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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.
It is widely acknowledged that increasing physical activity (PA) levels within `hard-to-reach' groups is challenging. Researchers in the School have addressed these challenges resulting in impacts in two recognized `hard-to-reach' groups: ethnic minority communities and patients who are at risk of disease onset and/or are suffering from diminished quality of life/disability due to chronic disease. In the former, our research has demonstrated how to make PA accessible and appropriate; in the latter, in addition, we have increased physical activity levels. In both examples, our research has changed professional training and/or standards.
In this case study we describe an interrelated collection of impacts on healthcare in the NHS; these are summarised in the Table below.
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.
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.
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.
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).
Research undertaken at the Centre for Physical Activity and Health Research within the Sport and Exercise Sciences Research Institute has directly contributed to changes in public policy surrounding the health benefits of exercise and has informed the development of international and national physical activity guidelines.
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.