Table 1 Summary of included studies

 Bernsten, 2017, Norway [22]

Randomized cross over

N = 8, 25%

Age (Mdn, IQR): 39(3)

BMI (Mdn, IQR): 24(7)

Active adults

E-bike vs. CB (4 conditions, hilly vs. flat terrain)

Trials conducted on same day, 2-min break between trials

Route 1: 8.1 km, flat route

Route 2: 7.1 km, one hill climbed twice 130 m elevation gain. Self-selected intensity

 Gojanovic, 2011, Switzerland [18]

Non-randomized cross over

N = 18, 33.33%

Age: 35.7 (±9.7)

BMI: 24.0 (±3.3)

Inactive adults

E-bike LA vs. E-bike HA vs. CB vs. walking

Trials conducted over 2-days. 30-min break between trials conducted on same day

Biking: 5.1 km, 178 m elevation gain, average gradient 3.4% Instructed to ride at comfortable pace maintaining 60 rpm

Walking: 1.7 km, uphill, 110 m elevation gain, average grade 6.5%

 Hansen, 2017, Belgium [21]

Randomized cross over

N = 17, 13%

Age: 64 (±7)

Coronary artery disease

E-bikes LA vs. E-bike HA vs. CB

Trials conducted on separate days (3–4 days between)

10 km, 102 m elevation change

No traffic or stop and go points

Instructed to cycle at self-selected pace on prespecified mode

 La Salle, 2017, USA [26]

Randomized cross over

N = 12, 50%

Age: M = 25(±1), F = 22(±1)

Body Fat %: M = 16.8(±1.9), F = 23.4 (±3.3)

Active adults with cycling experience

E-bike pedal assist vs. E-bike NA

Trials conducted in same day. Average time between trials 12-min

3.54 km, hill 0.64 km 11% gradient

Seven pedestrian crossings participants required to dismount and walk. Self-selected pace

 Langford, 2017, USA [23]

Non-randomized cross over

N = 17, 35%

Age: < 20 yrs. = 3, 20-30 yrs. = 10, 31-40 yrs. = 2, > 50 yrs. = 2

BMI: M = 26.1, F = 23.1

Adults, part of e-bike sharing system

E-bike vs. CB vs. Walking

Trials conducted on separate days (minimum 24h rest)

4.4 km, 1.6 km downhill (− 33.2 m), 1.8 km flat (− 0.3 m), 1.0 km uphill (+ 33.5 m). Self-selected pace

 Louis, 2012, France [27]

Randomized cross-over

N = 20 (10 T, 10 UT)

Age: T = 38.7 (±14.8); UT 28.9 (±6.3)

BMI: T = 22 (±1.1), UT = 22.2 (±3.7)

Highly active adults (T)

Recreationally active adults (UT)

E-bike NA vs. E-bike LA vs. E-bike HA

Trials conducted on same day. 5-min breaks between trials

Completed on indoor trainer.

Instructed to pedal at specified mode for total of 45-min at pre-specified speeds: 15-min at 16 km/hr., 21 km/hr. and free speed totaling 45-min.

 Meyer, 2014, Germany [28]

Non-randomized cross over

N = 3, 0%

Age: 25, 25, 27

Weight (Kg): 74, 71, 79

Active adults, recreational cyclists

E-bike pedal assist vs. E-bike no assist

Trials conducted on separate days, 1-day apart.

27 km track divided in 5 sections

 Simons, 2009, Netherlands [20]

Non-randomized cross over

N = 12, 50%

Age: 52.2 (8.7), range 32–60

BMI: 24.5 (2.6)

42% inactive adults

58% recreationally active adults

E-bike NA vs. E-bike LA vs. E-bike HA

Trials conducted in same day. One-hour rest between trials.

4.3 km, flat route, two stop and go section participants required to dismount and restart. Self-selected pace on pre-specified intensity

 Sperlich, 2012, Germany [19]

Randomized cross over

N = 8, 100%

Age: 38(±15)

BMI: 25.3 (±2.1)

Inactive adults

E-bike pedal assist vs. E-bike no assist

Trials conducted in same day. One-hour rest between trials.

1.9 km × 5 = 9.5 km, 200 m uphill 1, 5.9%, 700 m downhill, 300 m uphill 2, 5.8%, 700 m flat. Self-selected pace and gear

 Theurel, 2011, France [24]

Non-randomized cross over

N = 22, 18% female

Age: M = 41(±11), F = 34(±9)

Weight (Kg): M = 68(±18), F = 76(±10)

Active postal workers

E-bike vs. CB

Trials conducted on same weekday, 1-month apart

Postal route, one group completed rides in residential neighbourhood, the other completed the ride in downtown location

 Theurel, 2012, France [25]

Non-randomized cross over

N = 10, 50% female

Age: F = 30 (±12), M = 35 (±14)

Active adults

E-bike vs. CB

Trials separated by 1 week

30-min of intermittent cycling on inside track alternating cycling of 10 sec duration and recovery of 20 sec. Aimed to complete 60 m in 10 sec (average speed = 21.6 km/hr)

 Cooper, 2018, UK [32]

Single group feasibility

N = 20 (report on 18)

Age: 58.1 (±7.9)

BMI: 30.2 (4.4)

Type 2 Diabetes

One group e-bike

Up to 5 months

E-bike training provided. Provision of e-bike for up to 5-months. Support for mechanical issues provided. No instruction on how or when to ride bike

 De Geus, 2013, Belgium [29]

Non-randomized cross over

N = 24, 46%

Age: M = 47(±7) F = 43(±6)

BMI: M = 27.0 (±2.8), F = 24.7 (±4.6)

Inactive adults ^a

E-bike vs. Control

Control = 4 weeks

E-bike = 6 weeks

Instructed to ride e-bike at least three times per week to commute to and from work

 Hochsmann, 2017, Switzerland [30]

Pilot randomized controlled trial

N = 32, 13%

Age, (Mdn, IQR): F = 35(34–45), M = 43(38–45)

BMI, (Mdn, IQR) E-bike = 29 (27,31), regular bike = 28 (26,29)

Inactive adults

E-bike vs. CB

4 weeks

Instructed to use bike for active commute to work on at least 3-days per week, over 6 km. Self-selected pace

 Malnes, 2016, Norway [31]

Single group pilot

N = 25, 72%

Age: 42(±12)

BMI: M = 25.4(±12.3), F = 28.7(±15.8)

Inactive adults

One group e-bike

Up to 8 months

3 sites: 2 provided e-bikes for up to 8-months, 1 e-bike up to 3-months.

Instructed to use bike as desired. In 2-centres if e-bikes not used they were withdrawn from participant. Group was separated into high and low fitness groups based on baseline testing

 Page, 2017, UK [33]

Non-randomized two group

N = 31, 80%

Age Range: 21-55 years

Unclear

E-bike commuting vs. passive commuting

Data reported mid-way into intervention – 2 months

No instructions on how to ride bike, full roadside assistance provided.

 Peterman, 2016, USA [13]

Single group

N = 21, 70% (of 20 in analysis)

Age: 41.5 (±11.5).

Inactive adults

One group e-bike

4 weeks

Instructed to ride e-bike at least 3 days per week for at least 40-min for commuting