Anatomical Concepts (UK)
Masters of Rehabilitation Engineering


Opinions, Ideas & News from Anatomical Concepts

Bike Labyrinth and Combating Dementia

Exercise is often proposed as a safe intervention to delay cognitive decline in people with dementia. This is backed by research and doesn’t involve taking medication. Some researchers suggest that the evidence for exercise alone is still inconclusive and have proposed that combining physical exercise with cognitive stimulation may be more successful in this respect.

The increasing prevalence of dementia greatly impacts healthcare and society, stressing the need for global action. Since there is no cure or effective disease-modifying drug to treat the most common types of dementia to date, research should also focus on the development and implementation of non-pharmacological interventions as an alternative or add-on therapy

Exergaming with Bike Labyrinth is an intervention in which physical exercise is combined with cognitive stimulation in a single task. A recent randomised controlled study deployed Bike Labyrinth with a group of older adults with dementia and compared exergame training, aerobic training and an active control intervention consisting of relaxation and flexibility exercises.

Interactive cycle routes stimulate cognition as well as providing exercise

Interactive cycle routes stimulate cognition as well as providing exercise

Individuals with dementia were randomized to the three arms of the study and individually trained three times a week during 12 weeks. Cognitive functioning was measured at baseline, after the 12-week intervention period and at 24-week follow-up by neuropsychological assessment.

The domains of executive function, episodic memory, working memory and psychomotor speed were evaluated. Test scores were converted into standardized z-scores that were averaged per domain. Between-group differences were analysed with analysis of covariance.

Data from 115 people with dementia (mean (SD) age = 79.2 (6.9) years; mean (SD) MMSE score = 22.9 (3.4)) were analysed. There was a significant improvement in psychomotor speed in the aerobic and exergame groups compared to the active control group (mean difference domain score (95% CI) aerobic versus control 0.370 (0.103–0.637), p = 0.007; exergame versus control 0.326 (0.081–0.571), p = 0.009).

The effect size was moderate (partial η2 = 0.102).

No significant differences between the intervention and control groups were found for executive functioning, episodic memory and working memory.

The study found that both exergame training and aerobic training improve psychomotor speed, compared to an active control group. This finding may be clinically relevant as psychomotor speed is an important predictor for functional decline.

Bike Labyrinth provides exergame stimulation in the form of interactive cycle routes. The user is immersed in a virtual environment consisting of hundreds of cycle routes recorded at sites around the world or even in the users local area. As the user pedals they are moved through the environment to experience the sights and sounds of the location. This system is a popular add-on for our RehaMove FES Cycling clients but has a particularly strong niche with older clients with dementia.


“The quest for synergy between physical exercise and cognitive stimulation via exergaming in people with dementia: a randomized controlled trial”

Esther G. A. Karssemeijer, Justine A. Aaronson, Willem J. R. Bossers, Rogier Donders, Marcel G. M. Olde Rikkert and Roy P. C. Kessels,

in Alzheimer’s Research and Therapy, (2019) 11:3.