BMC Geriatrics · Oct 19, 2026
Outdoor cycling competence and balance control in older adults – cross-sectional analysis of the BiPerAge trial
By Rogler J, Krumpoch S, Freiberger E et al.
Background: Although cycling offers numerous health benefits, age-related functional decline can increase the risk of accidents. Identifying balance components linked to outdoor cycling competence could inform targeted assessment and training. We aimed to exploratorily investigate the association between outdoor cycling competence and static, dynamic, and reactive balance control in older adults. Methods: In this exploratory cross-sectional analysis of baseline data from a two-center randomized controlled trial, 116 community-dwelling adults aged ≥ 65 years with ≥ 3 errors on a standardized outdoor cycling course completed a balance test battery: Short Physical Performance Battery (SPPB), including gait speed, Modified Balance Error Scoring System (MBESS) and Four Square Step Test (FSST). Cycling-specific trunk balance was assessed with the Perturbation Stationary Bicycle Robotics (PerStBiRo) system, which delivers unannounced angular-tilt perturbations during stationary cycling. We derived mediolateral (ML) trunk sway during unperturbed cycling (UPC) and trunk time-to-peak angle (s) and trunk sway (°) during perturbed cycling (PC). Spearman correlations and multivariable models adjusted for age, sex and country were used to examine associations with the number of errors in the standardized outdoor cycling course. Results: Participants (mean age 74.0 ± 5.4 years; 53% women) made 13.1 ± 8.0 errors on the outdoor cycling course. In bivariate analyses, more outdoor cycling errors were weakly associated with more total errors on the MBESS (r s = 0.213, p = 0.022), slower gait speed (r s = -0.203, p = 0.029), greater ML trunk sway during UPC (r s = 0.246, p = 0.009), shorter trunk time-to-peak angle (r s = -0.289, p = 0.002) and lower trunk sway in PC (r s = -0.295, p = 0.002). In multivariable analyses, longer FSST time (B = 1.28 [95% CI 0.39, 2.17], p = 0.005) and greater trunk sway during UPC (B = 2.68 [0.60, 4.77], p = 0.012) were independently associated with more cycling errors. Conclusions: This study shows weak associations between outdoor cycling competence and dynamic balance control during both UPC and FSST. Low trunk sway during UPC on the PerStBiRo is weakly associated with better outdoor cycling competence. These findings could be further evaluated in future studies aiming to improve outdoor cycling competence. Trial registration: This is a retrospective analysis of BiPerAge study data registered at clinicaltrials.gov: NCT06453473 (initial submission: 11/06/2024), link: https://clinicaltrials.gov/study/NCT06453473 .