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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 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.
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.
This research into the effective management of exertion intensity, symptoms and pain in the treatment of cardiovascular and neuromuscular diseases has resulted in the setting of national and international standards for safe and effective education, training and professional practice.
Physical activity forms a core component in the prevention and rehabilitation of cardiovascular disease and in genetically acquired neuromuscular disorders. Physical activity benefits are linked to the volume — frequency, intensity and duration — of participation, which will bring about physiological and/or psychosocial improvements.
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.
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.
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 term `Green Exercise' was first coined at the University of Essex to describe physical activity undertaken in `green' surroundings. Essex research demonstrates and quantifies the associated benefits to health and well-being. This research has stimulated changes to the policies and practices of health and environmental organisations, and has also been used in the private sector to support a consumer engagement campaign. Most notably, the mental health charity Mind used the findings of Essex research as part of a successful Big Lottery bid. This led to Ecominds, a £7.5M, 5 year programme supporting 130 environmental projects nationwide, which have improved the mental health of participants via green activity engagement.
The modified shuttle test (MST), developed at the University of Ulster by Professor Bradley and colleagues, is an evidence-based exercise test that is having the following impacts: