bicycling. Open original publication

Segura, C., et al. (2020). Effect of a High-Intensity Tandem Bicycle Exercise Program on Clinical Severity, Functional Magnetic Resonance Imaging, and Plasma Biomarkers in Parkinson's Disease. Open original publication

Tiihonen, M., et al. (2019). Parkinson’s disease patients benefit from bicycling - a systematic review and meta-analysis. Open original publication

Ridgel, A. L., et al. (2015). Dynamic high-cadence cycling improves motor symptoms in Parkinson’s disease. Open original publication

Post-Covid

Vitacca et al. (2022). In-Patient Trajectories and Effects of Training in Survivors of COVID-19–Associated Acute Respiratory Failure. Open original publication

Spinal cord injury

Dionne, J., et al. (2023). Safety and Feasibility of Early Activity-Based Therapy Following Severe Traumatic Spinal Cord Injury: Results from a Single-Arm Pilot Trial. Open original publication

Phadke, C. P., et al. (2018). Impact of passive leg cycling in persons with spinal cord injury: A systematic review. Open original publication

Galea, M. P., et al. (2017). SCIPA Switch-On: A Randomized Controlled Trial Investigating the Efficacy and Safety of Functional Electrical Stimulation–Assisted Cycling and Passive Cycling Initiated Early After Traumatic Spinal Cord Injury. Open original publication

Nardone, A., et al. (2017). Passive cycling in neurorehabilitation after spinal cord injury. Open original publication

Nardone, R., et al. (2016). Effects of passive pedaling exercise on intracortical inhibition in humans with spinal cord injury. Open original publication

Rayegani et al. (2011). The Effect of Electrical Passive Cycling on Spasticity in War Veterans with Spinal Cord Injury. Open original publication

Rayegani, S. M., et al. (2011). The Effect of Electrical Passive Cycling on Spasticity in War Veterans with SCI. Open original publication

Kakebeeke, T. H., et al. (2005). The effect of passive cycling movements on spasticity after spinal cord injury. Open original publication

Stroke

Radovanović V., et al. (2025). The Significance of Robot-Assisted Therapy on the Recovery of Motor Function in Patients After Ischemic Stroke. Open original publication

Romanova E., et al. (2025). Functional Recovery in Patients with Atrial Fibrillation and Diabetes Mellitus Following Early Post-Stroke Rehabilitation. Open original publication

Linder, S., et al. (2024). The utilization of forced-rate cycling to facilitate motor recovery following stroke. Open original publication

Linder et al. (2023). Increased Comfortable Gait Speed Is Associated With Improved Gait Biomechanics in Persons With Chronic Stroke Completing an 8-Week Forced‑Rate Aerobic Cycling Intervention. Open original publication

Holzapfel, S. G., et al. (2019). Acute effects of assisted cycling therapy on post-stroke motor function. Open original publication

Vanroy, C., et al. (2017). Effectiveness of Active Cycling in Subacute Stroke: A Randomized Controlled Trial. Open original publication

Peri, A., et al. (2016). Can FES-Augmented Active Cycling Training Improve Motor Recovery in Stroke Patients?. Open original publication

Bauer, P., et al. (2015). Functional electrical stimulation-assisted active cycling—Therapeutic effects in patients with hemiparesis from 7 days to 6 months after stroke: A randomized controlled pilot study. Open original publication

Various Diseases

Jansen, M., et al. (2013). Assisted Bicycle Training Delays Functional Deterioration in Boys With Duchenne Muscular Dystrophy: The Randomized Controlled Trial “No Use Is Disuse”. Open original publication

STADING & BALANCING

Discover the latest research and clinical evidence behind our STADING & BALANCING products.

Clinical Evidence Summaries

Jäggi, S. M., et al. (2023)

Feasibility and effects of cognitive-motor exergames on fall risk factors in typical and atypical Parkinson’s inpatients: A randomized controlled pilot study

The use of cognitive-motor exergames is safe, easy to implement, and shows promising effects on cognitive and motor functions in Parkinson’s patients undergoing inpatient rehabilitation.

Design: Randomized controlled pilot study | 40 Patients

Population: 40 Parkinson patients (72.4 ± 9.54 years)

Intervention: Cognitive-motor exergames in addition to conventional rehabilitation

Intensity: 5x per week, Training intervention within inpatient rehabilitation; duration approx. 4 weeks

Outcome: 97% adherence; no adverse events; significant improvements in cognitive tests (Go/No-Go, reaction time, D-KEFS) and motor functions (5x sit-to-stand, SPPB)

Open original publication

Ordahan, B., et al. (2015)

Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study

The additional training with the balance trainer leads to greater improvements in balance and mobility in stroke patients compared to conventional rehabilitation alone, while no significant difference is observed in the level of independence in daily activities.

Design: Randomized controlled trial (RCT) | 40 Patients

Population: 50 stroke patients (hemiplegia, mean age 57 years)

Intervention: Balance‑trainer training in addition to conventional rehabilitation vs. conventional rehabilitation only

Intensity: 30 sessions of 20 minutes each, 5×/week, 6 weeks

Outcome: Significantly greater improvements in balance and mobility in the intervention group

Open original publication

Clinical Evidence by Indications

Balance Disorders

Haksever, B., et al. (2021). The Dynamic Innovative Balance System Improves Balance Ability: A Single-blind RCT. Open original publication

Swanenburg, J., et al. (2020). Exergaming With Integrated Head Turn Tasks Improves Compensatory Saccade Pattern in Some Patients With Chronic Peripheral Unilateral Vestibular Hypofunction. Open original publication

Dementia

Swinnen, N., et al. (2021). The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial. Open original publication

Geriatric Rehabilitation

Altorfer, A., et al. (2021). Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study. Open original publication

Roh, C., et al. (2021). Efficacy of an Integrated Training Device in Improving Muscle Strength and Balance. Open original publication

Multiple sclerosis

Schättin, A., et al. (2021). Design and Evaluation of User-Centered Exergames for Patients with Multiple Sclerosis: Multilevel Usability and Feasibility Studies. Open original publication

Neurological diseases

Thera-Trainer Team, et al. (2023). Avoiding falls through balance training (THERA-Trainer). Open original publication

Chan, K., et al. (2021). Effects of exergaming on functional outcomes in people with chronic stroke: A systematic review and meta‐analysis. Open original publication

Older adults

Manser, P., et al. (2024). Exergame training to improve cognitive and physical function in older adults: a randomized controlled trial. Open original publication

Seinsche, J., et al. (2023). Older adults' needs and requirements for a comprehensive exergame-based telerehabilitation system: A focus group study. Open original publication

Uematsu, A., et al. (2023). Effects of 8 weeks of exergaming on dual-task gait and cognition in healthy older adults. Open original publication

Hou, H., et al. (2022). Effect of Cognition and Dual-Task Training on Older Adults' Cognitive and Motor Function. Open original publication

Hou, H., et al. (2022). The effects of exergame training on physical and cognitive functions in older adults: A randomized controlled trial. Open original publication

Jiang, J., et al. (2022). Effects of exergames on executive functions, cognitive and motor functions in older adults: a systematic review. Open original publication

Bakker, J., et al. (2020). Balance training monitoring and individual response during unstable vs. stable balance Exergaming in elderly adults: Findings from a randomized controlled trial. Open original publication

Palmgren, A., et al. (2020). Effectiveness of evidence-based balance training transferred into clinical setting. Open original publication

de Bruin, E. D., et al. (2019). Playing Exergames Facilitates Central Drive to the Ankle Dorsiflexors During Gait in Older Adults; a Quasi-Experimental Investigation. Open original publication

Maillot, P., et al. (2019). Effects of exergame training on cognitive and physical functions in healthy older adults. Open original publication

Morat, M., et al. (2019). Effects of Stepping Exergames Under Stable Versus Unstable Conditions on Balance and Strength in Healthy Community-Dwelling Older Adults: A Three-Armed Randomized Controlled Trial. Open original publication

Rebsamen, S., et al. (2019). Exergame-Driven High-Intensity Interval Training in Untrained Community-Dwelling Older Adults: A Formative One-Group Quasi-Experimental Feasibility Trial. Open original publication

Swanenburg, J., et al. (2018). Exergaming in a Moving Virtual World to Train Vestibular Functions and Gait: A Proof-of-Concept-Study with Older Adults. Open original publication

Schättin, S., et al. (2016). Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized Controlled Study. Open original publication

Lesinski, M., et al. (2015). A Systematic Review and Meta-analysis: Effectiveness of Balance Training for Older Adults. Open original publication

Parkinson’s disease

Jäggi, S. M., et al. (2023). Feasibility and effects of cognitive-motor exergames on fall risk factors in typical and atypical Parkinson’s inpatients: A randomized controlled pilot study. Open original publication

Stroke

Evers, J., et al. (2024). Neuroathletic training in stroke rehabilitation: A single-blind randomized controlled trial. Open original publication

Huber S., et al. (2021). Personalized Motor-Cognitive Exergame Training in Chronic Stroke Patients: A Feasibility Study. Open original publication

Ordahan, B., et al. (2015). Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study. Open original publication

Lee, M., et al. (1996). Clinical evaluation of a new biofeedback standing balance training device. Open original publication

GAIT

Discover the latest research and clinical evidence behind our GAIT products.

Clinical Evidence Summaries

Kim, Y., et al (2024)

Identifying optimal candidates and interventions in physical therapy and exoskeletal and end-effector robot-assisted gait training for balance, gait, and cognition: A longitudinal study of 190 patients with stroke

Robot-assisted gait rehabilitation, particularly using end-effector systems, can significantly improve balance, gait ability, and cognitive function in stroke patients. The study identified patient groups that are most likely to benefit from specific types of robotic therapy in order to optimize rehabilitation

Design: Long-term observation (over several months), individualized treatment plan balancing robot-assisted training and conventional therapy | 190 Patients

Population: 190 stroke patients

Intervention: Physical therapy, supplemented by robot-assisted gait therapy using exoskeleton or end-effector devices

Intensity: a personalized balance between robot-assisted training and conventional therapy

Outcome: The subgroup that underwent end-effector-based training showed significantly greater improvements in balance, walking speed, and cognitive function; exoskeleton-based therapy also had a positive effect, but end-effector training was more effective

Open original publication

Lee, D., et al. (2024)

Robot-Assisted Gait Training in Individuals With Spinal Cord Injury: A Meta-analysis

Robot-assisted gait training significantly improves walking ability, muscle strength, and activities of daily living in patients with spinal cord injuries. Subacute patients and longer intervention periods (>2 months) show greater benefits.

Design: Meta-analysis | 23 Publications

Population: 690 patients with spinal cord injuries

Intervention: Robot-assisted gait training (RAGT) using various types of robots (end-effectors, exoskeletons, wearable robots)

Intensity: Variable duration, often longer than 2 months; 5 treatments per week

Outcome: Significant improvements in activities of daily living
Significant improvements in muscle strength and walking distance

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Lee, D., et al. (2023)

End-effector lower limb robot-assisted gait training effects in subacute stroke patients: A randomized controlled pilot trial

The combination of end-effector-based robot-assisted gait therapy and conventional physical therapy significantly improves walking ability in subacute stroke patients more effectively than conventional therapy alone.

Design: Randomized controlled pilot study | 49 Patients

Population: 49 patients with subacute stroke

Intervention: 30 minutes of end-effector training + 1.5 hours of conventional physical therapy vs. 2 hours of conventional physical therapy

Intensity: 5 treatments per week over 4 weeks

Outcome: Significant improvements were observed in all measured parameters in both groups; the robot group showed a significantly greater improvement in walking ability

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Bruni, V., et al. (2018)

What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis

Robot-assisted gait rehabilitation for stroke patients shows significant overall improvements in walking ability, although no clear advantage of any particular type of device has been identified.

Design: Meta-analysis | 13 Publications

Population: 1144 stroke patients

Intervention: Robot-assisted gait rehabilitation (e.g., exoskeletons, end-effector devices)

Outcome: Significant improvements on ≥3 functional assessment tests (e.g., Functional Ambulation Categories, FAC); minimal differences between devices; positive effects on walking ability and muscle strength

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Mazzoleni, S., et al. (2017)

Robot-assisted end-effector-based gait training in chronic stroke patients: A multicentric uncontrolled observational retrospective clinical study

Robot-assisted end-effector-based gait training demonstrates significant motor improvements in patients with chronic stroke and can be effective as a standalone form of rehabilitation.

Design: Uncontrolled retrospective observational study | 100 Patients

Population: 100 patients with chronic stroke

Intervention: Robot-assisted end-effector gait training as the sole rehabilitation intervention

Intensity: Training over several weeks

Outcome: Significant improvements in overall motor performance, walking endurance, balance, coordination, muscle strength, and spasticity; groups with mild and more severe walking impairments benefited

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Hesse, S. (2013)

Evidence of end-effector based gait machines in gait rehabilitation after CNS lesion

End-effector-based gait trainers lead to a significantly higher rate of regaining the ability to walk independently in stroke patients than conventional physical therapy alone.

Design: Meta-analysis | 568 Patients

Population: 568 stroke patients from 9 RCTs; some with other CNS lesions (case reports only)

Intervention: End-effector-based gait training (especially GT I) + physical therapy vs. physical therapy alone

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Mehrholz, J., et al. (2012)

Electromechanical-assisted gait training after stroke: A systematic review comparing end-effector and exoskeleton devices

Electromechanically assisted gait rehabilitation following a stroke improves walking ability. In this review, end-effector devices showed advantages over exoskeletons in terms of achieving independent walking.

Design: Meta-analysis | 18 Publications

Population: 885 stroke patients from 18 RCTs; mean age and functional status varied

Outcome: End-effector devices led to a significantly higher rate of regaining the ability to walk independently compared to exoskeleton systems (p = 0.03).

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Clinical Evidence by Indications

Cerebral palsy

Choi, S., et al. (2024). Overground Gait Training With a Wearable Robot in Children With Cerebral Palsy. Open original publication

Multiple sclerosis

Asirelli, P., et al. (2024). Can robotic gait training with end effectors improve lower-limb functions in patients affected by multiple sclerosis? Results from a retrospective case–control …. Open original publication

Neurological diseases

Hotz, V. J., et al. (2024). Robot-assisted gait training in patients with various neurological diseases. Open original publication

Hotz, V. J., et al. (2024). Robot-assisted gait training in patients with various neurological diseases: Mixed-methods feasibility study. Open original publication

Hesse, S. (2013). Evidence of end-effector based gait machines in gait rehabilitation after CNS lesion. Open original publication

Spinal cord injury

Lee, D., et al. (2024). Robot-Assisted Gait Training in Individuals With Spinal Cord Injury: A Meta-analysis. Open original publication

Kim, J., et al. (2021). Effects on the Motor Function, Proprioception, Balance, and Gait Ability of the End-Effector Robot-Assisted Gait Training for Spinal Cord Injury Patients. Open original publication

Shin, J., et al. (2021). Effects of end-effector robot-assisted gait training on gait and balance in spinal cord injury patients. Open original publication

Stroke

Bonanno, L., et al. (2025). May Patients with Chronic Stroke Benefit from Robotic Gait Training?. Open original publication

Unverricht, P., et al. (2025). The Feasibility and Therapeutic Effect of Hybrid End-effector Robot-Assisted Gait Training. Open original publication

Chen, S., et al 2024 (2024). How robot-assisted gait training affects gait ability, balance and quality of life after stroke: A systematic review. Open original publication

Kim, Y., et al (2024). Identifying optimal candidates and interventions in physical therapy and exoskeletal and end-effector robot-assisted gait training for balance, gait, and cognition: A longitudinal study of 190 patients with stroke. Open original publication

Lee, D., et al. (2023). End-effector lower limb robot-assisted gait training effects in subacute stroke patients: A randomized controlled pilot trial. Open original publication

Kim, J., et al. (2020). Neuroplastic effects of end-effector robotic gait training for hemiparetic stroke: a randomised controlled trial. Open original publication

Marensi, E., et al. (2020). Effectiveness of Intervention Based on End-effector Gait Trainer in Older Patients With Stroke: A Systematic Review. Open original publication

Aprile, I., Iacovelli, C., Goffredo, M., Cruciani, A., Galli, M., Simbolotti, C., ... & Franceschini, M. (2019). Efficacy of end-effector Robot-Assisted Gait Training in subacute stroke patients. Open original publication

Goffredo, M., et al. (2019). Stroke Gait Rehabilitation: A Comparison of End-Effector, Overground Exoskeleton, and Conventional Gait Training. Open original publication

Bruni, V., et al. (2018). What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis. Open original publication

Mazzoleni, S., et al. (2017). Robot-assisted end-effector-based gait training in chronic stroke patients: A multicentric uncontrolled observational retrospective clinical study. Open original publication

Mehrholz, J., et al. (2012). Electromechanical-assisted gait training after stroke: A systematic review comparing end-effector and exoskeleton devices. Open original publication