Echocardiography, cardiorespiratory fitness and rehabilitation in paediatric congenital heart disease. Sport and Health Sciences, PhD (GW4 BioMed MRC DTP)

Supervisory team:
Professor Craig Williams, Department of Sport and Health Sciences, University of Exeter
Professor Rod Taylor, University of Exeter Medical School
Dr Guido Pieles University of Bristol
Professor Massimo Caputo, University of Bristol

Project details:
After a child has undergone corrective heart surgery, cardiorespiratory fitness is an important factor of successful outcome, but its prescription is under-utilised. This project will use systematic reviews, cardiorespiratory and echocardiography testing and an intervention providing bespoke biomedical information for the patient and clinicians.

The aim of this PhD studentship is to:
Study 1 (1-12 months). To produce a Cochrane systematic review on the importance of cardiorespiratory fitness, physical activity and muscular strength for young people with congenital heart disease (CHD). A Cochrane protocol paper was published in 2014 but has recently been withdrawn and we propose to reactivate this review on behalf of the Cochrane Heart review panel. The review would identify gaps in the literature and recommend future avenues, informing our research for studies #2 and 3, in combination with our previously acquired pilot data.

Study 2 (12-18 months). Laboratory based study examining pulmonary gas exchange, haemodynamic (heart rate and blood pressure) and cardiac response to moderate and high intensity exercise. A group with congenital heart disease (male and female, 10-21 y) would be tested and be compared against two groups, a healthy non-athletic and a healthy athletic group. The exercise modality would be on a reclined exercise bike allowing the researchers to capture cardiac response to exercise using state of the art echocardiographic techniques during exercise, a novel methodology recently established by Williams and Pieles. In this innovative approach, myocardial performance would be directly assessed using 2D and 3D speckle tracking, a clinically established method to assess cardiac function that is more sensitive than traditional cardiac parameters and should help inform what exercise intensities are safe for people with different severities of congenital heart disease. This work builds on previous pilot work by Pieles and Williams (American Journal of Applied Physiology, 2015). This in time will allow for individualised physical activity/exercise guidelines to be produced for this population.

Study 3 (18-36 months). Multicomponent exercise and physical activity training study. Having produced the review paper (study 1) and the lab based study (study 2) an exercise/physical activity programme to increase fitness, improve clustered cardiovascular health and promote physical activity in this population would be designed. This would be a single centre randomised control trial. The target audience would be involved in the intervention design and crucially the interventions compliance and acceptance by the target audience will be evaluated. Participants would be measured at three time points; pre-and-post and at follow up of 6 months. The physiological outcome measures from this intervention would be following the same protocol as Study 3 but with additional anthropometric (body size), metabolic (TNFa, lipids and insulin) and cardiac heart rate modelling and various resting and exercise echocardiographic parameters to increase specificity. Other measures of health-related quality of life will also be recorded via a validated questionnaire.

To apply for this project, please complete the application form at https://cardiff.onlinesurveys.ac.uk/gw4-biomed-mrc-dtp-student-2019 by 5pm Friday 23 November 2018.