The CHAIN Programme

The CHAIN (Cycling Against Hip Pain) programme is a six week exercise and education treatment pathway for people with hip osteoarthritis and other forms of hip pain. It was conceived by Professor Robert Middleton and Associate Professor Thomas Wainwright of the Orthopaedic Research Institute 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.

How is it delivered? The programme was delivered in Bournemouth in partnership with Bournemouth University, The Royal Bournemouth and Christchurch Hospitals NHS Trust, BH Live (The Littledown Centre) and Actipath (data management company). Patients presenting with degenerative hip osteoarthritis were referred into the programme by an orthopaedic surgeon and then attend a specialist one-to-one assessment with an exercise referral consultant at a local leisure centre. They then completed six weeks of cycling and education, led by a physiotherapist and qualified spin instructor. Participants were also supplied electronically with a home exercise programme, education advice and spinning tutorials so that they could stretch and cycle in their own time. Throughout CHAIN, participants were encouraged to make plans for lifestyle change and continuous exercise participation that would support the ongoing self-management of osteoarthritis once the programme completed. At the end of the six weeks, a one-to-one progress review occurred, and pre and post-programme scores for function, speed, strength, self-reported health and goal achievement were recorded and sent back to the participant and their GP in a personalised report.

Results from the CHAIN programme:

  • 86% of participants reported improvements in walking and completing daily activities.
  • 100% of participants said they would recommend the programme to a friend.
  • 83% of participants had increased leg strength.
  • Participants reported feeling fitter and stronger, having improved flexibility, less disturbed sleep and reduction in pain and their need to take analgesics.
  • Participants also reported feeling more motivated to continue exercising.

The research on the CHAIN programme continues to grow, and this year, the Orthopaedic Research Institute will launch a randomised controlled trial to compare the effects of taking part in CHAIN to standard physiotherapy care for the treatment of hip pain in partnership with The Royal Bournemouth Hospital and the University of Exeter.

To get more insights in the patient benefits and outcomes of the CHAIN programme , read the 2015 CHAIN report  on the evaluation of the CHAIN programmes Oct 2013 to April 2015.