Indoor cycling is an effective and low-cost way of treating hip osteoarthritis which could save the NHS millions, according to the CLEAT study by Bournemouth University.

Hip osteoarthritis is a leading cause of disability in older people in the UK, affecting 3.2 million people. Published today in Lancet Rheumatology, the research by Bournemouth University (BU) and University Hospitals Dorset (UHD) suggests that using indoor cycling as an intervention for the illness could save the NHS resources – hip surgery costs £6,000 – as well as reduce waiting lists.

Bournemouth University launched the CHAIN (Cycling against Hip Pain) programme in 2013, targeting people with hip osteoarthritis and other forms of hip pain. Based on the latest National Institute for Health and Care Excellence (NICE) guidelines for treating osteoarthritis, the study worked with 96 patients referred by their GPs.

After eight one-hour, weekly static cycling group classes, participants reported improvements in pain, function and quality of life, as well as more confidence, knowledge and motivation to exercise.

Following the completion of the initial programme, the local NHS Trust commissioned the programme to take referrals from secondary care. Again, the 167 participants showed improvements. A five-year follow-up showed that the majority of the patients were still self-managing their hip pain and 57 per cent had not pursued surgery.

In 2020, the CLEAT trial was launched – to compare the CHAIN programme with usual physiotherapy care. Participants attended Active Littledown in Bournemouth, run by BH Live, once a week for eight weeks. Each session involved 30 minutes education from a physiotherapist about how to manage their arthritis and a 30 minute cycling session, led by an exercise specialist. The control group received the usual physiotherapy at the local hospital.

Researchers discovered that participants who took part in the weekly cycling and education sessions reported better recovery outcomes compared to participants who undertook regular physiotherapy.

Tom Wainwright, professor of orthopaedics at BU and a physiotherapist at UHD, was the chief investigator, he says: “For the time it takes to treat one patient using standard physiotherapy, we can treat multiple patients in a group session and provide them with better outcomes. This has proved to be more cost-effective than standard treatment and so we hope this will contribute to reducing NHS waiting times for physiotherapy treatment in the future.

“What this latest study has shown is that indoor cycling improves clinical outcomes and is far more cost-effective when compared to usual physiotherapy care.”

BU’s Professor Rob Middleton and orthopaedic surgeon at UHD said: “Hip replacements cost the NHS over £6,000 per patient, so avoiding surgery for hip problems reduces the burden on the NHS, saves money, and provides better outcomes for patients. Now with this new study we can also see the potential for static cycling to save further money for the NHS by bringing down waiting lists for physiotherapy.”

Dr Peter Wilson, chief medical officer at UHD said: “We are an ageing population and increasingly we are seeing more patients with osteoarthritis that need either surgery or physiotherapy. Finding alternative ways to treat these patients could help reduce waiting times and the financial demand on NHS services.”

The future aim of CHAIN is a national rollout, providing other clinical teams across the UK with the knowledge and skills to set up their own interventions. The BU team have also developed a virtual course on its education app, allowing individuals to follow the programme from their home or gym using a static bike. Wainwright hopes these interventions will be adopted to change the way that hip pain is treated.

The study was funded by the National Institute for Health Research (NIHR).