Promoting cardiovascular health
Working within state-of-the-art facilities and collaborating with world-leading laboratories to perform cutting edge research.
The Cardiovascular Health Sciences Research Group, led by Prof. Dick Thijssen, is an internationally recognised group with a shared interest in the biology and physiology of the cardiovascular systems in health and disease.
Our shared commitment is to understand the impact and importance of exercise training and physical activity for promoting and maintaining cardiovascular and cardiorespiratory health and the prevention of cardiovascular diseases. The clinical and societal importance of this research is emphasised when looking at our contemporary lifestyle, which is characterised by physical inactivity. Engagement in physical activity and exercise training is a logical and highly effective strategy. Therefore, we examine a range of lifestyles from highly active (elite) endurance athletes to those with sedentary behaviours and/or the presence of cardiovascular disease.
Whilst there are notable and distinct research areas in the group, there is clear cross-over and interaction that promotes an understanding of the cardiovascular system from the sub-cellular level all the way to whole body responses to physical activity.
Our two main areas of expertise are:
- Cardiac function and structure in health and disease
- Vascular function and structure in health and disease
Find out about our research into these topics below.
Cardiac function and structure in health and disease
This team includes Professors Keith George, Greg Whyte, John Somauroo, and Dr. David Oxborough as well as post-doctoral research Fellows, PhD students, MSc students and honorary research associates. The primary focus is the assessment of cardiac anatomy and function after exposure to exercise, acquired or inherited diseases or a combination of these factors.
The group has contributed to landmark studies on the impact of regular exercise training on cardiac function and structure. For example, a series of unique studies have been performed that examined evidence for sport-specific remodeling of the heart (athlete’s heart). This research makes a significant contribution to our ability to differentiate physiological adaptation of the heart from pathological changes (the Grey Zone) and this is another central theme of the group. There is close collaboration with Liverpool Heart and Chest Hospital with a dedicated joint sports cardiology clinic, assessing athletes with symptoms, identifying and differentiating between cardiac disease and extremes of cardiac physiology, utilising state of the art techniques including cardiac echocardiography including strain, cardiopulmonary exercise testing and cardiac MR. Our applied cardiac pre-participation screening of various athletes groups both at LJMU and on location at a variety of clubs and venues sets out to identify cardiovascular health or in the very rare cases the presence of hereditary or congenital cardiovascular disease that may predispose to sudden cardiac death (SCD). This is a topic which gains significant media coverage due to the occurrences of SCD or aborted SCD incidents in elite athletes and was the focus of an impact case study (4* world leading) at REF2014.
We have initiated a large number of cardiac screenings in athletes in the UK and worldwide. We have collaborative research projects investigating cardiac adaptation in endurance athletes including 100 mile ultra-endurance runners in UK and US (with Stamford University, San Francisco) and cyclists with British Cycling (Velodrome, Manchester); black versus Caucasian athletes in variety of sports including British Aikido Olympic team, Nigerian Olympic Team, amateur and professional elite boxers; female versus male athletes in elite academy and international football teams (including Liverpool FC); cardiac effects of chronic steroid abuse in bodybuilders; advisors and lecturers to Saudi Arabian and Hong Kong cardiologists on setting up cardiac screening programmes. We have also contributed to an ongoing >6,000 athletes screening programme of Sports Medicine Hospital in Qatar.
We also assess the impact of acute bouts of exercise on the heart. This involves:
- Phenomenon of exercise-induced cardiac fatigue
- Presence of post-exercise impairment in (diastolic) dysfunction of the heart
- Release of cardiac troponin in response to exercise
Our work and publications in this area are world leading and have integrated with the development of new imaging tools and techniques that have helped our understanding of these complex processes. The new tools are now being applied to clinical studies of disease identification, progression and responsiveness to interventions.
Vascular function and structure in health and disease
Members of this team include Profs. Dick Thijssen, Helen Jones, Tim Cable and Daniel Green, as well as Drs. David Low, Ellen Dawson and Nicola Hopkins. This active team aims to understand the acute and chronic impact of exercise training and inactivity on vascular function and structure in health and disease. The overarching focus of the group’s research is to understand and explain the cardioprotective effects of exercise training in the primary and secondary prevention of non-communicable diseases, which is potentially regulated through direct effects on the vasculature (conduit, cutaneous and cerebral vessels). We aim to achieve these goals through the use and development of novel state-of-the-art technology and interventions.
A common theme in the group is to understand the mechanisms that mediate changes in vascular function and structure with exercise training or physical inactivity. One of these stimuli relates to the impact of different blood flow patterns (or shear stress) on these adaptations. By understanding the stimuli responsible for adaptation, we aim to optimise the effects of physical activity and exercise training in healthy individuals as primary prevention and individuals with cardio or cerebrovascular risk factors or pathological disease.
Our group have a keen interest in employing novel interventions to assist in primary and secondary interventions that we also combine with different types of exercise training including non-pharmacological substances, environmental temperature, ischemic preconditioning to enhance the shear stress stimulus and vascular adaptation which can improve clinical outcome.
A number of members of the group have a research interest in female physiology and promoting physical activity and exercise across the lifespan. Understanding the impact and consequences of estrogen and androgens on the vascular system (e.g. post-menopausal, polycystic ovary syndrome, pregnancy) provide important insight into targets for novel non-pharmacological intervention. For example, one research project is examining the impact of pregnancy on cerebrovascular function and investigate if interventions such as regular supervised exercise and reducing sitting time can improve the vascular health of the mother and baby. We refer to the individual group member’s webpages for their specific research interests and current research projects.
A key element in our research is focused on adopting state-of-the-art techniques to accurately determine the impact of acute exercise and chronic exercise training interventions on the cardiovascular tree. Specifically, we have extensive experience in optimising strategies to examine the flow-mediated dilation, a frequently used test to examine conduit artery vascular function. Recently, we developed the carotid artery reactivity test, a novel measure to assess carotid artery vascular health. We also developed a test to examine the flow-mediated dilation of cerebral arteries. Furthermore, the integrity of the microcirculation of the skin is also a topic of investigation using local infusion of vasoactive compounds by microdialysis, whilst we explore (non)invasive strategies to examine the structure of skin blood vessels. The access to and expertise related to this large range of technology, allows for the assessment of vascular structure and function across the whole arterial tree, and provides us with powerful and technically unparalleled tools to examine human cardiovascular health.
- Demonstrating the impact of exercise training and physical activity to improve cardiovascular risk in asymptomatic and symptomatic populations
- Cross-sectional and longitudinal studies on exploring the impact of endurance and resistance exercise on remodelling of the athlete’s heart (i.e. Morganroth Hypothesis) and vessels (i.e. athlete’s artery)
- Introduction of the risk factors gap, a concept that describes the fact that traditional cardiovascular risk factors cannot fully explain the occurrence of future cardiovascular events, whilst the ‘gap’ may be related to vascular function and structure
- Reference values for athletic and non-athletic populations for cardiac function and structure
- Landmark studies on improving the methodology and protocol standardisation of measuring endothelial function through the flow-mediated dilation, leading to internationally accepted guidelines/papers on reference values
- Studies that introduced ischaemic preconditioning, a simple and non-invasive strategy involving repeated occlusion of a limb with a blood pressure cuff, to enhance exercise performance and vascular health
- Provision of detailed insight into key stimuli that mediate cardiac and vascular adaptation to exercise
Development and contribution to the set-up of guidelines of pre-exercise screening in adolescent and adult athletes and non-athletes
Read the case study: Sudden cardiac death – preventing the tragedy
- Evidence for the impact of exercise training/rehabilitation to improve fitness and cardiovascular function for a large number of clinical groups, including heart failure, coronary artery disease, type 1-2 diabetes mellitus, (childhood) obesity, spinal cord injury, and the elderly
Projects and collaborations
Selection of current projects
- EU FP7 projects CARE-MI (2008-2012; £524K; 11 partners) and ENDOSTEM (2010-2013; £212k; 16 partners), pursuing world leading research in cardiac stem cell biology
- EU FP7 project AFRESH (2010-2013), related to linking lifestyle-interventions (exercise training and diet) to improvement in cardiovascular and metabolic health
- BBSRC iCASE-project (2014-2017) on the impact of sedentary behaviour in deskworkers on cerebral and peripheral vascular health and strategies to prevent these effects
- Stoke Mandeville-Masson Research Award (2015-2017) to explore the impact of low-intensity electro-stimulation on the prevention of pressure-ulcers in spinal cord injury
- Exploring the impact of heat and cold-related interventions on the regulation of peripheral and cerebral vessels
- Understanding the impact of dietary flavonoids on the cardiovascular system
External collaboration with organisations such as the Liverpool Heart and Chest Hospital (Dr Jay Wright), has allowed the group to examine the impact of endothelial damage or removal (during diagnostic or treatment procedures) on vascular function and the role of exercise training in patients with coronary artery disease. There are also collaborative links with the gynaecology (Mr Nabil Aziz) and obstetrics (lead midwife Gillian Houghton) team at Liverpool Women’s Foundation Trust, the Departments of Obesity and Endocrinology at University Hospital Aintree (Dr Daniel Cuthbertson) and University of Liverpool (Prof. Graham Kemp, MARIARC). We also have key collaborations with the orthopeadics (Mr Daniel Perry) and cardiac (Mr Atillio Lotto) teams at Alder Hey Children's Hospital.
Previous work with the University of Oxford has involved identifying the neural circuits controlling vasomotor responsiveness in humans using deep brain stimulation. An established international collaboration is present with the University of Western Australia (Perth, Australia), which facilitates world-leading research on understanding the role of hemodynamic factors on (cardio-/cerebro)vascular adaptation. Another strong international collaboration is established through the Radboud University Medical Centre (Nijmegen, Netherlands), allowing us to study the impact of various models of physical deconditioning (e.g. bed rest, casting) on the vasculature and to better understand the marked cardiovascular risk associated with physical inactivity. Furthermore, recent collaborations with dedicated spinal cord injury centres such as Stoke Mandeville (Dr. Stewart) and Reade Hospital (Amsterdam, the Netherlands, Prof. Janssen) have allowed for the set-up and implementation of studies on the cardiovascular consequences of a spinal cord injury, and the role of exercise training and physical activity to mitigate these effects.
Collaborations with the ‘Cardiac Function’ team are strong over a range of topics and projects include the coupling between adaptations and responses to exercise of the cardiac and vascular systems. Other internal collaborations exist with staff from other research groups such as Professor Jonathan Jarvis, Professor Anton Wagenmakers, Professor Claire Stewart, Professor Graeme Close, Professor Warren Gregson and Dr Robert Erskine.
Search publications written by this group.
8 papers found
Cardiac output during exercise related to plasma atrial natriuretic peptide but not to central venous pressure in humans.
Yoshiga C, Dawson EA, Volianitis S and Warberg J and Secher NH
Carotid Artery Function Is Restored in Subjects With Elevated Cardiovascular Disease Risk After a 12-Week Physical Activity Intervention
Buckley BJR, Watson PM, Murphy RC, Graves LEF and Whyte G and Thijssen DHJ
Diagnostic accuracy and Bayesian analysis of new international ECG recommendations in paediatric athletes
McClean G, Riding NR, Pieles G, Watt V, Adamuz C, Sharma S, George KP and Oxborough D and Wilson MG
Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?
Tryfonos A and Green DJ and Dawson EA
Relationship Between Endothelial Function and the Eliciting Shear Stress Stimulus in Women: Changes Across the Lifespan Differ to Men.
Holder SM, Brislane Á, Dawson EA, Hopkins ND, Hopman MTE, Cable NT, Jones H, Schreuder THA, Sprung VS, Naylor L, Maiorana A, Thompson A and Thijssen DHJ and Green DJ
Scaling to produce size-independent indices of echocardiographic derived aortic root dimensions in elite Rugby Football League players
Oates SA, Forsythe L, Somauroo JD, George KP and Papadakis M and Oxborough D
Meet the people working within this research group.
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Please contact us if you are interested in working or collaborating with us:
Email: Professor Dick Thijssen
Or call: +44 151 904 62 64