The upper body ergometer – or as we usually call it the UBE or “arm bike” for short – has been causing a bit of a stir in the field of Occupational Therapy lately in various Facebook groups and other online forums.

Why, you may ask?

It’s because it isn’t exactly the most functional, meaningful, or occupation-based treatment we can provide for our patients. But many occupational therapists use it on a regular basis.

Using the UBE happens to be a treatment that can be (and is) grossly overused by therapists in many settings. And I’m not just talking about the therapists that just set their patient up so they can document and not give the patient an adequate treatment, which of course is highly unethical.

But there are also well-meaning therapists that think the arm bike is a beneficial and necessary intervention.

I totally get it.

We are all struggling with higher and higher productivity standards with more and more documentation to get done.

Let’s remember that we should be focusing on what the patient actually needs to work on versus what is convenient for us.

And while many therapists do use the arm bike as a biomechanical approach, many current occupational therapy programs are veering away from this and encouraging practitioners to focus almost solely on occupation-based treatments to stay true to our field.

I believe sticking to occupation-based and functional interventions is really important, but it’s also not easy sticking to only occupation-based treatments when we are given an hour and a half a day, five days a week, with a patient that only takes an hour to do all of their self-care tasks.

When the UBE May Actually Be Beneficial

That being said, there are times when I do believe the UBE can be beneficial for patients.

For instance, many of our patients are very deconditioned, are recovering from a cardiac surgery or episode, or have decreased ROM in one or both upper extremities from a variety of illnesses or ailments.

In these cases, I may have a patient perform high intensity intervals on the UBE where they are actually benefiting cardiovascular-ly (is that even a word?) vs. just standing there pedaling away, having an easy conversation. (It’s useful to have the patient do the arm bike while in standing too to improve their tolerance.)

If an older adult is out of breath during bathing tasks, wouldn’t it benefit them to participate in at least a little bit of activity tolerance retraining in addition to their ADLs?

But here’s the thing that bugs me when I use the UBE: it’s not functional.

Is it beneficial? I think so, but is it something physical therapy should lean towards while we focus on occupations? It’s such a tough question. There just is not a clear-cut answer to that.

I will say that I do believe a lot therapists absolutely are overdoing it since it’s easy to just set the patient up and go do other tasks while still billing for time.

We Are Occupational Therapists, Not Personal Trainers

My opinion is the same for the NuStep, recumbent bike, and other various exercise equipment gyms may have.

I think we should gear our treatments towards function, as we are occupational therapists and not personal trainers.

Of course, if we are using our skilled expertise and see that it really will benefit as a preparatory method, don’t rule it out completely. As long as it isn’t just the result of being lazy coming up with functional ideas.

It’s of course up to your clinical judgement, but do think twice before you throw your patients on the UBE or NuStep day in and day out.

Lastly, please share your thoughts on this! Whether you agree or disagree, I want to start a conversation.

Post your thoughts in the comments below, as well as any functional alternatives you may have that has replaced the arm bike. (Reaching in closets or community re-entry, perhaps?)

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  • Kimberly Sudol March 24, 2018   Reply →

    I completely agree!! I have this discussion frequently with my COTA’s who use the UBE way too much and are not giving our patients the full care they deserve. Since I work both inpatient and in home health, I see the poor outcome this type of therapy yields. I have expressed the desire for our therapists to provide functional activities our patients will need to do at home combined with wrist weights to increase strength and endurance, ie. reaching into the closet to hang clothes up, static standing balance/activity tolerance while completing cognitive exercises or folding laundry, simulating going to get the mail at the end of the driveway, and doing simulated laundry tasks with wrist weights on (ie bending down to get laundry in/out of washer and dryer).

    • Sarah Stromsdorfer, OTR/L March 25, 2018   Reply →

      I love your occupation-based treatments! These are so important to be doing to maintain our distinct value in our current healthcare system, and I hope your colleagues are receptive to your treatment ideas. I’m hopeful that as OT schools are focusing more on the importance of occupation, that new grads will be utilizing this much more than the UBE and pegs. Thanks for your comment!

  • Adrian July 25, 2022   Reply →

    I always appreciate when OTs, especially experienced, challenge the norm of current practice. I’m a new grad and am always striving for occupation based, or at least functional, interventions. And I will admit that it is difficult with productivity standards and policy barriers (e.g. inability to individualize patients). However the occupation based interventions presented here have sparked my problem solving and creative mind again. Thank you for helping me see the bigger picture and reminding me of why I got into OT!

    • Sarah Stromsdorfer, OTR/L July 29, 2022   Reply →

      I’m so glad you’ve got your creativity wheels spinning! I know it’s hard when we’re pushed with so many demands as therapists.

  • Jill September 1, 2022   Reply →

    I am in my level 2s right now and have seen the arm bike use a few times. My educator is great at making things occupation based and functional. However I did ask about the arm bike. She says that it helps with a lot of COPD/ post COVID patients with endurance and with those who have physical activity goals. It also helps regain arm motion as a pre-cursor before grading up to other activities. I agree, but I had a professor who was very against the arm bike. I am still conflicted on my thoughts but loved reading yours!

    • Sarah Stromsdorfer, OTR/L October 1, 2022   Reply →

      The UBE can definitely be helpful in certain situations (COPD and other cardiopulmonary conditions, like you mentioned) but it can certainly be overused which is a lot of the “controversy” regarding it 🙂 I’m glad you enjoyed the article!

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