Dr David Oxborough

School of Sport and Exercise Sciences

The heart of an athlete: The development of clinical knowledge and practical skills in the curriculum as well as job opportunities in Sport and Exercise Science graduates

Recent events have brought into stark relief how important it is to understand, and differentiate, the adaptation of the human heart to high-level sports training versus a range of hereditary or congenital heart diseases. We marvelled at the upper limits of human performance during the Tokyo Olympics, in many cases driven by the “Athlete’s Heart” as our performance engine.  A few weeks earlier, in Denmark during the Euro2020, we couldn’t understand how a young, healthy elite athlete could have a cardiac arrest before 50 000 people in a football stadium and millions on TV.

Research work at LJMU over the last 20 years has sought to illuminate the differences between the athletic and diseased heart in young athletes. This work has led to significant new knowledge as well as development of tools for investigation, procedures for data analysis and international assessment criteria used in “Pre-participation Cardiac Screening”.   

Specific Project Work

Dr. David Oxborough leads a team for staff and students within the School of Sport and Exercise Sciences studying the Athlete’s Heart. Chris Johnson (VC Studentship), Geert Kleinnibbelink (Match Funded-Radboud), Lynsey Forsythe (Match-Funded-Cardiac Risk in the Young), Sean Robinson (Cardiac Risk in the Young Funded), Aleah Mohammad (Malaysian National Sports Medicine Institute Funded), Mohammed Qasem (Kuwait Government Funded), Ben Brown (VC Studentship), Nathan Riding and Gavin MacLean (ASPETAR Qatar Sports Medicine Funded) have all been involved in research studies assessing the Athlete’s Heart in UK and international sporting groups.  This work represents a significant national and international collaborative effort to record the upper limit of cardiac electrical, structural and function adaptations to training and to develop sensitive measurement techniques for identifying athletes with disease. In performing this research work LJMU PhD students have had to demonstrate a range of practical skills and academic knowledge that are also now developed in the curriculum we offer in undergraduate and postgraduate taught programmes.

Impact on curriculum

Within the Sport and Exercise Science degree at LJMU Dr. Oxborough and his team designed a novel level 6 module in “Cardiovascular Physiology”.  This module taught the content related to the Athletes Hear and included the development of key skills associated with cardiac assessment, pre-participation cardiac screening as well as technical skills in blood pressure measurement, electrocardiography (ECG) and heart imaging (ultrasound).  One important aspect was the in-depth development of knowledge, practical skills and data analysis associated with ECG testing that represents a cornerstone in clinical cardiac assessment. This skill development, across multiple laboratory sessions, was then assessed in a “real-world” ECG examination. This content and skills set was directly developed from the teams’ research findings and remains unique in the UK.  This module has been one of the most popular final year offerings on the programme at LJMU since its launch and generates excellent student evaluation of teacher involvement, learning as well as the assessment of practical skills. Further curriculum development came through the offer of final year student placements and dissertation projects working on pre-participation cardiac screening events at local professional Rugby League teams, the British Cycling Federation and with Premier League footballers. In engaging with these placements the students are experiencing a truly unique opportunity working with high profile athletes, excellent research and clinical scientists whilst developing exceptional technical and interpersonal skills. A similar development has also been launched for the MSc Clinical Exercise Physiology as students can be placed within the Sports Cardiology clinic at Liverpool Heart and Chester Hospital with LJMU (Dr. David Oxborough and Prof Rob Cooper) and NHS staff.

Broader Change

One of the most important changes resulting from this work has been the student’s broader understanding of work and career opportunities within the realm of clinical exercise physiology and clinical exercise sciences. The Scientific and Echocardiography Training Programmes (STP and ETP) are postgraduate direct entry vocational pathways to train cardiac scientists to provide diagnostics and intervention within healthcare settings. Both programmes are extremely competitive with only 30 places per year and only 10% of applications being successful. Over the past three years, 15 LJMU sport science students have obtained places on the STP and ETP. This disproportionate representation demonstrates the translational impact of our curricula on their unique skillsets and in providing strong sector-based employability.

This clinically related research work and curriculum development have also made a significant contribution to the recent development of a UK-wide “Clinical Exercise Physiology” register and professional representation, training, and development.  The recognition, organisation, and governance of this new “allied health profession” has the potential to deliver huge health benefits for members of the public who want to optimise their own health through being more active.  Likewise, this could drive a significant rise in employment opportunities linked to accredited MSc course provision. Finally, Dr. Oxborough’s team of staff and students have integrated their Athletes Heart and Pre-participation Cardiac Screening research work into 2 REF Impact Case Studies in 2014 and 2021.

Connor Mottram BSc and MSc Clinical Exercise Physiology graduate LJMU – current STP programme: “My BSc and MSc were the perfect steppingstones to gaining a place on the STP/ETP. They helped me by providing me with practical and academic skills I could talk about in interviews. Practical skills such as learning how to take blood pressure manually, 12-lead ECG, and in my case multiple echo labs really equipped me with a skill set that now proves to be invaluable in my everyday working life on the ETP”. 

Ellie Routledge BSC and MSc Clinical Exercise Physiology graduate LJMU – current STP programme trainee: The MSc is a fantastic programme that helped me gain a place on the STP programme.  The MSc introduced a broad range of clinical diagnostic investigations, such as ECGs, echocardiograms, vascular ultrasound, and cardiopulmonary exercise testing, taught by world leaders. We got to engage in cardiac screening days for elite sports teams and placements at local hospitals. I believe this prepared me exceptionally well to gain a place on the cardiac STP as I developed my knowledge in this area, something which I believe is distinctive to other MSc programmes.