Positive skill transfer in balance and speed control from balance bike to pedal bike in adults: A multiphase intervention study

Gary C C Chow; Sophia C W Ha

doi:10.1371/journal.pone.0298142

. 2024 Feb 29;19(2):e0298142. doi: 10.1371/journal.pone.0298142

Positive skill transfer in balance and speed control from balance bike to pedal bike in adults: A multiphase intervention study

Gary C C Chow ^1,^*, Sophia C W Ha ^1,²

Editor: Bojan Masanovic³

PMCID: PMC10903920 PMID: 38422110

Abstract

Background

Learning to cycle can be challenging for adults who did not acquire the necessary skills during childhood. Balance bikes have been used to teach children how to cycle, but it was unclear whether this approach could also be effective for adults.

Purpose

To address this, a multi-phase intervention study was conducted to investigate whether healthy adults could be taught to cycle independently through the use of a balance bike.

Methods

In Phase 1, a case-control observational study was conducted in which 13 cyclists and 8 non-cyclists completed balance bike tests. Based on the findings, an 8-session intervention pre- and post-test study was conducted in Phase 2, using an 8 × 20-minute balance bike training programme to improve cycling postural stability and control. Another 11 non-cyclists completed the novel programme. The time taken to complete the balance bike tests was compared before and after the program, while their cycling confidence was recorded in each session. To assess the effectiveness of the programme, participants were invited to cycle on a pedal bike to evaluate their ability to cycle independently.

Results

The results in Phase 1 showed that cyclists performed better on the balance bike than non-cyclists, with Bayes factor analyses providing evidence of this difference, BF₀₁ = 0.228 in the 15 m sprint test and BF₀₁ = 0.138 in the two-turn curved sprint test. The novel training programme in Phase 2 demonstrated remarkable effectiveness in improving their balance bike riding performance, as evidenced by the Bayes factor for completion times in the repeated measures being BF₀₁ < 0.001. All participants were able to cycle independently with confidence after the programme.

Conclusions

This study sheds light on the idea that it’s never too late for adults to learn how to ride a bike. It provides evidence that healthy adults can learn to ride independently with the help of a balance bike, a tool that’s commonly used for teaching children. The study identifies five key principles for effective balance bike training in adults, including focusing on riding speed, gliding to turn, building cycling confidence, engaging high motor skills, and using a dual-task approach. Our evidence-based training programme offers a safe, enjoyable, and effective way for adults to develop the skills and confidence they need to ride, even if they’ve never ridden before.

1. Introduction

Cycling is one of the most popular modes of physical activity for active transportation or leisure purposes around the world. An international study found a large increase in government support for expanding the bikeway network among 14 large bicycle-friendly cities in Europe and North America [1] to deal with the pandemic. Many cities replaced the space of motor vehicles with bike lanes for bicycles, including Paris, Berlin, and London. As a result, a healthier mode of transportation, which reduces pollution and protects citizens from viruses, was created. However, recent data noticed that an average of 9.7% of the total population in 10 countries do not know how to cycle [2].

Learning to cycle independently is a common rite of passage for children. In recent years, the average age for achieving this milestone has decreased. Children born between 2000–2019 now learn to cycle independently at an average age of 5.22 y, compared to 5.68 y for those born between 1980–1999 and 6.21 y for those born between 1960–1979 [2]. This trend can be attributed to the increasing availability of dedicated cycling tracks and child-size-friendly bicycles, which make it easier for children to learn at an earlier age. However, many individuals who struggle to cycle independently as adults often trace their difficulties back to ineffective learning approaches [3]. Negative learning experiences, such as falling while learning to ride a two-wheel bike, can discourage them from persisting in their learning journey. Similarly, using bicycles with training wheels can prove ineffective in acquiring essential cycling skills and stability [4], potentially delaying the age at which individuals learn to cycle independently [3].

In recent times, balance bikes have emerged as a popular alternative to overcome the challenges associated with traditional learning approaches for cycling. These challenges primarily involve ineffective methods and negative experiences. Balance bikes, which lack pedals and allows rider to walk or sprint while seated [5], offer a more intuitive and effective way to acquire skills and improve cycling stability. In fact, studies have shown that balance bikes are more effective in helping riders learn the essential skill of maintaining balance on two wheels compared to bikes with training wheels, which prioritize on pedalling skills [3,4]. With the right support, including access to affordable, appropriately sized adult balance bikes, along with effective learning design, individuals of all ages can overcome these barriers and learn to cycle independently.

Maintaining cycling stability mainly depends on gliding a bike with feet off the ground. [5–7]. When learning to cycle, it is not surprising that cyclists fall if they cannot maintain their posture. A balance bike is anecdotally regarded as a safe tool for learning to cycle quickly due to the similar balance strategy. When an appropriate method is used to stimulate learners’ vision and their body coordination for balance, learning to cycle with minimized fear of falling is very probable. The transfer of learning refers to the concepts that skills acquired during practice can be applied to other situations [8]. For example, if an individual learns to balance on a balance bike, they may be able to transfer that skill to riding a two-wheel bike. This is because the balance bike has helped them develop the necessary balance and coordination skills required to ride a two-wheel bike. Positive transfer occurs when the skills learned on the balance bike improve the individual’s ability to a new but similar task, riding on a two-wheel bike [3]. On the other hand, negative transfer occurs if the skills learned on the bike with training wheels actually hinder the individual’s ability to learn [3,6]. Zero transfer would occur if the skills learned on a balance bike have no effect on their ability to ride a pedal bike.

Riding on a balance bike has been proven to be an effective method for positively transferring the skills needed to learn how to cycle [6]. In fact, a study indicated that children could learn how to cycle within a short period of two weeks with the assistance of balance bike [7]. Additionally, a retrospective study has highlighted the benefits of using balance bike can be beneficial in educating or re-educating children to learn how to cycle, ultimately lowering the learning age [3]. Learning to control a balance bike is attainable, and even preschool children with varying fundamental motor skill level could improve the capacity of balance bike control with eight weeks of free play on a balance bike [9]. Moreover, a higher volume of practice, known as motor skill engagement (MSE), on a balance bike led to more improvement in balance bike skills [9].

However, the effectiveness of learning to cycle by using a balance bike is still a topic yet to be fully explored, and scientific evidence supporting its effectiveness is limited. If the ability to ride a balance bike is transferrable to a pedal bike, it is expected that cyclists should be superior in riding and controlling a balance bike compared with the non-cyclists. Nonetheless, it is reasonable that adults who cannot cycle independently could improve their ability through sufficient practice on a balance bike, which in turn allows them to ride a pedal bike afterwards. Additionally, it is reasonable to assume that adults may feel more confident riding a two-wheel bike becoming acquainted with riding a balance bike. Therefore, this study adopted a multi-phase intervention approach that had two aims and phases: (1) to identify whether previous cycling experience is associated with riding performance on a balance bike via a case-control observational study and develop an eight 20-minute balance bike training programme using these data; (2) to evaluate whether healthy adults without cycling experience could develop essential cycling stability on a balance bike and transfer the skills to a pedal bike using a single-arm trial.

2. Methods

This study was a multi-phase intervention study including a case-control observational study in Phase 1 and an 8 × 20-minute balance bike training single-arm trial in Phase 2 (Fig 1). From June 2021 to August 2022, healthy adults were recruited on the basis of cycling experience (with or without) by convenience sampling (via online and poster advertising). The inclusion criterion is (1) aged 18 years or above. The exclusion criteria are (1) suffering from serious injuries that may affect balance performance (previous injuries that have been fully recovered are acceptable), (2) significant musculoskeletal, cardiovascular (e.g., hypertension), neurological (e.g., peripheral neuropathy), visual, vestibular, or other sensorimotor disorders, (3) muscle fatigue on the day of the assessment, and (4) capable to ride a motorcycle. All participants were screened by a sports scientist according to the above inclusion and exclusion criteria. The eligibility criteria were the same in Phases 1 and 2.

All procedures were approved by the Human Research Ethics Committee of The Education University of Hong Kong (Ref. no. 2020-2021-0285) and in accordance with the Declaration of Helsinki. Informed written consent was obtained from each participant before experimentation. The confidentiality of participants’ information was ensured both during and after the data collection process. Additionally, all measurements were carried out by an experienced sports scientist, with the support of a research assistant in an indoor multi-game court to ensure accuracy and consistency. The STROBE checklist is available to the reader as S1 Appendix.

Study design

In this study, participants were classified into two groups: cyclist group and non-cyclist group. Studies typically identified three criteria for independent cycling: the ability to self-launch, riding a bike continuously for a certain distance, and braking without assistance [6]. However, the combination of criteria varied across studies. Since braking using the handlebar is not part of a balance bike’s design, participants in this study who were able to self-launch and ride a pedal bike for 5 minutes continuously were classified as the cyclist group, while those who were unable to do that were classified as the non-cyclist group.

A total of 21 participants took part in Phase 1, including 13 cyclists (6 males and 7 females; age: 22.62 ± 2.14 years; height: 167.12 ± 10.97 cm; weight: 62.49 ± 12.21 kg) and 8 non-cyclists (3 males and 5 females; age: 22.13 ± 1.36 years; height: 164.00 ± 5.45 cm; weight: 56.30 ± 3.49 kg). Their demographics (i.e., age and gender), anthropometrics (i.e., height and weight), and physical functional capacity (i.e., jump height of countermovement jump [CMJ]) were measured. Following that, the times of completion for two assigned balance bike manoeuvres were recorded. The research team used the information collected in Phase 1 to develop an eight 20-minute balance bike training programme that attempted to address non-cyclists’ needs on acquiring riding skills on a balance bike.

In Phase 2, another 12 non-cyclists were recruited using the same criteria to participate in the study, of whom 11 completed the entire study (2 males and 9 females; age: 36.73 ± 15.74 years; height: 160.68 ± 9.12 cm; weight: 57.50 ± 12.57 kg). One individual withdrew from the study due to personal reasons. The 11 non-cyclists were required to attend two testing sessions at the same time on two different days (i.e., baseline, T1; post-test, T2), and each session lasted for approximately 1.5 hours. The measurements and the two balance bike manoeuvres were duplicated at T1. Participants were then encouraged to complete the 8 × 20-minute balance bike training. Their riding distance in each session and their cycling confidence level (on a pedal bike) after each session were documented. At T2, after undergoing an identical physical functional capacity test, participants were verbally interviewed about their perception of the learning experience. They were invited to self-launch and ride a pedal bike to determine whether they could be up-skilled as a cyclist after the balance bike training.

Based on the available literature, the following hypotheses have been derived concerning cycling experience and the effectiveness of the balance bike training intervention: Hypothesis 1: It is anticipated that individuals with prior cycling experience, referred to as cyclists, will display superior performance in riding and controlling a balance bike compared to individuals without prior cycling experience, referred to as non-cyclists. Hypothesis 2: Non-cyclists who undergo the balance bike training intervention will demonstrate enhanced performance in balance bike tests and experience an increase in confidence levels when riding a two-wheel bike after engaging in practice with a balance bike.

Anthropometrics

Participants’ body height and weight were measured by a portable height rod stadiometer (Detecto, PHR, MO, USA) and digital scale (Tanita BWB-800, MA, USA) respectively. They were asked to stand on the height rod stadiometer and digital scale for the measurements. The graduation unit was 0.1 cm for height and 0.1 kg for weight.

Physical functional capacity

Participants’ physical functional capacity was measured by CMJ using Takei Vertical Jump Meter (TVJM; T.K.K. 5406 Jump MD, Takei Scientific Instruments Co. Ltd., Niigata, Japan). High reliability (r = 0.90) was reported for CMJ [10–13]. Participants were required to stand on the Takei rubber mat with a belt secured around the waist. The belt weighs 0.6 kg and is connected to the mat with a measurement cord which initially represented the distance between the waist and the ground. The cord elongated during a jump. The smallest measurement unit was 1 cm, and its error was up to ± 2 cm. After familiarisation, participants were instructed to jump with their hands on their hips as high as possible. The average jump height of three trials was used for analysis.

Balance bike testing

A 15-m sprint (Fig 2A) and a two-turn curved sprint (Fig 2B) [14] were adopted from a recent study. The first manoeuvre consisted of a start, an approach to top speed, and a run-stop in two routes: an approach run, followed by a zip-zap turn. Participants were requested to ride and sprint at full speed. Sufficient time was given to participants to familiarise themselves with a 20-inch balance bike and the testing setup. To ensure that participants could comfortably and safely balance on the bike during testing, they were ample time to become familiar with a 20-inch balance bike and the testing setup. The seat height of the bike was then adjusted to fit each participant’s body, enabling them to place both feet on the ground with slightly bent hips and knees [9,14]. This position allowed for proper extension of the hip and knee joints when propelling themselves forward. The average time completion (s) of five trials were assessed by a pair of timing gates (Brower Timing Systems, Utah, USA) that were placed at the start and finish lines. The measuring system has been found to be accurate in recording 0–20 m running speed (r = 0.911, p < .01) [15].

Cycling confidence

Previous studies have used self-report cycling confidence to examine the effectiveness of cycling training among adults [16,17]. In this study, cycling confidence was assessed verbally after each of the eight training sessions and the two testing sessions (i.e., T1 & T2), resulting in a total of 10 recorded confidence scores. Participants were asked to rate their confidence to ride a pedal bike on a five-point Likert scale (1 = not confident; 2 = slightly confident; 3 = somewhat confident; 4 = fairly confident; 5 = very confident).

Self-perception of the learning experience

Before the pedal bike trial at T2, a structured interview was conducted to assess the participants’ perception regarding their acquisition of cycling skills during the programme. The interview lasted for 3 minutes and consisted of two questions: Q1) How did you feel after completing the balance bike training programme? and Q2) Which specific elements do you feel you developed after completing the balance bike training programme that contributed to changes of your cycling confidence?

Cycle independently

In this study, being able to cycle independently was defined as when a participant can self-launch and ride a pedal bike for 5 minutes continuously. At the end of the balance bike training programme, participants were invited to ride a 20-inch conventional pedal bike, which was of the same size as the balance bike used in the training. The time taken by participants to cycle independently was recorded and reported, in 15-minute intervals: below 15 minutes, 16 to 30 minutes, 30 to 45 minutes, and 45 to 60 minutes. The trial had a maximum time limit of 60 minutes.

Balance bike training programme development

In Phase 1, key cycling performance variables, issues, and preferences were determined by combing participants’ functional capacity, balance bike testing data, perceived confidence in two groups. Other factors, such as cycle patterns on balance bike, previous training experience, appropriate training features and designs, and offering autonomy support in the training, were also considered in the development of balance bike training programme. After completing data collection in Phase 1, a sport scientist developed the balance bike training programme to address the needs of non-cyclists.

Motor-skill engagement (MSE) on a balance bike

The distance travelled (km) by each participant on balance bike was collected using cycle computer (CC-RS200W, Cateye Quick Cyclocomputer, Osaka, Japan). Participants were able to read the data monitor attached to the handlebar. The data was also used to determine the MSE on a balance bike during the training programme in Phase 2.

Data analysis

The SPSS Statistics 28.0 software package (Armonk, NY: IBM Corp.) was used for the statistical analyses. A fully Bayesian inferential statistical approach was used to provide probabilistic statements [18]. Analysis in Phase 1, due to the lack of strong a priori evidence, non-informative prior was used [19]. A Bayesian two-sample t-tests were used to compare the outcome variables between cyclists and non-cyclists. Then, new prior distributions of cyclists and non-cyclists on the outcome parameters were collected. Specific to the non-cyclists, Bayesian related sample normal tests were used to evaluate the effects of balance bike training on the time of completion of the two balance bike tests and the jump height in CMJ. A Bayes factor for related-sample t test was used to determine the changes of cycling confidence at post-test (T2) compared to the pre-test level (T1).

The strength of the evidence for the null hypothesis against the alternative hypothesis (or models) can be expressed as a Bayes Factor (BF₀₁), which is an odds ratio. The size of BFs can be interpreted as providing anecdotal (BF₀₁ = 1/3–1), moderate (BF₀₁ = 1/10–1/3), strong (BF₀₁ = 1/30–1/10), very strong (BF₀₁ = 1/100–1/30), and extreme (BF₀₁ < 1/100), in favour of alternative hypothesis compared to null hypothesis [20,21]. Evidence for the null hypothesis was set as anecdotal (BF₀₁ = 1–3), moderate (BF₀₁ = 3–10), strong (BF₀₁ = 10–30), very strong (BF₀₁ = 30–100), and extreme (BF₀₁ > 100) [20,21]. Effect size (ES), and Cohen’s d values of 0.2, 0.6, and 1.2 were defined as small, moderate, and large effect sizes, respectively [22].

This study adopted Bayesian updating with a simulation-based approach for sample size calculation in Phase 1, sample size was continued to increase until the Bayes factor was sufficient, indicating strong evidence in favour of the alternative hypothesis.

3. Results

Phase 1: Assessments between cyclists and non-cyclists

Cyclists demonstrated faster completion time on a balance bike in the 15m sprint test (BF₀₁ = 0.228, p = 0.013, d = 1.89) and two-turn curved sprint (BF₀₁ = 0.138, p = 0.037, d = 3.31) than the non-cyclists (Table 1). No differences were found between the two groups in the demographic data as well as the jump height in CMJ.

Table 1. Balance bike performance and jump height in Phase 1 and Phase 2.

Phase 1: Case-Control Observational Study
	Cyclists (n = 13)		Non-cyclists (n = 8)	Bayes Factor (BF₀₁)	p value	Effect Size (d) (95%CI)
15m sprint test (s)	4.90 ± 1.16		6.79 ± 2.03	0.228	0.013*	-1.23 (-2.18, -0.26)
Two-turn curved sprint test (s)	6.35 ± 1.30		9.66 ± 3.61	0.138	0.007*	-1.37 (-2.33, -0.37)
Jump height in CMJ (cm)	37.64 ± 8.06		35.13 ± 9.07	2.701	0.516	0.30 (-0.59, 1.18)
Phase 2: 8 × 20-minute balance bike training single-arm trial
	Non-cyclists (n = 11)		Pre–Post (95%CI)	Bayes Factor (BF₀₁)	p value	Effect Size (d) (95%CI)
	Pre	Post	Pre–Post (95%CI)	Bayes Factor (BF₀₁)	p value	Effect Size (d) (95%CI)
15m sprint test (s)	7.07 ± 1.21	5.39 ± 0.92	1.68 (1.00, 2.36)	< 0.001	<0.001*	1.66 (0.71, 2.57)
Two-turn curved sprint test (s)	9.25 ± 1.26	6.64 ± 0.83	2.60 (1.84, 3.37)	< 0.001	<0.001*	2.29 (1.13, 3.43)
Jump height in CMJ (cm)	26.15 ± 8.45	28.42 ± 8.45	-2.27 (-3.34, -1.20)	0.019	<0.001*	-1.42 (-2.26, -0.55)

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Note: CMJ: Countermovement jump; Means ± standard deviations are presented unless specified otherwise. * p < 0.05.

Phase 1: Balance bike training programme development

The balance bike programme was based on five principles: riding speed, gliding to turn, cycling confidence, high MSE, and a dual-task approach. Each session was tailored to participants’ riding abilities, and an instructor-to-participant ratio of 1: 2 to 1: 4 was used regarding the participants’ availability. The training approach used an authentic learning approach that presented challenges resembling real-world scenarios. Table 2 provides an overview of the balance bike intervention framework.

Table 2. Brief description of 8 × 20-minute balance bike training programme.

Session	Prerequisite (Minimum)	Learning Objectives		Route Design	Dual-Task Activities (e.g.)
	Prerequisite (Minimum)	Motor	Cognitive
	Able to:	Able to:	Able to:
1st	• Walk / Run with the bike.	• Glide the bike independently. • Slow down by TWO feet.	• Keep riding on slow lane. • Rest / Stop only at Rest Zone. • Leave the rest zone with cautious.	4-Corners Round Route with Rest Zone (Two-Lane-One-Way)	• Talk with Others. • Ride with partner side by side.
2nd	• Glide the bike. • Stop at rest zone when necessary.	• Glide the bike fast for 10 m. • Speed up and overtake others at the fast lane. • drop back if necessary and return to the slow lane. • Slow down by TWO feet at high speed.	• Sound the horn before overtaking. • Stay at slow lane with same speed / slow down allowing others to overtake. • Keep a healthy vision by head movement for road safety	4-Corners Round Route with Rest Zone (Two-Lane-One-Way) + Diagonal Highway (One-Lane-One-Way)	React to the signals by instructor. • Name the object. • Ride to the site.
3rd	• Glide the bike fast for 10 m. • Stop at rest zone when necessary. • Overtake others.	• Keep your head and eyes oriented 3–4 seconds ahead.	• Turn Left / Right with early signals (e.g., hands). • Enter to and exit from roundabout with clear route map in mind.	4-Corners Round Route with Rest Zone (Two-lane-Two-way) + Roundabout in centre (4-Exit)	• Lead others to follow a bike trip. • Follow the leaders to ride.
4th	• Keep your head and eyes oriented 3–4 seconds ahead. • Turn Left / Right with early signals (Voice / hands).	• Keep your head and eyes oriented 3–4 seconds ahead.	• Turn Left / Right with early signals (e.g., hands). • Enter to and exit from roundabout with clear route map in mind.	4-Corners Round Route with Rest Zone (Two-lane-Two-way) + Roundabout in centre (4-Exit)	Eye on the traffic chaos (Instructor play as a passenger or another rider)
5th	• Control the bike with all essential skills on a wide lane.	• Lean forward and stride for sprints. • Speed up and slow down for multiple turns.	• Keep on a same lane after U-turn.	E-shaped Route (Two-Lane-One-Way)	Speed Competition
6th	• Control the bike with all essential skills on a wide lane.	Hand off from handle to collect and place an object when riding on a bike.	• Locate a moving object (Instructor) when riding on a bike.	E-shaped Route (Two-Lane-One-Way) + Collection Point	Deliver object from Collection Point to Instructor or vice versa.
7th	• Control the bike with all essential skills on a wide lane.	• Maintain balance when riding on a narrow track. • Maintain balance on a Two-Lane-Two-Way route.	• Decide the best option of route for task.	4-Corners Round Route with Rest Zone (Two-lane-Two-way) + Diagonal Highway (One-Lane-One-Way & Narrow) + Collection Point	Deliver object from Collection Point to Instructor or vice versa. React unexpected situation (provided by instructor)
8th	• Control the bike with all essential skills on a wide route.	• Combine all skills towards both predicted and unexpected situations.	• Combine all skills towards both predicted and unexpected situations.	4-Corners Round Route with Rest Zone (Two-lane-Two-way) + Roundabout in centre (4-Exit) + Collection Point	Deliver object from Collection Point to Instructor or vice versa. Open route for free ride (No restriction on speed, direction, task).

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Note: Programme were developed based on 5 training principles for learning to cycle 1) riding speed, 2) gliding to turn, 3) cycling confidence, 4) high MSE, and 5) dual-task approach; Each training should travel in between 1.5–2 km to achieve motor skill engagement; Verbal encouragement is provided by Instructor.

Given faster times of completion of 15m sprint, and two-turn curved sprint in cyclist, the programme emphasized riding speed and gliding to turn throughout the programme. Participants were encouraged to practice the route as much as possible during the standardized 20-minute session to achieve a longer travelling distance or more successful completion of task. At the end of each session, the instructor shared the distance travelled by each participant using cycle computer, allowing participants to track their progress over time.

Due to the previous poor cycling experience of adult non-cyclist, autonomy support and mastery of the skills were the key variable for their active participation (i.e., high MSE) with confidence, participants had the freedom to choose the speed, skill, and level of participation, including when to stop at rest area or use the overtaking lane. The instructor encouraged participants to ride as fast as they could, but also provided acceptance to participants who preferred to ride at their own pace, even if it was slower, with the aim of ensuring that participants felt comfortable and in control of the bike while also pushing themselves to improve their performance.

To challenge participants’ cycling stability, the training programme included activities that involved riding a balance bike while performing additional tasks (i.e., dual-task approach) that required executive functions [23], such as visual scanning to find a moving target or delivering an object with one hand when riding. The programme was designed as a series of challenges that simulated different scenarios encountered on cycling tracks (Fig 3), such as navigating traffic chaos or taking turns leading the group, to encourage participants to adapt to unexpected situations for better cycling stability.

Fig 3 — Note: (1): Stop at rest zone; (2): Encountering other riders; (3): Turn into the diagonal highway (One-Lane-One-Way); (4): Speed up at the diagonal highway; (5) Enter to and exit from roundabout in centre (4-Exit); (6) slow down at the diagonal highway before exit; (7): Exit to the major cycling track; (8) Taking turns leading the group; (9) Follow the leaders to ride; (10): Overtaking others at the fast lane.

Phase 2: Assessment for balance bike intervention

Compared to Phase 1, non-cyclists in Phase 2 (n = 11) displayed comparable demographics but older (36.72 ± 15.74 years, BF₀₁ = 0.30, p = 0.019, d = 1.21) and jumped lower in CMJ (26.15 ± 8.45 cm, BF₀₁ = 0.53, p = 0.041, d = -1.03). Balance bike performances in the two testing manoeuvres were similar across Phases 1 and 2.

Repeated measures were conducted for the 11 non-cyclists who attended all balance bike training and the two testing sessions (Table 2). Participants accumulated 14.88 ± 2.09 km in the eight 20-minute balance bike training sessions, which is expected to have a high MSE according to Kavanagh et al.’s [9] definition. On average, participants travelled 1.62 ± 0.40 km in the first session and gradually increased across the programme and attained 2.02 ± 0.31 km in the last session (Fig 4). As a result, spending less time at rest and/or faster riding speed were shown.

Fig 4 — Note: MSE: Motor-skill engagement on a balance bike; Cycling confidence (1 = not confident; 2 = slightly confident; 3 = somewhat confident; 4 = fairly confident; 5 = very confident).

Based on the verbal survey conducted during Phase 2 of the study, participants reported feeling fairly to very high level of confidence with their cycling abilities, with a score of 4.45 ± 0.52 out of possible 5, after completing all training sessions. Participants commented that after completing the balance training programme (Q1), they felt comfortable riding a balance bike (n = 11), experienced a reduction in their fear of falling (n = 6), and felt more relaxed while holding onto the handles of the bike (n = 4). Specifically, in response to Q2, participants commented on the improvements in their cycling confidence, including an increased capacity of controlling the bike during gliding and turning (n = 7), and an increase in their skills and knowledge for handling the traffic chaos (n = 4). At the end of the study (T2), there was a significant increase in participants’ cycling confidence compared to that at T1 with a difference of 3.09 ± 0.83 (BF₀₁ <0.001, p < 0.001, d = 3.72). Out of the eleven participants, eight were able to self-launch and ride a pedal bike continuously within 15 minutes, while the remaining three were able to cycle independently within 16 to 30 minutes (n = 1) and 45 to 60 minutes (n = 2).

4. Discussion

In this multi-phase intervention study, we first examined whether the riding performance on a balance bike in healthy adults with cycling skills differed from those without cycling skills (Phase 1). We then tested our novel balance bike training to investigate if it could improve the balanced bike performance of adults who could not ride independently and thus allow them to ride a pedal bicycle afterwards (Phase 2). The first stage reported faster time of completion in the balance bike tests in cyclists than non-cyclists (very strong evidence for H₁) but no evidence for CMJ jump height. Thus, the balance bike manoeuvres demonstrated their capabilities to divide healthy adults with and without the ability to cycle. In the second stage, a meaningful balance bike training effect on balance bike performance (extreme evidence for H₁) and the CMJ jump height (very strong evidence for H₁) were reported following the 8 × 20-minute balance bike training programme in the Phase 2. Noteworthily, all non-cyclists, with a wide range of age (19–63 y), learned to cycle a pedal bike independently after completing eight 20-minute sessions of our novel balance bike programme. They did not receive any instruction about pedalling a pedal bike in the sessions. This study provided evidence of positive riding skill transfer from a balance bike to a two-wheel bike and building confidence for every adult to learn how to cycle with dignity.

The balance bike manoeuvres designed by Kavanagh et al. [14] were adopted in this study. Previously, they assessed the ability of young children to ride a balance bike using the time of completion. In this study, we presented compelling evidence to support the efficacy of the two balance bike tests in distinguishing and assessing healthy adults with different cycling backgrounds on novel motor skills. We found that the balance bike testing results were 4.39 to 7.25 times more likely under the alternative hypothesis (H₁) than under the null hypothesis (H₀), yielding very strong evidence in favour of the alternative hypothesis. Our study revealed that cyclists had significantly faster completion times than non-cyclists on the 15 m sprint and the two-turn curved sprint, with times of 1.89 s and 3.31 s respectively. These findings support our hypotheses that cyclists would demonstrate superior performance in riding and controlling a balance bike when compared to non-cyclists.

The ability to maintain balance while cycling depends on various factors as cycling strategies, controlling lateral deviation, and level of expertise, which are important in restoring balance in unstable cycling situation [24]. Large differences in effect size have been observed in both straight and two-curved turn sprints, but lower limb muscle-related performance on the CMJ test is not found to be related to cycling capabilities. While a systematic review and meta-analysis have shown correlations between measures of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan [25], it should be noted that the perturbed stance test, which was commonly used to measure balance in previous studies, may not fully reflect the unique balance strategy and control required for cycling. Similarly, the CMJ test may not fully capture the motor coordination required for cycling. These findings support a previous study that suggests cycling is a standalone motor skill that derives from locomotion, object control or stability [14]. It is also important to note that the physical activity background of the participants in the study was not strictly controlled, meaning that there may have been participants with different sports experience in the non-cyclist group in Phase 1. Therefore, although the non-cyclists’ CMJ performance improved in Phase 2, it was still lower than that of the non-cyclists in Phase 1 (28.42 ± 8.45 vs 35.13 ± 9.07 cm). The improvement in Phase 2 could be attributed to increased balance and/or lower limb muscle training (e.g., strengthening glutes, quadriceps, hamstrings, and calves) when riding a balance bike, which may have contributed to the increased CMJ height.

Concerning a bicycle’s self-stability, continuing at a stable speed, and turning techniques play important roles. For typical cycling, 3.59 to 4.88 m·s^-1, predicted by the Whipple model, seems to be an optimal range to maintain in. Riding too fast or too slow would likely result in falling [26]. While the participants in this study only sprinted and glided on a balance bike in the balance bike 15 m sprint tests, in Phase 1, cyclists could still achieve an average of 3.24 m·s^-1 in the sprint test, while non-cyclists could only achieve 2.37 m·s^-1. It could be because cyclists tended to glide the balance bike, while non-cyclists tended to walk with the balance bike [5]. These patterns (i.e., walk, run, glide) have been previously categorized in a study where it was found that as riding speed on a balance bike increased, the frequency of foot contact with the ground decreased and locomotor modes with longer flight phases began to emerge [5]. Therefore, we decided that our balance bike training in phase 2 focused on teaching non-cyclists to attain a relatively high riding speed by gliding to attain bicycle self-stabilisation. In additional to riding speed, Cain et al. [27] reported that experienced cyclists tended to maintain cycling stability by trunk sway more than steering when compared with less experienced cyclists. A similar observation was made in the post-intervention interview where participants reported feeling more comfortable and capable of controlling the bike to glide and turn, and being able to relax their grip on the handlebars during riding after the training intervention. Altogether, practising gliding and leaning the body while turning at high speed would enhance cycling skills. The effectiveness of our Phase 2 balance bike training was evidenced by the shortened time of completion in the findings of Phase 2 by 1.68 s and 2.61 s in the two tracks, correspondingly. Participants might have acquired the ability to maintain balance on a balance bike and thus gain sufficient confidence to glide on it, as opposed to walking or running only.

Our original balance bike training programme had several strengths. We recognized that simply engaging in general training, such as strength training, is insufficient to improve balance function [28]. In order to maximize the transfer of learning and promote effective skill acquisition in real-world scenarios [8], a task-specified and multi-faceted approach is necessary. This approach was similar with Harper et al.’s perspective on learning in balance recovery intervention [29], which emphasizes training variety of exposing participants to a representative sample of postural disturbances and possible responses that they would encounter in daily life. Moreover, it highlights the need to provide training complexity to enhance cognitive involvement to aid in the generalization of learning. When learning to ride a balance bike, a task-specified approach can improve near transfer by focusing on specific skills required for balancing and control. However, a multi-faceted approach is needed for far transfer to apply these skills to real-world cycling scenarios. This includes navigating turns and obstacles on a cycling track, as well as maintaining control over their riding path when encountering other riders.

Kavanagh et al. [9] found that children (aged 4.5 ± 0.5 y) who rode their balance bike over greater distances (>10.5 km in 8 weeks) improved more on the time of completion in balance bike tests. Our participants accumulated 14.88 ± 2.09 km, which is defined to have a high MSE [9]. Compared to previously published cycling training programmes that range from 135 [30] to 270 minutes [31], our study took a mid-range approach, with an accumulated training time of 160 minutes. This duration is relatively short, which is important since lack of time is a commonly reported barrier to engaging in structured exercise [32]. Accumulating multiple short bouts of exercise has been shown to provide similar health and fitness benefits as longer continuous exercise modes [33,34]. Additionally, short bouts of exercise provide more opportunities for individuals to fit exercise into a busy day. Our recent multiple-short bouts design allowed participants to have a time-efficient programme that could potentially maintain high motivation and reduce the accumulation of physical and mental fatigue and burden on the participants.

Furthermore, 100% of the participants in Phase 2 self-reported that their cycling confidence improved tremendously during the training programme and was able to cycle independently regardless of their age and cycling experience prior to our programme. This suggested that educating individuals to ride a balance bike greatly benefits learning to cycle independently. As noted in a previous systematic review [6], fear of falling is the biggest barrier to learning to cycle. However, our recent study found that most participants were able to reduce their fear of falling by regaining balance on the balance bike through the use of their feet and having greater control over their riding speed. This suggests that balance bike training can be effective method for reducing fear of falling not just for children and youth riders, but also for adult riders. Subsequently, to facilitate the natural balance response and allow it to fully develop, we followed the recommendation of Oddsson [28] and instructed the participants’ instructors to refrain from providing “too early” external support, such as holding onto the handlebar, when the participants lost their balance on a balance bike. By doing so, we aimed to nurture and fully execute the natural balance responses of the participants. Our programme also included elements to disrupt cycling stability, e.g., stopping the balance bike at a rest zone and before stop signs and starting to ride, that built the sense of safe cycling on cycle lanes. There was no injury due to falling in our training. Positive cycling experience coupled with increased skill and confidence leads to more frequent cycling [16]. The balance bike and level ground allowed participants to feel safe so that their cycling confidence was gradually built across the sessions. As a result, participants learn to view the riding speed and fear of falling as controllable.

Real-world situations were introduced to learners concurrently after they master basic riding skills in our training [35–38]. The present programme incorporates a dual-task approach. This has been emphasised for assessing and training balance control in patients with balance impairments [39,40] and young adults [41]. By enhancing cognitive performance and thus cognitive activities during static and dynamic postures through dual-task training, falls could be prevented [40]. A nearly authentic environment, context and situation were created for task-based learning, i.e., a series of balance bike activities to challenge participants’ riding manoeuvres and postural control, i.e., stability, in different scenarios were developed. Our training covered the essential skills that have been commonly identified [6] and the open skills demanded during cycling, i.e., reactions to the environment and other road users [42]. Participants were instructed to turn their heads when they were ready to turn. During head movements, they were instructed to look at specific spaces to determine the riding speed and timing of turning and even made precues loudly to further enhance attention on the traffic scenario. Indeed, the ability to handle multiple tasks is important to promote participants’ cycling safety awareness. Thus, our training programme provided a platform for the participants to develop new cycling motor skills through balance bike experience in gaining confidence, balance, and speed control, and without neglecting the importance of understanding cycling safety applied on the cycling tracks. However, it is important to recognize the potential influence of cultural differences on cycling behaviour. The recent design of the balance bike training programme focused on simulating cycling scenario on cycling tracks in Hong Kong, including the position of slow and fast lanes, cycling rules, and cycling etiquette. While this training was effective in improving participants’ cycling confidence in these scenarios, future studies in other settings should consider necessary amendments to account for cultural differences and the unique challenges of cycling in different scenarios, like cycling on road. By doing so, participants may be better able to develop cycling confidence needed to navigate a variety of cycling environments.

Our study had several limitations that should be considered when interpreting the results. Firstly, the sample size was relatively small, which may limit the generalizability of the findings to other populations. Future studies with larger sample sizes would be beneficial to confirm the validity of the results and increase external validity. Additionally, the recruitment of adult participants was difficult, possibly due to concerns about their capability to learn to ride a balance bike and potential embarrassment about not being able to so. This may have affected the generalizability of the results. Future studies could explore ways to address these concerns and increase participation rates among adults, such as providing additional support and encouragement to participants or offering incentives to participate. Secondly, the study only included a one-group sample to test the intervention, which did not allow for a direct comparison to other training approach of learning to cycle, such as free play riding. A future study that includes a control group using different methods would be useful to compare the effectiveness of the balance bike intervention to other established methods.

Additionally, there were specific limitations related to our study design. Firstly, the task prioritisation of the participants was unknown, and future studies should investigate the effect of variable and fixed priority in dual task training. Several studies revealed additional advantage of variable priority over fixed priority [40,43,44]. Since our training did not explicitly prompt the participants to primarily focus on balance bike control or external stimuli, their task prioritisation strategy was unable to be determined. Further investigation is warranted. Secondly, the lower threshold of Motor Skill Engagement (MSE) for transferring stability skills from a balance bike to a two-wheel bike was not established in our study, as all non-cyclists in this study were able to cycle after the balance bike training. Some participants even accumulated over 10.5 km of riding distance (i.e., high MSE) after only six sessions. If a future study could recruit a large sample size with varied MSE and ability to gain cycling skills, more information could be discovered to shorten the training duration. Thirdly, the lack of strict control over the physical activity background of the participants in this study may have contributed to the heterogeneity of participants’ backgrounds. Future studies should measure and control physical activity levels to include a more diverse population and make the findings more generalizable. Thirdly, previous study in children and youth have suggested that individual who engaged in physical activity less than twice a month tend to learn how to cycle later than those who engaged in physical activity on a daily basis. This highlights the importance of physical activity in developing cycling skills. However, in our study, the lack of strict control over the physical activity background of the participants may have contributed to the heterogeneity of participants’ backgrounds. Future studies should measure and control physical activity levels to include a more diverse population and make the findings more generalizable.

5. Conclusion

This study provides valuable evidence for the effectiveness of balance bike tests and a novel balance bike intervention in teaching adults how to ride a bike. Specifically, our findings suggest that the novel balance bike training, which incorporated five principles (riding speed, gliding to turn, cycling confidence, high MSE and a dual-task approach), was particularly effective in promoting balance bike performance and facilitating positive transfer of learning to cycling independently. The data attained from successful new cyclists could be further utilized to design a critical riding speed and minimum distance travel on a balance bike for optimal positive transfer of learning to ride a pedal bike. However, it is important to acknowledge the limitations of our study and the need for further research to confirm these findings and address these limitations. Nonetheless, this study provides valuable initial evidence and highlights the potential of the balance bike intervention as a useful tool for teaching cycling skills to adults.

Supporting information

S1 Appendix. STROBE checklist.

(DOCX)

pone.0298142.s001.docx^{(42.1KB, docx)}

S2 Appendix. Dataset for adult balance bike.

(XLSX)

pone.0298142.s002.xlsx^{(14.5KB, xlsx)}

Acknowledgments

We would like to express our sincere gratitude to our research assistant, Yu-Hin Kong and student-helpers for their invaluable assistance throughout the course of this project. Their dedication, diligence, and expertise have played a critical role in the success of this research endeavour. We are truly appreciative of their contributions to this manuscript.

Data Availability

All relevant data are within the manuscript.

Funding Statement

We acknowledge the support of the Seed Funding Grant 2020/21 (RG 70/2020-2021R) from the Faculty of Liberal Arts and Social Sciences, as well as the Departmental Fund (04789) of the Department of Health and Physical Education from the Education University of Hong Kong. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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PLoS One. doi: 10.1371/journal.pone.0298142.r001

Decision Letter 0

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5 Jun 2023

PONE-D-23-13359Positive Skill Transfer in Balance and Speed Control from Balance Bike to Pedal Bike in Adults: A Multiphase Intervention StudyPLOS ONE

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Reviewer #1: The authors demonstrated the effectiveness of a balance bike intervention resulting in independent cyclists after the intervention. The study does appear to be novel, particularly because of the adult population. The entire manuscript should be reviewed for grammar and clarity. Please see more detailed comments below.

Introduction

Line 62-64, citations needed.

Opening paragraph seems to unnecessarily bounce between international and Hong Kong.

How do the 10 countries in the study of adults who do not know how to cycle relate to Hong Kong. In other words, what indicates that it is similar for Hong Kong.

Review entire document for English readability. Example: “These parents are difficult to coach their children to cycle which would lead to fewer individuals being able to cycle in a generation”

Line 75: explain the relevance of later cycling learning ages to the present study.

Line 76: how are these barriers relevant to current study – use of balance bike as an adult”

Line 100: I’m not sure that balance bike should be considered an emerging tool. They have been around for a long time, however they may be growing in popularity.

Line 105: oddly phrased: “To the best of our knowledge, it is plausible that adults may feel more comfortable”

Overall, the introduction can be more direct and linear leading to the purpose of the study. For example, COVID-19 is not the only or main reason for cycling popularity. It seems out of place to mention in the context of this study.

Additionally, you should include the studies that have been conducted using balance bikes. Here is just one for example: Mercê C, Branco M, Catela D, Lopes F, Cordovil R. Learning to Cycle: From Training Wheels to Balance Bike. International Journal of Environmental Research and Public Health. 2022; 19(3):1814. https://doi.org/10.3390/ijerph19031814

Methods

I would suggest providing all phase 1 details then phase 2 details rather than going back and forth for different phases of the methods.

Line 153: statement can be clarified “Step 2 was to record the times of completion of two anticipated balance bike manoeuvres.” Consider stating the “length of time to complete…” it is unclear what “anticipated” is referring to in this context.

Discussion

New information should not be presented in the discussion. For example, you discuss observations about cyclist v non-cyclist techniques of leaning while riding. There is no discussion of this in the results, were these observations systematically observed?

Similarly, you provide statements such as: The participants stated that they reduced their fear of falling as they could regain balance on the balance bike by putting their feet on the ground and could fully control their riding speed” which are not discussed as being collected systematically or in the results.

Line 48-50 Statement appears to be about your study, but has an external citation. Review for clarity.

Line 358 and subsequent paragraph: This seems to be describing more how you designed the intervention rather than a discussion of your findings. Consider moving this discussion to methods describing intervention development.

It seems that the limitation section can be expanded, for example more broadly issues with small sample size. You only used a one-group sample to test the intervention. You did not have a comparison to traditional methods (training wheels) to see if that could also produce independent cyclists after the same amount of training.

Reviewer #2: General Comments:

The manuscript addresses a very interesting and current topic, it presents an intervention program to learn to cycle in adults, which also brings innovation.

However, the methodological component has several weaknesses, it is necessary to explain in more detail the process of developing the program, supporting it with an adequate theoretical and conceptual framework. The sample is very small so the conclusions are, in some cases, abusive. It is necessary to clarify the limitations of the study.

Introduction

Lines 81-83 – The balance bike affords several and different types of locomotion pattern besides “walk” and “sprint”. Even this variety of patterns is pointed out as one of the causes for their greater efficiency during learning. This is a point worth exploring further in the discussion. Suggested reading: doi.org/10.3390/children9121937

Line 84 – please include a reference.

Line 89 - The reference used only gives suggestions for using the balance bike as preparation for traditional cycling. However, this transition or transfer is not studied by these authors. You should include references that study this transfer. Suggested reading: doi/full/10.1080/17408989.2021.2005014

Line 93 - The reference used does not include adult participants, which is the target population of the present manuscript. In this sense, authors should seek to add references with their target population if possible. And, clarify the Kavanagh’s study population.

Lines 98-104 - There are already several studies that support why the balance bike enables this balance exploration and training, and consequently promotes a more effective and efficient transfer to traditional cycling. Please use references and avoid "Anecdotal evidences", the suggested readings in the comments above may help.

Methods

Lines 137-139 - Please explain the reasons for the definition of the criterion cyclist/non-cyclist. The ability to brake safely was not considered, why?

Line 144 – Sample - The sample size is quite small. This is a weakness that may compromise the external validity of the results. This limitation should be discussed and clearly presented in the article's discussion.

Lines 163-178 - It is mentioned in the introduction that one of the objectives is to develop an intervention programme with the balance bike for adults. However, this presentation of the programme only identifies a guiding principle (dual-task). How did this development process take place? Who developed it, a motor learning specialist? It is also mentioned that the observational study (phase 1) supports the development of the programme, how? Can you give some practical examples?

Lines 173, 175-176 - Please clarify the speed condition. Initially you state that the speed was self-selected by the participant, subsequently you state that you were asked to run the course at the highest possible speed. The speed is a variable that influences the learning with the balance bike, this should be a variable to explore in the programme.

Table 1 - Table 1 mentions various cycling patterns with the balance bike such as "walk" "run" and "glide". These patterns have already been categorized in a previous study, you should reference the study and clearly present what you mean by each of the patterns you are referencing.

Table 1 - From the description of the exercises it is possible to see that the manipulation of speed was taken into account. Please explain in the programme presentation the role of speed in the learning of cycling and how you manipulated it in order to promote this learning.

Lines 201-202 – Please introduce a reference.

Line 208 - Please clarify if this scale has been validated/used in any other previous studies or if it was developed for the present manuscript.

Lines 217-223 - Please clarify "positive transfer" by supporting it with references. What criteria are used for the distinction between "quick positive motor skill transfer" "late positive motor skill transfer" and "zero transfer"? These criteria for distinction should be clarified and supported by references.

Discussion

CMJ – There is a concern for the application of the CMJ test, being that it is then compared and reported between groups. However, the reason for the "importance" or connection of this test with the balance bike is not clear. Please clarify it.

293-295 – Please clarify this sentence, I was not able to understand it meaning.

297 - It mentions "one of our 4 hypotheses", I cannot find the clear presentation of the hypotheses in the text.

331 - They address the strengths of the intervention programme presented. What are its weaknesses? Please identify above (in the programme description) what the participant/instructor ratio is.

333 – “Training should be a task-specified and multi-faceted approach.” I personally fully agree with this statement. But it should not be presented without contextualisation, that is, what is the theoretical or conceptual basis that supports it? This should be the same as that which supports the development of the programme and which, until now, has been omitted.

333-334 - “Adopting a balance bike in our training provided cycling-specific lateral deviations to the riders.” How can the authors state this so surely? Have the lateral deviations been measured?

346-348 - The fear of falling is identified in literature as one of the biggest barriers to learning to cycle on a traditional bicycle, strengthen this sentence with literature references.

358 – “Real-world situations”? Did the programme include a component of cycling on the road with car traffic?

385 – Limitations - Physical activity influences learning to cycle in children (there is at least one recent study that finds this association), can you strengthen this presentation with references. Another major limitation was not controlling for participants' prior experience on various bicycles. We do not know if the previous experience influenced the type of transfer found "quick positive motor skill transfer" "late positive motor skill transfer" and "zero transfer", however, considering that learning can be seen as the sum of experiences, we can assume that yes. This weakness should be presented and discussed.

392 – “Extreme evidence” based on a study of only 11 adults is abusive. please reconsider the use of this expression.

393 – How did you arrive at these 5 principles? This is a discussion to complement the discussion section.

Reviewer #3: This manuscript proposes to study the transfer of skills between balance cycling and pedaling in adults.

The authors are to be congratulated for the methodological rigor they try to imprint in this study, however some questions arise as you read:

- Both the title and the second objective refer to transfer between motor skills, however, the authors do not describe what they mean by positive transfer or what is meant by transfer in general. It is recommended that this be done in the framework.

- Another aspect is that it is not made clear, which skill is meant to assess transfer. The authors should be clear in this definition, since the act of pedaling is not present in the first bicycle. This should be clarified.

In the Methods section - The bicycle being the means to test the transfer, the difference between the bicycles used for each condition is not explained.

- In the Methods section, ln. 117-118 - the characteristics of each phase are presented. In phase 2, what is the rationale for choosing 8x20-minutes? Why not more or less time or sessions?

- In the Methods section, ln. 142 - anthropometric measurements were performed. What measurement protocols were used? What expertise does the measurer have?

- In the Methods section, ln. 146 - the cultural context in motor learning is very important, as well as the learning possibilities between sexes, decades of birth and their motor availability. This difference between elements of each sex is a weakness of the study. To bridge these differences, assessing motor competence would be recommended. Did you do this? How do you support the results in light of the contexts?

- In the Methods section, ln. 166 - "Challenge-Taking Course." A schematic/image illustrating the course would be welcomed. This allows the principle of replicability to be guaranteed.

- In the Methods section, ln. 172 - "Solve real-world challenges": Which ones? How were they simulated in this situation?

- In the Methods section, ln. 201-202 - There are several ways to calculate the optimal saddle height. The way they use is unclear, especially the "slightly bent" of the knees and hips. Can they be clearer? Have you not used any protocols?

- In the Methods section, ln. 219 - Is the classification "Quick positive transfer" or "late positive transfer" your classification or used by other authors? What is the rationale for having 15 minutes as the cut-off value? How does a person who can perform the task in 15 minutes differ so much from one who can do it in 16 minutes?

- In the Results section, ln. 266 - The authors indicate that confidence in cycling was assessed across sessions. What results come from this...is there a session that shows a jump in confidence in bicycling? I recommend statistical treatment of these data.

- In the Results section, ln. 303 - Was stability assessed in any way across sessions? No reference to such an evaluation appears, which makes the use of this term abusive.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Marco Branco

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PLoS One. 2024 Feb 29;19(2):e0298142. doi: 10.1371/journal.pone.0298142.r002

Author response to Decision Letter 0

3 Jul 2023

Journal: PLOS ONE Decision: Revision required [PONE-D-23-13359]

Manuscript Status: Pending major revisions

Manuscript ID: PONE-D-23-13359

Type: Article

Positive Skill Transfer in Balance and Speed Control from Balance Bike to Pedal Bike in Adults: A Multiphase Intervention Study

Point-by-Point Response

Reviewer 1

Point raised by Reviewer #1: C01

The authors demonstrated the effectiveness of a balance bike intervention resulting in independent cyclists after the intervention. The study does appear to be novel, particularly because of the adult population. The entire manuscript should be reviewed for grammar and clarity. Please see more detailed comments below.

Response by author:

Thanks for the recognition and we are going to revise the manuscript to address the suggestions.

Point raised by Reviewer #1: C02

Introduction

Line 62-64, citations needed.

Response by author:

Those sentences shared the same citation of

Research Office Legislative Council Secretariat. Bicycle-friendly policy in Hong Kong. Transport. February 4, 2021. Accessed 28 Aug, 2022. https://www.legco.gov.hk/research-publications/english/2021issh17-bicycle-friendly-policy-in-hong-kong-20210204-e.pdf

Therefore, the introduction has been revised “According to Research Office Legislative Council Secretariat [3], the total length of cycle tracks in Hong Kong increased from 206.8 km in late 2011 to 225.2 km in early 2020, representing a nearly 9% increase. In addition, the government plans to build an additional 104.6 km of cycle tracks in the foreseeable future. Despite Hong Kong is also seeking a move to become more bicycle-friendly like other regions [2] by building and extending cycle paths, Hong Kong had a low bicycle usage (i.e., percentage of people using bicycles in everyday life in each city) of 0.5% compared with its regional counterparts [3].”

Point raised by Reviewer #1: C03

Opening paragraph seems to unnecessarily bounce between international and Hong Kong.

Response by author

Accepted the comments and revised the opening paragraph.

Line 56 – 71, Para 1.

Point raised by Reviewer #1: C04

How do the 10 countries in the study of adults who do not know how to cycle relate to Hong Kong. In other words, what indicates that it is similar for Hong Kong.

Response by author

Accepted the comments and revised the sentences to make it clear.

“However, recent data noticed that an average of 9.7% of the total population in 10 countries do not know how to cycle [2]. According to Research Office Legislative Council Secretariat [3], the total length of cycle tracks in Hong Kong increased from 206.8 km in late 2011 to 225.2 km in early 2020, representing a nearly 9% increase. In addition, the government plans to build an additional 104.6 km of cycle tracks in the foreseeable future. Despite Hong Kong is also seeking a move to become more bicycle-friendly like other regions [2] by building and extending cycle paths, Hong Kong had a low bicycle usage (i.e., percentage of people using bicycles in everyday life in each city) of 0.5% compared with its regional counterparts [3].”

Point raised by Reviewer #1: C05

Review entire document for English readability. Example: “These parents are difficult to coach their children to cycle which would lead to fewer individuals being able to cycle in a generation”

Response by author

The entire document has been revised for English readability.

E.g., Line 69 – 84

“Learning to cycle independently is a common rite of passage for children, often taught by their parents as they approach school age. In recent years, the average age for achieving this milestone has decreased. Children born between 2000–2019 now learn to cycle independently at an average age of 5.22 y, compared to 5.68 y for those born between 1980–1999 and 6.21 y for those born between 1960–1979 [2]. This trend can be attributed to the increasing availability of dedicated cycling tracks and child-size-friendly bicycles, which make it easier for children to learn at an earlier age. However, some parents may face challenges teaching their children to cycle due to concerns about their own cycling safety [4]. A recent cycling study in Hong Kong found that 15.6% of parents do not know how to ride a two-wheel bike [5], which can limit their ability to teach their children to cycle. For many individuals, not being able to cycle independently as an adult can often be tracked back to ineffective learning approaches [6] or insufficient childhood playtime with parents [2]. Negative learning experiences, such as falling while learning on a two-wheel bike, can discourage them from continuing to learn. Similarly, using a bicycle with training wheels can also be ineffective in acquiring essential cycling skills and stability [7], and may delays the age at which individuals learn to cycle independently [6]. However, in recent years, balance bikes have become a popular alternative to overcome these challenges. These bikes lack pedals and allows rider to walk or sprint while seated [8], making it easier to acquire the necessary skills and improve cycling stability. In fact, studies have shown that a balance bike can be more effective in helping riders learn the essential skill of maintaining balance on two wheels, compared to bikes with training wheels that focus on pedalling skills [6, 7]. With the right support, including access to affordable, appropriately sized adult balance bikes and effective learning design, individuals of all ages can overcome these barriers and learn to cycle independently.”

Point raised by Reviewer #1: C06

Line 75: explain the relevance of later cycling learning ages to the present study.

Response by author

We revise the sentences to make it clear.

“…This trend can be attributed to the increasing availability of dedicated cycling tracks and child-size-friendly bicycles, which make it easier for children to learn at an earlier age. However, some parents may face challenges teaching their children to cycle due to concerns about their own cycling safety [4]. A recent cycling study in Hong Kong found that 15.6% of parents do not know how to ride a two-wheel bike [5], which can limit their ability to teach their children to cycle.”

Point raised by Reviewer #1: C07

Line 76: how are these barriers relevant to current study – use of balance bike as an adult”

Response by author

The paragraph has been revised.

“…However, in recent years, balance bikes have become a popular alternative to overcome these challenges. These bikes lack pedals and allows rider to walk or sprint while seated [8], making it easier to acquire the necessary skills and improve cycling stability. In fact, studies have shown that a balance bike can be more effective in helping riders learn the essential skill of maintaining balance on two wheels, compared to bikes with training wheels that focus on pedalling skills [6, 7]. With the right support, including access to affordable, appropriately sized adult balance bikes and effective learning design, individuals of all ages can overcome these barriers and learn to cycle independently.”

Point raised by Reviewer #1: C08

Line 100: I’m not sure that balance bike should be considered an emerging tool. They have been around for a long time, however they may be growing in popularity.

Response by author

We agree the observation and has been revised the sentences.

Point raised by Reviewer #1: C09

Line 105: oddly phrased: “To the best of our knowledge, it is plausible that adults may feel more comfortable”

Response by author

We revised the sentence as

“In fact, studies have shown that a balance bike can be more effective in helping riders learn the essential skill of maintaining balance on two wheels, compared to bikes with training wheels that focus on pedalling skills [6, 7]. With the right support, including access to affordable, appropriately sized adult balance bikes and effective learning design, individuals of all ages can overcome these barriers and learn to cycle independently.”

Point raised by Reviewer #1: C10

Response by author

Thanks for the comments and the introduction has been revised.

Additional references are also cited in the recent study.

Point raised by Reviewer #1: C11

Methods

I would suggest providing all phase 1 details then phase 2 details rather than going back and forth for different phases of the methods.

Response by author

Thanks for the comments. We consider the suggestions deeply and made some rearrangements to present the study clearly.

Point raised by Reviewer #1: C12

Response by author

Sentences were revised accordingly,

“In Phase 1, the participants’ demographics (i.e., age and gender), anthropometrics (i.e., height and weight), and physical functional capacity (i.e., jump height of countermovement jump [CMJ]) were measured. Following that, the times of completion for two assigned balance bike manoeuvres were recorded.”

Point raised by Reviewer #1: C13

Discussion

Response by author

Thanks for the comments. We tried to revise the discussion in our study to make it clear with evidence support.

“…A similar observation was made in the post-intervention interview where participants reported feeling more comfortable and capable of controlling the bike to glide and turn, and being able to relax their grip on the handlebars during riding after the training intervention.”

Point raised by Reviewer #1: C14

Response by author

At T2, researcher interviewed the participants and video recorded their responses. To clarify this missing procedure, a new section was added in the methods and the results.

“Methods

… At T2, after undergoing an identical physical functional capacity test, participants were verbally interviewed about their perception of the learning experience. They were invited to self-launch and ride a pedal bike to determine whether they could be up-skilled as a cyclist after the balance bike training.”

“Self-perception of the learning experience

“Results

Point raised by Reviewer #1: C15

Line (3)48-50 Statement appears to be about your study, but has an external citation. Review for clarity.

Response by author

We revised the sentences to clarify the message.

“Subsequently, to facilitate the natural balance response and allow it to fully develop, we followed the recommendation of Oddsson [30] and instructed the participants’ instructors to refrain from providing “too early” external support, such as holding onto the handlebar, when the participants lost their balance on a balance bike. By doing so, we aimed to nurture and fully execute the natural balance responses of the participants.”

Point raised by Reviewer #1: C16

Response by author

We consider the suggestion deeply, but we feel that it is important to include a discussion of the design of intervention (i.e., balance bike training programme) in the discussion section.

Some amendment was made in this paragraph to highlight the recommendation to the future studies.

“…However, it is important to recognize the potential influence of cultural differences on cycling behaviour. The recent design of the balance bike training programme focused on simulating cycling scenario on cycling tracks in Hong Kong, including the position of slow and fast lanes, cycling rules, and cycling etiquette. While this training was effective in improving participants’ cycling confidence in these scenarios, future studies in other settings should consider necessary amendments to account for cultural differences and the unique challenges of cycling in different scenarios, like cycling on road. By doing so, participants may be better able to develop cycling confidence needed to navigate a variety of cycling environments.”

Point raised by Reviewer #1: C17

Response by author

We agreed that our study had several limitations, so we added this concern into the discussion. However, consider we have sufficient evidence to know traditional methods may negatively affect the learning of cycle, we made the sentences as,

“...Secondly, the study only included a one-group sample to test the intervention, which did not allow for a direct comparison to other training approach of learning to cycle, such as free play riding. A future study that includes a control group using different methods would be useful to compare the effectiveness of the balance bike intervention to other established methods.”

Reviewer #2

Point raised by Reviewer #2 C01

General Comments:

The manuscript addresses a very interesting and current topic, it presents an intervention program to learn to cycle in adults, which also brings innovation.

Response by author

Thanks for the comments. We revise the manuscript to address the suggestions.

Point raised by Reviewer #2 C02

Introduction

Response by author

Sentences in Introduction section has been revised.

“These bikes lack pedals and allows rider to walk or sprint while seated [8], making it easier to acquire the necessary skills and improve cycling stability.”

In the discussion, we added,

“…It could be because cyclists tended to glide the balance bike, while non-cyclists tended to walk with the balance bike [8]. These patterns (i.e. walk, run, glide) have been previously categorized in a study where it was found that as riding speed on a balance bike increased, the frequency of foot contact with the ground decreased and locomotor modes with longer flight phases began to emerge [8].”

Point raised by Reviewer #2 C03

Line 84 – please include a reference.

Response by author

References had been added.

Point raised by Reviewer #2 C04

Response by author

Agree the comment. Reference had been replaced.

“Riding on a balance bike has been proven to be an effective method for positively transferring the skills needed to learn how to cycle [9].”

Point raised by Reviewer #2 C05

Response by author

To clarify the meaning, the sentences had been revised.

“Learning to control a balance bike is attainable, and even preschool children with varying fundamental motor skill level could improve the capacity of balance bike control with eight weeks of free play on a balance bike [12]. Moreover, a higher volume of practice, known as motor skill engagement (MSE), on a balance bike led to more improvement in balance bike skills [12].”

Point raised by Reviewer #2 C06

Response by author

Thanks for the comments. We had revised the sentence to refine the message.

Point raised by Reviewer #2 C07

Methods

Lines 137-139 - Please explain the reasons for the definition of the criterion cyclist/non-cyclist. The ability to brake safely was not considered, why?

Response by author

To clarify the definition, a new section was added before Participant section,

“Study design

In this study, participants were classified into two groups: cyclist group and non-cyclist group. Studies typically identified three criteria for independent cycling: the ability to self-launch, riding a bike continuously for a certain distance, and braking without assistance [9]. However, the combination of criteria varied across studies. Since braking using the handlebar is not part of a balance bike’s design, participants in this study who were able to self-launch and ride a pedal bike for 5 minutes continuously were classified as the cyclist group, while those who were unable to do that were classified as the non-cyclist group.”

Point raised by Reviewer #2 C08

Response by author

We agreed that our study had several limitations, so we added this concern into the discussion.

“…Firstly, the sample size was relatively small, which may limit the generalizability of the findings to other populations. Future studies with larger sample sizes would be beneficial to confirm the validity of the results and increase external validity. Additionally, the recruitment of adult participants was difficult, possibly due to concerns about their capability to learn to ride a balance bike and potential embarrassment about not being able to so. This may have affected the generalizability of the results. Future studies could explore ways to address these concerns and increase participation rates among adults, such as providing additional support and encouragement to participants or offering incentives to participate.”

Point raised by Reviewer #2 C09

Lines 163-178 - It is mentioned in the

introduction that one of the objectives is to develop an intervention programme with the balance bike for adults.

However, this presentation of the programme only identifies a guiding principle (dual-task). How did this development process take place? Who developed it, a motor learning specialist? It is also mentioned that the observational study (phase 1) supports the development of the programme, how? Can you give some practical examples?

Response by author

We clarified the message in two sections

“Methods

Balance bike training programme development

“Results

Phase 1: Balance bike training programme development

The balance bike programme was based on five principles: riding speed, gliding to turn, cycling confidence, high MSE, and a dual-task approach. Each session was tailored to participants’ riding abilities, and an instructor-to-participant ratio of 1: 2 to 1: 4 was used regarding the participants’ availability. The training approach used an authentic learning approach that presented challenges resembling real-world scenarios. Table 1 provides an overview of the balance bike intervention framework…

… The programme was designed as a series of challenges that simulated different scenarios encountered on cycling tracks, such as navigating traffic chaos or taking turns leading the group, to encourage participants to adapt to unexpected situations for better cycling stability.”

Point raised by Reviewer #2 C10

Response by author

We clarified the message in the

“Results

Phase 1: Balance bike training programme development …

Given faster times of completion of 15m sprint and two-turn curved sprint in cyclist, the programme emphasized riding speed and gliding to turn throughout the programme. Participants were encouraged to practice the route as much as possible during the standardized 20-minute session to achieve a longer travelling distance or more successful completion of task. At the end of each session, the instructor shared the distance travelled by each participant using cycle computer, allowing participants to track their progress over time.

Due to the previous poor cycling experience of adult non-cyclist, autonomy support and mastery of the skills were the key variable for their active participation (i.e., MSE) with confidence, participants had the freedom to choose the speed, skill, and level of participation, including when to stop at rest area or use the overtaking lane. The instructor encouraged participants to ride as fast as they could, but also provided acceptance to participants who preferred to ride at their own pace, even if it was slower, with the aim of ensuring that participants felt comfortable and in control of the bike while also pushing themselves to improve their performance.”

Point raised by Reviewer #2 C11

Response by author

We support the suggestions and revised the sentences in the discussion section.

“It could be because cyclists tended to glide the balance bike, while non-cyclists tended to walk with the balance bike [8]. These patterns (i.e. walk, run, glide) have been previously categorized in a study where it was found that as riding speed on a balance bike increased, the frequency of foot contact with the ground decreased and locomotor modes with longer flight phases began to emerge [8].”

Point raised by Reviewer #2 C12

Response by author

Riding speed was taken into account and emphasized a high priority during the training session. We revised the sentences in “Motor-skill engagement (MSE) on a balance bike” to highlight this important message.

“Results

Phase 1: Balance bike training programme development …

Point raised by Reviewer #2 C13

Lines 201-202 – Please introduce a reference.

Response by author

The sentences had been revised and two references were cited.

“The seat height of the bike was then adjusted to fit each participant’s body, enabling them to place both feet on the ground with slightly bent hips and knees [12, 17]. This position allowed for proper extension of the hip and knee joints when propelling themselves forward.”

Point raised by Reviewer #2 C14

Line 208 - Please clarify if this scale has been validated/used in any other previous studies or if it was developed for the present manuscript.

Response by author

We have revised the section.

“Previous studies have used self-report cycling confidence to examine the effectiveness of cycling training among adults [19, 20]. In this study, cycling confidence was assessed verbally after each of the eight training sessions and the two testing sessions (i.e., T1 & T2), resulting in a total of 10 recorded confidence scores. Participants were asked to rate their confidence to ride a pedal bike on a five-point Likert scale (1 = not confident; 2 = slightly confident; 3 = somewhat confident; 4 = fairly confident; 5 = very confident).”

Point raised by Reviewer #2 C15

Lines 217-223 - Please clarify "positive transfer" by supporting it with references.

What criteria are used for the distinction between "quick positive motor skill transfer" "late positive motor skill transfer" and "zero transfer"? These criteria for distinction should be clarified and supported by references.

Response by author

Our original thought is to use a self-designed time frame to define “the speed of learning in transfer of learning”. However, we understand that this definition does not have sufficient evidence to support, therefore, we decided to report the time intervals of successful transfer only.

“Cycle Independently

… The time taken by participants to cycle independently was recorded and reported, in 15-minute intervals: below 15 minutes, 16 to 30 minutes, 30 to 45 minutes, and 45 to 60 minutes. The trial had a maximum time limit of 60 minutes.”

“Results

Phase 2: Assessment for balance bike Intervention

… Out of the eleven participants, eight were able to self-launch and ride a pedal bike continuously within 15 minutes, while the remaining three were able to cycle independently within 16 to 30 minutes (n = 1) and 45 to 60 minutes (n = 2).”

Point raised by Reviewer #2 C16

Discussion

Response by author

We try to clarify the reason in the discussion

“…While a systematic review and meta-analysis have shown correlations between measures of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan…”

Point raised by Reviewer #2 C17

293-295 – Please clarify this sentence, I was not able to understand it meaning.

Response by author

We revised the sentences to explain how we use the Bayes factor to indicate the efficacy of the selected balance bike test on distinguishing cyclist and non-cyclist in adults.

“In this study, we presented compelling evidence to support the efficacy of the two balance bike tests in distinguishing and assessing healthy adults with different cycling backgrounds on novel motor skills. We found that the balance bike testing results were 4.39 to 7.25 times more likely under the alternative hypothesis (H1) than under the null hypothesis (H0), yielding very strong evidence in favor of the alternative hypothesis.”

Point raised by Reviewer #2 C18

297 - It mentions "one of our 4 hypotheses", I cannot find the clear presentation of the hypotheses in the text.

Response by author

Thanks for the comments. We revised the statement to make it clear.

“Our study revealed that cyclists had significantly faster completion times than non-cyclists on the 15 m sprint and the two-turn curved sprint, with times of 1.89 s and 3.31 s respectively. These findings support our hypotheses that cyclists would demonstrate superior performance in riding and controlling a balance bike when compared to non-cyclists.”

Point raised by Reviewer #2 C19

331 - They address the strengths of the

intervention programme presented. What are its weaknesses?

Please identify above (in the programme description) what the participant/instructor ratio is.

We made some amendments in the discussion.

To clarify the participant/instructor ratio, we made clarification in the results section.

“Results

Phase 1: Balance bike training programme development

Point raised by Reviewer #2 C20

333 – “Training should be a task-specified and multi-faceted approach.”

I personally fully agree with this statement. But it should not be presented without contextualisation, that is, what is the theoretical or conceptual basis that supports it? This should be the same as that which supports the development of the programme and which, until now, has been omitted.

Response by author

Citation is added and sentences were revised to clarify the message.

“Our original balance bike training programme had several strengths. We recognized that simply engaging in general training, such as strength training, is insufficient to improve balance function [30]. In order to maximize the transfer of learning and promote effective skill acquisition in real-world scenarios [11], a task-specified and multi-faceted approach is necessary. This approach was similar with Harper et al.’s perspective on learning in balance recovery intervention .... However, a multi-faceted approach is needed for far transfer to apply these skills to real-world cycling scenarios. This includes navigating turns and obstacles on a cycling track, as well as maintaining control over their riding path when encountering other riders.”

Point raised by Reviewer #2 C21

Response by author

In recent study, we did not measure the lateral deviation, so we revised the sentences to make it clear and concise.

Point raised by Reviewer #2 C22

346-348 - The fear of falling is identified in literature as one of the biggest barriers to learning to cycle on a traditional bicycle, strengthen this sentence with literature references.

Response by author

We tried to strengthen this sentence as,

“As noted in a previous systematic review [9], fear of falling is the biggest barrier to learning to cycle. However, our recent study found that most participants were able to reduce their fear of falling by regaining balance on the balance bike through the use of their feet and having greater control over their riding speed. This suggests that balance bike training can be effective method for reducing fear of falling not just for children and youth riders, but also for adult riders.”

Point raised by Reviewer #2 C23

358 – “Real-world situations”? Did the programme include a component of cycling on the road with car traffic?

Response by author

In this study, the cycling scenario focused on the real-world situations on cycling track in Hong Kong, we modified the sentences to clarify it in the discussion.

Point raised by Reviewer #2 C24

Response by author

Thanks for your comments. While we acknowledge the importance of physical activity in learning to cycle, we have decided to keep our focus on the limitations of study design and small sample size.

Point raised by Reviewer #2 C25

Another major limitation was not controlling for participants' prior experience on various bicycles. We do not know if the previous experience influenced the type of transfer found "quick positive motor skill transfer" "late positive motor skill transfer" and "zero transfer", however, considering that learning can be seen as the sum of experiences, we can assume that yes. This weakness should be presented and discussed.

Response by author

“Cycle Independently

“Results

Phase 2: Assessment for balance bike Intervention

“Discussion

… Secondly, the lower threshold of MSE for transferring stability skills from a balance bike to a two-wheel bike was not established in our study, as all non-cyclists in this study were able to cycle after the balance bike training. Some participants even accumulated over 10.5 km of riding distance (i.e., high MSE) after only six sessions. If a future study could recruit a large sample size with varied MSE and ability to gain cycling skills, more information could be discovered to shorten the training duration. Thirdly, the lack of strict control over the physical activity background of the participants in this study may have contributed to the heterogeneity of participants’ backgrounds. Future studies should measure and control physical activity levels to include a more diverse population and make the findings more generalizable.”

Point raised by Reviewer #2 C26

392 – “Extreme evidence” based on a study of only 11 adults is abusive. please reconsider the use of this expression.

Response by author

We apologize this inaccurate expression and revised to,

“This study provides valuable evidence for the effectiveness of balance bike tests and a novel balance bike intervention in teaching adults how to ride a bike…

…this study provides valuable initial evidence and highlights the potential of the balance bike intervention as a useful tool for teaching cycling skills to adults.”

Point raised by Reviewer #2 C27

393 – How did you arrive at these 5 principles? This is a discussion to complement the discussion section.

Response by author

We try to explain it in the results

“Phase 1: Balance bike training programme development

The balance bike programme was based on five principles: riding speed, gliding to turn, cycling confidence, high MSE, and a dual-task approach…”

Reviewer #3

Point raised by Reviewer #3 C01

This manuscript proposes to study the transfer of skills between balance cycling and pedaling in adults.

The authors are to be congratulated for the methodological rigor they try to imprint in this study, however some questions arise as you read:

Response by author

Thanks for the recognition and we are going to revise the manuscript to address the suggestions.

Point raised by Reviewer #3 C02

Response by author

A paragraph has been revised and described in the Introduction section.

“The transfer of learning refers to the concepts that skills acquired during practice can be applied to other situations [11]. For example, if an individual learns to balance on a balance bike, they may be able to transfer that skill to riding a two-wheel bike. This is because the balance bike has helped them develop the necessary balance and coordination skills required to ride a two-wheel bike. Positive transfer occurs when the skills learned on the balance bike improve the individual's ability to a new but similar task, riding on a two-wheel bike [6]. On the other hand, negative transfer occurs if the skills learned on the bike with training wheels actually hinder the individual's ability to learn [6, 9]. Zero transfer would occur if the skills learned on a balance bike have no effect on their ability to ride a pedal bike.”

Point raised by Reviewer #3 C03

Response by author

Sentences had been added to clarify the concern,

“…if an individual learns to balance on a balance bike, they may be able to transfer that skill to riding a two-wheel bike. This is because the balance bike has helped them develop the necessary balance and coordination skills required to ride a two-wheel bike.”

Point raised by Reviewer #3 C04

In the Methods section - The bicycle being the means to test the transfer, the difference between the bicycles used for each condition is not explained.

Response by author

Sentences in “Cycle Independently” were revised,

“At the end of the balance bike training programme, participants were invited to ride a 20-inch conventional pedal bike, which was of the same size as the balance bike used in the training.”

Point raised by Reviewer #3 C05

- In the Methods section, ln. 117-118 - the characteristics of each phase are presented. In phase 2, what is the rationale for choosing 8x20-minutes? Why not more or less time or sessions?

Response by author

We discussed the rationale and benefits of our programme design in “Discussion” section

“Compared to previously published cycling training programmes that range from 135 [32] to 270 minutes [5], our study took a mid-range approach, with an accumulated training time of 160 minutes. This duration is relatively short, which is important since lack of time is a commonly reported barrier to engaging in structured exercise [33]. Accumulating multiple short bouts of exercise has been shown to provide similar health and fitness benefits as longer continuous exercise modes [34, 35]. Additionally, short bouts of exercise provide more opportunities for individuals to fit exercise into a busy day. Our recent multiple-short bouts design allowed participants to have a time-efficient programme that could potentially maintain high motivation and reduce the accumulation of physical and mental fatigue and burden on the participants.”

Point raised by Reviewer #3 C06

- In the Methods section, ln. 142 - anthropometric measurements were performed. What measurement protocols were used?

Response by author

A paragraph was added to clarify the information.

“Anthropometrics

Point raised by Reviewer #3 C07

What expertise does the measurer have?

Response by author

To clarify the information, sentences in Methods were revised.

“The confidentiality of participants’ information Participants’ was ensured both during and after the data collection process. Additionally, all measurements were carried out by an experienced sports scientist, with the support of a research assistant in an indoor multi-game court to ensure accuracy and consistency. The STROBE checklist is available to the reader as S2.”

Point raised by Reviewer #3 C08

Response by author

In this study, we use CMJ test to assess physical functional capacity in our recent adult population. We found no difference on CMJ jump height between two groups in Phase 1, and we suggested that it is not related to the cycling capacity.

“Large differences in effect size have been observed in both straight and two-curved turn sprints, but lower limb muscle-related performance on the CMJ test is not found to be related to cycling capabilities. While a systematic review and meta-analysis have shown correlations between measures of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan … may not fully reflect the unique balance strategy and control required for cycling.”

Point raised by Reviewer #3 C09

- In the Methods section, ln. 166 - "Challenge-Taking Course." A schematic/image illustrating the course would be welcomed. This allows the principle of replicability to be guaranteed.

Response by author

A figure was added.

Fig. 3. A schematic image illustrating the common setting of the challenge course.

Point raised by Reviewer #3 C10

- In the Methods section, ln. 172 - "Solve real-world challenges": Which ones? How were they simulated in this situation?

Response by author

We made clarification and examples to make the description clear.

“Results

Phase 1: Balance bike training programme development

To challenge participants’ cycling stability, the training programme included activities that involved riding a balance bike while performing additional tasks (i.e., dual-task approach) that required executive functions [25], such as visual scanning to find a moving target or delivering an object with one hand when riding. The programme was designed as a series of challenges that simulated different scenarios encountered on cycling tracks, such as navigating traffic chaos or taking turns leading the group, to encourage participants to adapt to unexpected situations for better cycling stability.”

Point raised by Reviewer #3 C11

Response by author

Description was revised and reference was added.

“To ensure that participants could comfortably and safely balance on the bike during testing, they were ample time to become familiar with a 20-inch balance bike and the testing setup. The seat height of the bike was then adjusted to fit each participant’s body, enabling them to place both feet on the ground with slightly bent hips and knees [12, 17]. This position allowed for proper extension of the hip and knee joints when propelling themselves forward.”

Point raised by Reviewer #3 C12

Response by author

“Cycle Independently

“Results

Phase 2: Assessment for balance bike Intervention

Point raised by Reviewer #3 C13

- In the Results section, ln. 266 - The authors indicate that confidence in cycling was assessed across sessions.

What results come from this...is there a session that shows a jump in confidence in bicycling?

I recommend statistical treatment of these data.

Response by author

To clarify the methods for cycling confidence, the sentences in “Cycling Confidence” were revised.

Accepted the recommendation to make a statistical treatment to determine the change of cycling confidence before and after the training programme. Therefore, new sentences were added in the data analysis and results.

“A Bayes factor for related-sample t test was used to determine the changes of cycling confidence at post-test (T2) compared to the pre-test level (T1).”

“According to the verbal survey conducted during Phase 2 of the study, participants reported feeling fairly to very confident with a score of cycling confidence: 4.45 ± 0.52 about riding a pedal bike after all training sessions. At the end of the study (T2), there was a significant increase in participants’ cycling confidence compared to that at T1 with a difference of 3.09 ± 0.83 (BF01 <0.001, p < 0.001, d = 3.72). Out of the eleven participants, eight were able to self-launch and ride a pedal bike continuously within 15 minutes, while the remaining three were able to cycle independently within 16 to 30 minutes (n = 1) and 45 to 60 minutes (n = 2).”

Point raised by Reviewer #3 C14

- In the Results section, ln. 303 - Was stability assessed in any way across sessions? No reference to such an evaluation appears, which makes the use of this term abusive.

Response by author

In that line (original line 303), it is a section for Discussion. The sentence is to highlight that cycling is a standalone motor skill that is derived from fundamental skill.

Attachment

Submitted filename: PONE-D-23-13359_Point-by-Point-Response.docx

pone.0298142.s003.docx^{(64.7KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0298142.r003

Decision Letter 1

Bojan Masanovic

24 Nov 2023

PONE-D-23-13359R1

Positive Skill Transfer in Balance and Speed Control from Balance Bike to Pedal Bike in Adults: A Multiphase Intervention Study

PLOS ONE

Dear Dr. Chow,

Please submit your revised manuscript by Jan 07 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Bojan Masanovic, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #4: All comments have been addressed

Reviewer #5: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: No

Reviewer #4: Yes

Reviewer #5: Yes

**********

6. Review Comments to the Author

Reviewer #1: The authors addressed many concerns adequately. However, some issues remain insufficiently addressed. Further proof reading is needed.

Abstract –

Avoid inflated language like “extreme” evidence, let the data speak for the impact.

Introduction – I suggest simplifying the background to be more directly related to your study purpose and outcomes. For example, you provide information about parents teaching children to ride, however, this is not a purpose or outcome of your study, so it is not relevant.

Also, is there evidence to suggest that increased cycle track miles have results in earlier learning. I do not see evidence of a cause-and-effect relationship.

Line 84, be more specific of what challenges balance bikes have helped to overcome. It does not seem like they overcome all the challenges listed before this statement.

Introduction can be examined to improve flow

Reviewer #4: I think that this study is original and that the results can contribute to practical application, and given results could be used for future reasrch on the same topic

Reviewer #5: very interesting study, and very current, considering that it includes elderly people.

A couple of suggestions:

- the tables should be formatted exactly the same way (table 1 and the same table)

- the title of the table should be (in one table it is bold, and in the other table it is not)

- Hypotheses are mentioned in the Discussion (paragraph 381-385), but I did not notice that the hypotheses were mentioned in the Method.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #4: No

Reviewer #5: No

**********

PLoS One. 2024 Feb 29;19(2):e0298142. doi: 10.1371/journal.pone.0298142.r004

Author response to Decision Letter 1

27 Nov 2023

Reviewer #1 - Comment #1:

The authors addressed many concerns adequately. However, some issues remain insufficiently addressed. Further proof reading is needed.

Response to Reviewer #1 - Comment #1:

We made further proof reading and provided our best effort to address the concerns. Please find the point-to-point response below:

---

Reviewer #1 - Comment #2:

Abstract –

Avoid inflated language like “extreme” evidence, let the data speak for the impact.

Response to Reviewer #1 - Comment #2:

The abstract has been updated according to the comment, we agree to “let the data speak the impact”.

Line 37 – 40 “…with Bayes factor analyses providing evidence of this difference, BF01 = 0.228 in the 15 m sprint test and BF01 = 0.138 in the two-turn curved sprint test. The novel training programme in Phase 2 remarkable effectiveness in improving their balance bike riding performance…”

Line 44 – 45 “…It provides extreme evidence that healthy adults can learn to ride independently with the help of a balance bike, a tool that's commonly used for teaching children…”

Besides, to clarify the interpretation of Bayes Factor, a paragraph in data analysis has been updated and a updated reference was added.

Page 14, line 286 – 292

“The strength of the evidence for the null hypothesis against the alternative hypothesis (or models) can be expressed as a Bayes Factor (BF01), which is an odds ratio. The size of BFs can be interpreted as providing anecdotal (BF01 = 1/3–1), moderate (BF01 = 1/10–1/3), strong (BF01 = 1/30–1/10), very strong (BF01 = 1/100–1/30), and extreme (BF01 < 1/100), in favour of alternative hypothesis compared to null hypothesis [2320, 21]. Evidence for the null hypothesis was set as anecdotal (BF01 = 1–3), moderate (BF01 = 3–10), strong (BF01 = 10–30), very strong (BF01 = 30–100), and extreme (BF01 > 100) [20, 21].”

New reference:

Kelter R. “Bayesian alternatives to null hypothesis significance testing in biomedical research: A non-technical introduction to Bayesian inference with JASP. BMC Med. Res. Methodol. 2020;20(1): 142, https://doi.org/10.1186/s12874-020-00980-6.

---

Reviewer #1 - Comment #3:

Also, is there evidence to suggest that increased cycle track miles have results in earlier learning. I do not see evidence of a cause-and-effect relationship.

Response to Reviewer #1 - Comment #3:

We agree to simplify the introduction.

Line 62 – 72

“…Learning to cycle independently is a common rite of passage for children… potentially delaying the age at which individuals learn to cycle independently [3].”

Therefore, the reference list is also updated.

Page 30 – 35

---

Reviewer #1 - Comment #4:

Line 84, be more specific of what challenges balance bikes have helped to overcome. It does not seem like they overcome all the challenges listed before this statement.

Introduction can be examined to improve flow

Response to Reviewer #1 - Comment #4:

Thanks for the comments. We revised the paragraph and clarified what challenges were.

Line 73

“In recent times, balance bikes have emerged as a popular alternative to overcome the challenges associated with traditional learning approaches for cycling. These challenges primarily involve ineffective methods and negative experiences. Balance bikes, which lack pedals and allows rider to walk or sprint while seated [5], offer a more intuitive and effective way to acquire skills and improve cycling stability. In fact, studies have shown that balance bikes are more effective in helping riders learn the essential skill of maintaining balance on two wheels compared to bikes with training wheels, which prioritize on pedalling skills [3, 4]. With the right support, including access to affordable, appropriately sized adult balance bikes, along with effective learning design, individuals of all ages can overcome these barriers and learn to cycle independently.”

---

Reviewer #4 - Comment #1:

I think that this study is original and that the results can contribute to practical application, and given results could be used for future reasrch on the same topic

Response to Reviewer #4 - Comment #1:

Thanks for the positive comments.

---

Reviewer #5 - Comment #1:

very interesting study, and very current, considering that it includes elderly people.

Response to Reviewer #5 - Comment #1:

Thanks for the positive comments.

---

Reviewer #5 - Comment #2:

A couple of suggestions:

- the tables should be formatted exactly the same way (table 1 and the same table)

- the title of the table should be (in one table it is bold, and in the other table it is not)

Response to Reviewer #5 - Comment #2:

Table 1 and 2 had been updated.

Page 15, line 286

Page 16, line 297 – Page18, line 301

---

Reviewer #5 - Comment #3:

- Hypotheses are mentioned in the Discussion (paragraph 381-385), but I did not notice that the hypotheses were mentioned in the Method.

Response to Reviewer #5 - Comment #3:

The hypotheses were added to the Method.

Page 9, line 172 – 179

“Based on the available literature, the following hypotheses have been derived concerning cycling experience and the effectiveness of the balance bike training intervention: Hypothesis 1: It is anticipated that individuals with prior cycling experience, referred to as cyclists, will display superior performance in riding and controlling a balance bike compared to individuals without prior cycling experience, referred to as non-cyclists. Hypothesis 2: Non-cyclists who undergo the balance bike training intervention will demonstrate enhanced performance in balance bike tests and experience an increase in confidence levels when riding a two-wheel bike after engaging in practice with a balance bike.”

Attachment

Submitted filename: PONE-D-23-13359_Point-by-Point-Response_231128.docx

pone.0298142.s004.docx^{(31.7KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0298142.r005

Decision Letter 2

Bojan Masanovic

21 Jan 2024

Positive Skill Transfer in Balance and Speed Control from Balance Bike to Pedal Bike in Adults: A Multiphase Intervention Study

PONE-D-23-13359R2

Dear Dr. Chi Ching, Gary Chow,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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Kind regards,

Bojan Masanovic, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The rematch lasted several laps.

It was difficult to bring it to an end.

Some reviewers did not respond later.

The authors have worked diligently and I think that in the end they deserve to have the manuscript published.

I think that the quality of this manuscript has reached the level of publication in Plos One journal.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #5: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #5: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #5: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #5: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #5: Yes

**********

6. Review Comments to the Author

Reviewer #1: The authors have done a nice job addressing remaining comments from all reviewers. The article addresses an important gap in the literature.

Reviewer #5: The topic is very interesting. Also, the work can serve as motivation for certain study programs and curricula. In addition, this scientific work is methodologically well-conceived and appropriate statistical procedures were used. In the chapter provided for the methodology, the methods of research implementation are explained in detail. The results of the research are clearly presented in tables. The discussion could have been more extensive, given the scope of the work, but this is not a crucial complaint.

In the work, the authors consulted contemporary and adequate literature, including 75 library units.

After the corrections, I am satisfied with the final version of the paper.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #5: No

**********

PLoS One. doi: 10.1371/journal.pone.0298142.r006

Acceptance letter

Bojan Masanovic

21 Feb 2024

PONE-D-23-13359R2

PLOS ONE

Dear Dr. Chow,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

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on behalf of

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Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Appendix. STROBE checklist.

(DOCX)

pone.0298142.s001.docx^{(42.1KB, docx)}

S2 Appendix. Dataset for adult balance bike.

(XLSX)

pone.0298142.s002.xlsx^{(14.5KB, xlsx)}

Attachment

Submitted filename: PONE-D-23-13359_Point-by-Point-Response.docx

pone.0298142.s003.docx^{(64.7KB, docx)}

Attachment

Submitted filename: PONE-D-23-13359_Point-by-Point-Response_231128.docx

pone.0298142.s004.docx^{(31.7KB, docx)}

Data Availability Statement

All relevant data are within the manuscript.

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PERMALINK

Positive skill transfer in balance and speed control from balance bike to pedal bike in adults: A multiphase intervention study

Gary C C Chow

Sophia C W Ha

Roles

Abstract

Background

Purpose

Methods

Results

Conclusions

1. Introduction

2. Methods

Fig 1. Flowchart of this multi-phase intervention study.

Study design

Anthropometrics

Physical functional capacity

Balance bike testing

Fig 2.

Cycling confidence

Self-perception of the learning experience

Cycle independently

Balance bike training programme development

Motor-skill engagement (MSE) on a balance bike

Data analysis

3. Results

Phase 1: Assessments between cyclists and non-cyclists

Table 1. Balance bike performance and jump height in Phase 1 and Phase 2.

Phase 1: Balance bike training programme development

Table 2. Brief description of 8 × 20-minute balance bike training programme.

Fig 3. A schematic image illustrating the common setting of the challenge course.

Phase 2: Assessment for balance bike intervention

Fig 4. Distance travelled and cycling confidence across the 8 × 20-minute balance bike training programme.

4. Discussion

5. Conclusion

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Bojan Masanovic

Roles

Author response to Decision Letter 0

Decision Letter 1

Bojan Masanovic

Roles

Author response to Decision Letter 1

Decision Letter 2

Bojan Masanovic

Roles

Acceptance letter

Bojan Masanovic

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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