A centre for progressive clinical research
Research at Atrium Health
In addition to being a centre for clinical rehabilitation, Atrium is a hub for translational research.
At the heart of Atrium Health is a culture of applied clinical research with many staff involved in local, national and international research projects.
Atrium co-ordinates and delivers clinical research for numerous academic partners in addition to undertaking their own clinical trials led by Stuart Ennis and Gordon McGregor.
A multitude of research projects are underway at Atrium Health, Centre for Exercise & Health. Clinical academics Gordon McGregor (Coventry University) and Stuart Ennis (Cardiff Metropolitan University) head-up a wide-ranging clinical research portfolio.
Mr Stuart Ennis
Dr Gordon McGregor
Mr Richard Powell
Projects delivered at Atrium Health primarily assess the acute and chronic physiological and psychosocial effects of exercise and physical activity in clinical populations. We run both observational studies and clinical trials.
Facilities, equipment and capability include:
- Fully equipped gym and exercise studio
- Functional fitness studio
- Clinic rooms and research laboratory
- Cardiopulmonary exercise testing
- Submaximal functional capacity exercise testing
- Cardiac ultrasound (echocardiography)
- Biochemistry – centrifuge and frozen sample storage
- Isometric leg strength dynamometry
- Peripheral arterial tonometry
- Laser Doppler vascular function
Research trials and Publications
Investigating the acute physiological response to exercise in end stage renal disease – from theory to practice (PRECISE)
Chronic kidney disease (CKD) affects between 5-10% of the world’s population, equating to ~740 million people worldwide. End stage renal disease (ESRD) is the result of a progressive loss of kidney function where the patient requires dialysis to replace the typical functions of the kidney.
The quality of life of these individuals can be poor as a result of various complications associated with CKD (e.g. heart disease, diabetes, muscle wastage, decreased fitness).
In an attempt to combat reduced physical fitness, many studies have applied long term exercise programmes. However, the body’s response to exercise in people with CKD is not well understood and a set of guidelines that informs safe and effective exercise prescription is lacking.
In patients with ESRD, this study aims to characterise the acute physiological response to exercise under different conditions. In doing so, the study aims to inform the development of guidelines for safe and effective intra-dialytic exercise training.
Link to paper- https://www.hindawi.com/journals/bmri/2018/8276912/
Link to clinical trials- https://clinicaltrials.gov/ct2/show/NCT03064555?term=PRECISE&cntry=GB&draw=1&rank=1
Contact- Scott McGuire
Early cardiac rehabilitation exercise training in patients with sternotomy (SCAR): a randomised controlled trial and economic evaluation.
Current guidelines recommend abstinence from supervised cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy.
This practice is not based on empirical evidence, thus imposing potentially unnecessary activity restrictions. The purpose of this trial is to compare CR exercise training commenced early (2 weeks post-surgery) with current usual care (6 weeks post-surgery) with a view to informing future CR guidelines for patients recovering from sternotomy.
Methods and analysis-
140 cardiac surgery patients, recovering from sternotomy, will be assigned to 8 weeks of twice-weekly supervised CR exercise training commencing at either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual care exercise training will adhere to current UK recommendations. Participants in the early CR group will undertake a highly individualised 2–3 week programme of functional mobility, strength and cardiovascular exercise before progressing to a usual care CR programme.
Outcomes will be assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery), post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome will be change in 6 min walk distance. Secondary outcomes will include measures of functional fitness, quality of life and cost-effectiveness.
Link to paper- https://bmjopen.bmj.com/content/8/3/e019748
Link to clinical trials- https://clinicaltrials.gov/ct2/show/NCT03223558
Contact- Stuart Ennis
High intensity interval training versus moderate intensity steady state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): a multi-centre randomised controlled trial and economic evaluation.
Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state).
High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in exercise capacity.
The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with Coronary Heart Disease (CHD) attending UK CR programmes.
Methods and analysis-
This pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK.
Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in exercise capacity. Secondary measures will assess physiological, psychosocial and economic outcomes.
Link to paper- http://bmjopen.bmj.com/content/6/11/e012843
Link to clinical trials- https://clinicaltrials.gov/ct2/show/NCT02784873
Contact- Dr Gordon McGregor or Richard Powell
The heart failure with preserved ejection fraction pathophysiology study (IDENTIFY-HFpEF)
Does increased arterial stiffness additionally to related to ageing, coupled with vascular effects of comorbidities, associate with HFpEF?
There has been a paradigm shift proposing that comorbidities are a major contributor towards the heart failure with preserved ejection fraction (HFpEF) syndrome. Furthermore, HFpEF patients have abnormal macro and microvascular function, which may significantly contribute towards altered ventriculo-vascular coupling in these patients.
The IDENTIFY-HF study is an observational study that investigates whether gradually increasing arterial stiffness (in addition to ageing) as a result of increasing common comorbidities, such as hypertension and diabetes, is associated with HFpEF.
Protocol paper yet to be published
Link to clinical trials- https://clinicaltrials.gov/ct2/show/NCT03186833
Contact- Dr Danish Ali
Enhanced psychological care in cardiac rehabilitation services for patients with new onset depressive symptoms compared with treatment as usual: The CADENCE Study.
The CADENCE study aims to develop and assess the feasibility and acceptability of an enhanced psychological care (EPC) intervention within cardiac rehabilitation services for patients with new-onset depressive symptoms, compared to treatment as usual.
The study will consist of two phases – a feasibility study and a pilot cluster randomised controlled trial (RCT).
A mixed methods approach will be used to assess the feasibility and acceptability of the EPC intervention to NHS cardiac rehabilitation nurses and to patients who experience depressive symptoms following an acute cardiac event.
This will include documenting ‘process information’ (e.g. patient flow through cardiac rehabilitation services and numbers of patients eligible for and recruited into the study), describing the socio-demographic characteristics of participating patients, conducting in-depth interviews with cardiac rehabilitation nurses and patients, and observing the delivery of EPC within participating cardiac rehabilitation services.
Link to trial information- http://medicine.exeter.ac.uk/research/healthresearch/primarycare/projects/cadence/
Kidney disease mediated cardiac and skeletal muscle impairment: effects of dynamic exercise training and low frequency electrical muscle stimulation during haemodialysis; a pilot study
The effects of low frequency electrical muscle stimulation in chronic heart failure; a randomised feasibility trial
Link to paper- https://bmjopen.bmj.com/content/7/8/e016148
The development and pilot trial of two programmes of rehabilitation for cancer patients (PRO-REHAB)
Link to clinical trials- http://www.isrctn.com/ISRCTN14861313
Physical activity programmes for community dwelling people with mild to moderate dementia (DAPA – Dementia And Physical Activity)
Link to clinical trials- http://www.isrctn.com/ISRCTN32612072
Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence
Link to paper- https://bmjopen.bmj.com/content/8/3/e019656
Exercise rehabilitation programmes for pulmonary hypertension: a systematic review of intervention components and reporting quality
Link to paper- https://bmjopensem.bmj.com/content/4/1/e000400
The effects of cardiac rehabilitation exercise training on left ventricular remodelling in post-myocardial infarction patients
Improving the accuracy of cardiovascular risk assessments delivered in community practice for high-risk patient groups. A tailored, cognitive behavioural approach intervention for mild to moderate anxiety and/or depression in people with chronic obstructive pulmonary disease
(TANDEM): A randomised controlled trial.
Atrium Health has been providing rehabilitation for vascular patients after donation from the Circulation foundation. Monies received came from 2 charitable trusts (Garfield Weston and James Tudor).
Atrium have hosted several research studies in collaboration with Warwick University and continue to plan future research bids at the Warwick Medical School and Clinical Trials Unit (CTU).
Two Atrium Directors, Gordon McGregor and Stuart Ennis, have completed their Doctorates at The Welsh University. They continue to collaborate with Atrium Health on current research studies.