A major study led by researchers at ORI and University Hospitals Dorset (UHD) has shown that group-based static cycling classes combined with education—known as the CHAIN programme—can deliver better outcomes for patients with hip osteoarthritis (OA) than standard physiotherapy, while using significantly less clinical time.
The research, funded by the National Institute for Health Research (NIHR) and published in The Lancet Rheumatology, reveals that participants receiving the CHAIN intervention reported improved function and quality of life, and the intervention was highly cost effective.
Professor Tom Wainwright, Chief Investigator and Professor of Orthopaedics at BU, said:
“For the time it takes to deliver one-to-one physiotherapy, we can treat multiple patients in a group cycling class and achieve better results. CHAIN is more cost-effective and scalable, offering a real opportunity to reduce NHS waiting times.”
The CHAIN (Cycling Against Hip Pain) programme involves eight weeks of weekly, physiotherapist-led education and studio cycling sessions. Originally launched in 2013, CHAIN is delivered by the physiotherapy department at UHD in partnership with local charity BH Live at their Littledown leisure centre in Bournemouth.
Professor Rob Middleton, Consultant Orthopaedic Surgeon and Professor of Orthopaedics at BU, added:
“Hip replacements cost the NHS over £6,000 per patient. Interventions like CHAIN that delay or avoid surgery can save the NHS substantial sums while improving outcomes.”
To scale CHAIN nationally, the BU team has developed a virtual version of the programme, allowing patients to follow sessions remotely from home or in community gyms using a static bike. A training toolkit has also been developed to enable other clinical teams across the UK to deliver the intervention.
Patient stories reinforce the impact of the programme. One participant, Sue, said:
“The first week I could barely get on the bike. By week three I already felt an improvement. Now I’m walking, dancing, and sleeping better.”
CHAIN offers a blueprint for sustainable, community-based OA management and reflects the NHS Long Term Plan’s commitment to prevention and self-care in musculoskeletal conditions.
To find out more about the CHAIN programme visit
Clinical and cost-effectiveness of a cycling and education intervention versus usual physiotherapy care for the treatment of hip osteoarthritis in the UK (CLEAT): a pragmatic, randomised, controlled trial – ScienceDirect – for Lancet Rheumatology publication.
Orthopaedic Research Institute | The CHAIN programme – for more information about the CHAIN programme
Orthopaedic Research Institute | ORI Education App – for the free digital app
