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Prof Doherty's research is themed around `safe and effective exercise for patients with complex cardiac disease' where, until his leading research had been carried out, thousands of patients were denied access to such services. Prof Doherty implemented the first prospective randomised control trial (RCT) in this population which has: benefitted patients directly by enabling more programmes to offer rehabilitation to this group of patients; impacted on clinical guidance nationally and internationally; contributed to Department of Health policy; and influenced the public and clinical populations through the NHS, British Heart Foundation, Arrhythmia Alliance and professional clinical groups.
The pioneering research carried out by Brookes' Movement Science Group (under the umbrella of the Centre for Rehabilitation) into the barriers and benefits of safe community led exercise for people with long-term neurological conditions, has significantly improved quality of life for many sufferers. Their research has raised awareness amongst healthcare and fitness professionals, and led to specific measures being put in place to facilitate and encourage exercise. These measures include the development of: clinical exercise and rehabilitation units, web-based physical activity support system, national occupational standards, and the only level 4 accredited exercise training course in the UK. The research has also led to the establishment of a registered charity that aims to increase exercise participation of people with long-term neurological conditions across the UK.
In this case study we describe an interrelated collection of impacts on healthcare in the NHS; these are summarised in the Table below.
The Physical Activity in Ageing, Rehabilitation and Health Research Group at Aberystwyth University has designed, implemented and evaluated rural Community Exercise Schemes (CESs), including GP referral of sub-clinical populations, and more specialised schemes, such as cardiac rehabilitation and falls prevention. This research has made a distinct and material contribution to the provision of CESs in the region by providing evidence to inform service planning and delivery, increase access to and engagement with services, improve health and influence professional standards, guidelines and training.
Smith's research in Exercise Science focuses on exercise adherence and health enhancing physical activity (HEPA). Doherty's research looks at `safe and effective exercise for patients with complex cardiac disease' and implemented the first prospective Randomised Control Trial in this population. Smith and Doherty have collaborated on an RCT, on `Active York' and on a successful proposal to the BHF. Smith's work has had an impact on practitioners and professional services by shaping regulatory frameworks for `exercise on prescription' schemes. In health, Doherty's research has benefitted patients directly by enabling hundreds of programmes to offer rehabilitation to patients with complex cardiac disease and has impacted on national and international practice.
The Case Study focuses on the work of Ibrahim Akubat, an exercise physiologist lecturer who joined the department in 2010. Based on his research, Akubat has enabled a range of clubs to monitor accurately players' training loads and understand their footballers' training outcomes. Akubat's research shows the superiority of the new individualised training load monitoring method over existing methods of monitoring internal training load and exercise dose in intermittent sports. This has led to coaches from numerous professional clubs, including those from the English Premier League, attending workshops to seek guidance on modifying their approaches to training load monitoring.
The University of Glasgow's Centre for Rehabilitation Engineering (CRE) has developed strategies and products that have influenced clinical practice in Spinal Cord Injury (SCI) worldwide. The CRE refined the concept of using Functional Electrical Stimulation (FES) for cycling and abdominal stimulation and defined its benefits to patients by establishing the nature of the medical benefits of the technology.
Working with clinical partners in the Southern General Hospital and Hasomed GmbH, the CRE co-developed FES products that are now used routinely in clinical rehabilitation. Hasomed sell ~500 units p.a. across the world, for use at home, in fitness centres and in SCI clinics to maintain health and wellbeing, thereby reducing patient morbidity and increasing their life expectancy.
Neuro-feedback, utilising a Brain Computer Interface for the treatment of pain associated with SCI, has also been developed into a clinical reality and a limited clinical trial has now shown its efficacy.
High intensity training: Impact can be evidenced on multiple levels ranging from adding to the public debate on exercise duration and providing information to the sports industry. This includes publication of the findings/applied recommendations of this research in lay magazines (e.g. Men's Health), books (e.g. The High Intensity Workout Dundee University Press 2012) and television shows (e.g. Horizon). In addition, the research has informed coaches (ice hockey and rugby union) and people working in the fitness industry (personnel trainers), and has contributed to the debate on exercise for health (Scottish Government).
The Human Performance Research Group at Aberystwyth University developed a novel high- intensity "warm-up" regime, known as "priming exercise". Performing this type of exercise can provide an ergogenic effect during subsequent exercise or competition. This research has impacted upon professional practice of sports scientists and coaches tasked with preparing elite athletes for competition. Specifically, previously warm-up exercise was performed prior to exercise, whereas now many practitioners apply priming exercise regimes. In addition, this practice has a direct impact upon the performance of both elite and amateur athletes.
It is important that valid outcome measures are used to assess clinical services and interventions to demonstrate that services are effective. Additionally, outcomes of interventions need to be meaningful to the patients reporting them, as this adds value to the outcome of trials over and above the statistically significant difference derived mathematically. Singh and colleagues explored the minimum clinically important difference of the incremental shuttle walking test for individuals with chronic respiratory disease. As a result of Singh's research, this threshold is now included in international guidelines for pulmonary rehabilitation and has also been introduced into research and practice among people attending cardiac rehabilitation over the last 5 years.