The CHAIN Study
CHAIN (Cycling against Hip pAIN) was conceived by Professor Robert Middleton and Professor Thomas Wainwright of the Orthopaedic Research Institute (ORI) at Bournemouth University, with the aim of promoting the self-management of osteoarthritic symptoms through lifestyle change. The programme is based on the latest National Institute for Health and Care Excellence (NICE) guidelines for the treatment of osteoarthritis, which recommend exercise (local muscle strengthening and aerobic training), education and weight loss where necessary.
The programme was first launched in 2013. Patients presenting with hip osteoarthritis or other forms of hip pain at a primary care service were referred by their GP. Ninety-six participants completed the course, and demonstrated improvements to pain, function and quality of life. In addition, participants reported an increase in knowledge, confidence, and motivation to exercise. The success of the programme and the partnership with BH Live was recognised by UK Active in 2014, when the CHAIN programme was a finalist in the national Healthy Partnership Award. CHAIN was also highlighted by SAGA in a publication looking at the best exercise for arthritis.
CHAIN class
Following completion of the initial programme, the local NHS trust (The Royal Bournemouth and Christchurch Hospitals NHS Trust) commissioned the programme to take referrals from secondary care to the CHAIN programme, which ran between February 2018 and September 2019. 167 participants completed the course, and demonstrated improvements similar to the original cohort in terms of pain, function, quality of life and motivation to exercise. A five year follow up of the original programme found that the majority of participants were still using self-management strategies to manage their hip pain, and 57% had not pursued surgical intervention.
In February 2020, ORI launched the CLEAT study, a randomised controlled trial to compare the CHAIN programme with usual physiotherapy care in the treatment of hip osteoarthritis. The trial, which was delivered in collaboration with University Hospitals Dorset, recruited 221 participants who were randomised to receive one of two interventions. Participants randomised to receive CHAIN attended a local leisure centre for one hour a week over eight weeks. In each session, they received 30 minutes of education from a physiotherapist on how to manage their arthritis, and a 30 minute cycling session, led by an exercise specialist. Participants randomised to the Physiotherapy group received usual care physiotherapy at their local hospital. To find out more information about the CLEAT trial, click here.
To hear what patients had to say about their experience of CHAIN, click here.
To see CHAIN in the media, click here.
A short YouTube video outlining the CHAIN programme –
CHAIN Research
Since it’s creation, a number of rigorous evaluations have demonstrated the efficacy of the CHAIN programme for improving function and pain in people with hip osteoarthritis. In addition, we have reported the methodology behind the design of the CHAIN programme and CLEAT trial. These reports are summarised below.
July 2025 – The Lancet Rheumatology
This article reports the findings from the CLEAT randomised controlled trial, comparing an eight-week cycling and education programme (CHAIN), run in groups at a local leisure centre, with usual one-to-one physiotherapy care at a local hospital, for people with hip osteoarthritis.
May 2023 – BMC Musculoskeletal Disorders
The CHAIN (Cycling against Hip pAIN) intervention is a group cycling and education intervention conceived as a way of implementing the NICE guidance. CycLing and EducATion (CLEAT) is a pragmatic, two parallel arm, randomised controlled trial comparing CHAIN with standard physiotherapy care for the treatment of mild-to-moderate hip osteoarthritis. This article describes the protocol of the CLEAT study.
July 2020 – SAGE Open Medicine
This article reports the findings from the second CHAIN programme, delivered in Bournemouth, Dorset between February 2018 and September 2019.
April 2020 – World Congress on Osteoarthritis
This abstract reports some of the methodological challenges that should be considered in the design of randomised controlled trials of group based versus one-to-one interventions in the treatment of osteoarthritis.
Self-management of hip osteoarthritis five years after a cycling and education treatment pathway
February 2020 – Healthcare
This article reports the results from a cross-sectional survey, conducted to collect data from participants who completed the CHAIN programme between 2013 and 2015.
Snapshot survey of physiotherapy practice for patients with hip osteoarthritis in the public sector
April 2017 – European Journal of Physiotherapy
This online survey was conducted to gain a snapshot view of physiotherapy practice within the public sector in the UK.
November 2016 – International Journal of Orthopaedic and Trauma Nursing
This article reports the results of the first CHAIN programme, delivered from 2013 until 2015 at a leisure centre in Bournemouth, Dorset.
November 2015 – Research Involvement and Engagement
This article reports how patients and members of the public were involved in the design of the CLEAT study, a randomised controlled trial comparing the CHAIN programme to standard care physiotherapy, in the treatment of hip osteoarthritis.
February 2015 – BMJ Case Reports
This article reports the significant improvements experienced by a 71-year-old gentleman presenting with hip osteoarthritis, in addition to a complex range of comorbidities, after completing the CHAIN programme.
