Under-desk movement for akathisia relief: A promising coping strategy
This article draws on research from Taubert & Back (2007), "The Akathisic Cyclist - An unusual symptomatic treatment," presented at the 10th Congress of the European Association for Palliative Care.
For those experiencing akathisia—that tormenting inner restlessness often requiring continuous movement—finding practical ways to incorporate movement into daily life can be essential. Under-desk treadmills, bicycles, and ellipticals may offer promising solutions for those struggling to balance their need for constant movement with daily responsibilities.
The clinical evidence
Taubert and Back (2007) documented a remarkable case that demonstrates the potential of repetitive movement devices for akathisia management. Their patient, a 47-year-old woman with metastatic ovarian cancer, experienced severe akathisia that left her continuously pacing corridors, unable to sit for meals or engage with family. After introducing a simple set of exercise pedals, they observed a profound improvement in her quality of life.
As the researchers noted, this intervention allowed her to "relieve the distressing urge to move, whilst still able to watch television, do crossword-puzzles, speak with relatives and eat meals." This simple solution transformed her experience, making the otherwise unbearable symptoms manageable.
Modern under-desk options
Today's market offers several options that build upon this concept:
Under-desk bicycle pedals most closely match the intervention described by Taubert and Back. These compact devices allow continuous pedaling while seated at a desk or table. They're typically quiet, portable, and adjustable for different resistance levels.
Under-desk treadmills provide another option for those who find walking movements more relieving than cycling. While requiring more space than pedals, they offer a natural walking motion that may help satisfy the urge to pace. For those who use a standing desk setup, a treadmill is an excellent complement, allowing continuous walking while remaining productive with work, reading, or other standing activities. This setup most closely mimics the natural pacing behavior many akathisia sufferers engage in, but in a more structured and productive context.
Under-desk ellipticals combine elements of both, offering fluid motion with adjustable resistance in a relatively compact footprint.
Unconventional alternatives
Beyond traditional under-desk equipment, several innovative and often less expensive options exist:
Bouncy bands originally designed for classroom use, these large elastic bands attach to chair legs, allowing the user to push against them with their feet. This provides both resistance and movement, potentially helping to channel restless energy while seated. The gentle rebounding effect may provide subtle proprioceptive feedback that some akathisia sufferers find calming.
Wobble boards or balance discs placed under the feet create an unstable surface that requires constant micro-adjustments. These subtle movements might help satisfy the need for motion without requiring full-body movement. The continuous weight-shifting engages core muscles while allowing the legs to remain in motion.
Fidget footrests featuring textured surfaces, rolling balls, or rocking mechanisms provide tactile and kinesthetic stimulation while seated. These can be particularly helpful for milder akathisia symptoms or when used in combination with other interventions.
Chair bungees simple elastic cords attached to chair fronts allow for bouncing and stretching movements with the legs. These DIY solutions can be created inexpensively with resistance bands and clips.
Practical implementation
When considering an under-desk movement solution for akathisia, several factors are worth considering:
Noise level: Opt for quieter models if you'll be using them in shared spaces
Size and portability: Consider whether you'll need to move the device between locations
Desk height adjustment: Ensure your desk provides adequate clearance for your knees while using the device
Resistance settings: Look for adjustable options to match your changing needs
Stability: Choose models with non-slip features to prevent shifting during use
Beyond medication management
The significance of Taubert and Back's findings extends beyond the specific case. As they noted, "A literature search found no reference to any such non-drug management of akathisia, and yet the benefit for this patient was profound."
While medication adjustments remain the primary approach to akathisia treatment—typically involving stopping or substituting the offending drugs—physical interventions offer complementary relief that can significantly improve quality of life while those medication changes take effect.
Worth trying
For those struggling with akathisia, especially when it interferes with daily activities requiring sitting, an under-desk movement device might provide meaningful relief. As Taubert and Back concluded, "light, repetitive exercises such as treading exercise pedals could make the unpleasant effects of akathisia more bearable in some patients and that this simple intervention can have a profound effect on a patient's quality of life."
The beauty of these movement-enabling solutions is their simplicity and accessibility. From professionally manufactured equipment to creative DIY alternatives, there are options to suit various budgets and preferences. While more research is needed, the low cost and potential benefit of these approaches makes them worth considering as part of a comprehensive akathisia management strategy.
Reference: Taubert, M. and Back, I. (2007). The Akathisic Cyclist - An unusual symptomatic treatment. Presented at the 10th Congress of the European Association for Palliative Care, Budapest, Hungary, 7-9 June 2007.