I have an elderly "compact long wheelbase" recumbent. It came with a 20 inch rear wheel, a 48-tooth single chainring in front, and a 7-speed cassette in back. The cogs run from 13 to 26.
Pedaling as fast as I can, elderly ladies up uprights pass me with little effort. On the flip side, there are a number of hills in my area that I can just barely negotiate without having to get off and push. Going up is a lot of No Fun.
After evaluating several ways to deal with the problem, I decided to add an intermediate gearset. Flip the 48-tooth chainset up front around to drive on the left, then fabricate a housing for a 68mm BB to take a standard 48-38-28 triple chainring on each side, with a post for the derailleur.
48 teeth up front and 13-26 in back looks pretty normal for 26" uprights. If I remove the 48 and 28 tooth chainrings from the left side, the speed step-up from 48 in front to 38 teeth is within a few percent of what I'd get if I could fit a 26" tire, if I use the 38-tooth center chainring on the right so the ratio is 1:1. Which would make the hill problem even worse, except I could now drop into "low range" with the 28-tooth chainring. I probably don't need the 48-tooth ring given the step-up, but I'll see if I have any use for it before I remove it.
The bike has a 1.5" square tube frame. The BB housing is welded in, but the seat slides forward and back with a yoke and pinch bolts. I'm making a sliding bracket like that to weld the new housing to; it will ride just in front of the seat yoke. I would just weld it to the seat yoke, except I usually remove the seat when transporting the bike, and that would be awkward with chains and a derailleur cable.
Yes, all that adds weight, complexity, and power loss. It's an exercise bike, and it already weighs 40+ pounds. A few extra pounds isn't a deal-breaker.