The relationship between cardiovascular risk, sympathetic nerve activity and physical activity in Rheumatoid Arthritis patients

An internally funded PhD Studentship is available within Liverpool John Moores University (LJMU). This is a joint project between the world leading departments of Research Institute for Sport and Exercise Sciences, The University of Liverpool, Aintree University Hospital and Western Sydney University. LJMU has world-class facilities and a large network of postgraduate students who all receive a programme of ongoing training and development.

The studentship will be based at LJMU in the Research Institute for Sport and Exercise Sciences. The PhD will focus on examining the relationship between endothelial function, sympathetic nerve activity and habitual physical activity in patients with rheumatoid arthritis (RA).

Rheumatoid arthritis (RA) is a chronic inflammatory condition with an incompletely understood pathophysiology. RA patients exhibit adverse cardiovascular (CV) risk profiles and are associated with increased mortality from CV related complications. Although traditional cardiovascular risk factors are present in RA patients they do not fully explain the increased CV risk. Elevated sympathetic nerve activity (SNA) in RA patients has been identified which may promote inflammatory markers and therefore contribute to CV risk. It is known that exercise is associated with improvements in CV health and autonomic function and thus low habitual physical activity (PA) may account, at least in part, for this.

Inherent cardiovascular risk and increased SNA can be amplified by associated concomitant risk factors, such as low habitual PA, which is highly prevalent in RA patients. Indeed, RA patients with long-term disease suppression have been identified as more physically active with less sedentary behaviour (SB) compared with RA patients with active disease. Behavioural change interventions that restore moderate exercise, reduce SB and meet guidelines for daily PA in RA are hypothesised to be of benefit to disease severity and associated concomitant risk. The effect of such a lifestyle change on CV risk, autonomic function and disease severity in RA is unknown. Such interventional studies designed to evaluate these possibilities will help improve our understanding of the pathophysiology of RA and, in particular, will shed light on the interplay between CV risk, pain and the autonomic nervous system.

The supervisory team will consist: Dr Tori Sprung, who has extensive experience of clinical trials, exercise interventions with high-risk clinical populations and invasive physiological techniques; Dr David Low, an integrative physiologist with expertise in autonomic and vascular function in healthy and patient populations and, Dr Chloe Taylor, a cardiovascular physiologist with expertise in microneurography- the direct recording of sympathetic nerve activity from the peripheral nerves of awake human participants.

Skills you will learn;
• Microneurography.
• Vascular ultrasound.
• Cerebral ultrasound.
• Physical activity monitoring.
• Exercise prescription/physical activity upregulation in a clinical group.
• Database data generation.
• Physiological testing (anthropometrics, online gas analysis, venous blood sampling etc).
• NRES ethics application process.
• Working within NHS guidelines.
• Patient recruitment and retention.
• Good clinical practice (GCP).
• Statistical analysis.
• Presentation skills.
• Critical thinking and scientific writing.
• Communication of scientific findings to lay audiences.

Specific eligibility requirements:

Essential:

• BSc (minimum upper-second honors degree) in a related discipline.
• Excellent communication skills to patient/lay and academic audience.
• Knowledge of physical activity monitoring.
• Experience of quantitative physiological data collection
• Highly motivated, inquisitive and a desire to learn.

Desirable:

• Relevant post graduate qualification (e.g. MSc).
• Previous experience in conducting research studies and/or clinical trials.
• Knowledge/experience of measuring endothelial function/sympathetic nerve activity.
• Knowledge of statistics.