A bridge over the river of sedentary behaviour: Passive exercise as a path to better health

The growing burden of physical and neurological disease poses a global challenge to patient health and greater society. Modifiable risk factors, such as engaging in regular physical activity (PA), have been identified and may alleviate these burdens. Despite updated international guidelines which recommend regular PA, especially planned and structured forms referred to as exercise, actual uptake of PA remains low. To address this, previous work has outlined a step-wise framework aimed at promoting engagement in PA wherein individuals gradually transition into low-intensity exercise before progressing to higher intensities. Notably, the transition into exercise may still be too much for individuals with chronic conditions and/or those with movement-impairing symptoms. For these individuals, we recommend passive exercise (i.e., movement independent of volitional muscle activation; e.g., motorized cycle ergometry) as an intermediate and preliminary step between sedentary behaviour and active exercise (i.e., volitional movement). Passive exercise has long been used as a rehabilitative technique following injury; however, its utility in other contexts such as pre-rehabilitation, behavioural change, and the promotion of brain health, is under-explored. Accordingly, this article first outlines examples of how passive exercise supports rehabilitation strategies, before describing a modified step-wise framework for the promotion of PA. We conclude by providing examples of how passive exercise can effectively support and optimise overall health in select populations.