The Cardiovascular Epidemiology strand within our Cardiovascular Health Sciences Research Group is a dynamic and cross-cutting theme that focuses on understanding the determinants and distribution of cardiovascular diseases and associated outcomes. This research strand is supported by a diverse portfolio of grants and publications. Notably, recent funding includes the MS Data Discovery Award for investigating cardiovascular outcomes in individuals with multiple sclerosis and a EU Horizon grant to investigate personalised medicine for atrial fibrillation associated stroke. Example externally funded and ongoing projects include the Huawei Stroke Study, which evaluates the use of smart wearables for detecting atrial fibrillation in patients post-stroke, and the Liverpool Heart and Brain Project (L-HARP), which examines cardiovascular risk and outcomes following stroke.
We use a range of data sources, including global databases, the UK Biobank, individual patient data from trials (IPD meta-analysis), as well as collaborations with disease-specific registries and charities. We embed co-design methods into all our funded epidemiological work to ensure our research is patient-centred and clinically relevant.
Our team has published extensively in cardiovascular epidemiology, with key papers highlighting the impact of cardiac rehabilitation on clinical outcomes in several cardiovascular disease populations including AF, HF and stroke. We are also interested in the significance of cardiac complications following stroke (stroke-heart syndrome), and the role of modifiable lifestyle behaviours in mitigating cardiovascular risk. Through interdisciplinary collaboration, this work underscores our commitment to advancing cardiovascular health through rigorous, state-of-the-art research.
Staff: Dr Ben Buckley
Collaborating organisations: LCCS
MOTIVATE is a group of projects exploring how mobile health (mHealth) technologies can help people with long-term conditions, or those at risk of them, start and maintain a physically active lifestyle. Each project is tailored to its target population but uses advances in biofeedback and data sharing to make home-based virtual physical activity and exercise programs more effective. MOTIVATE encourages both general physical activity and purposeful exercise, which are known to improve health outcomes. The interventions are based on behaviour change theory and include three main parts:
- Counselling to help change behaviour.
- Wearable devices that provide biofeedback.
- Ways to share this feedback with healthcare professionals, who can then give remote guidance to patients.
MOTIVATE has also pioneered the decentralised approach to clinical trials, where participants provide data using remote “home-based” solutions. This approach decreases participant burden, enabling larger and more diverse populations (ethnic and geographic) to be recruited, generating more representative data.
The MOTIVATE projects
MOTIVATE-T2D
The original MOTIVATE project funded by a joint UK Medical Research Council and Canadian Institute of Health Research Diabetes Research Team Grant (MR/T032189/1). The project aims to investigate the feasibility of the MOTIVATE-T2D intervention in people with newly diagnosed type 2 diabetes. To find out more see our MOTIVATE-T2D protocol paper.
MOTIVATE-LJMU
MOTIVATE-LJMU was the first MOTIVATE trial to be published. It showed that MOTIVATE led to excellent uptake and adherence of purposeful exercise in people at risk of developing a long term condition. The work was funded by UK Research and Innovation.
MOTIVATE-CEW
The increasing prevalence of severe obesity in children has led to NHS England establishing specialist paediatric Complications from Excess Weight (CEW) services. These services aim to use holistic multidisciplinary teams to treat obesity-related conditions in young people. The project aims to assess the feasibility of introducing an exercise specialist led, mHealth supported, PA and exercise programme to the Alder Hey Children's Hospital CEW service. This work is funded by the Alder Hey Children’s Charity.
MOTIVATE-Clatterbridge
Immunotherapy (using the body’s immune system to target and kill cancer cells) is becoming a more common treatment for cancer. Although it’s effective the side effects can be significant. One of the most common and difficult side effects is tiredness. This can have a huge impact upon mood and quality of life. One way to improve energy levels is to increase physical activity before and during treatment. This project aims to implement the MOTIVATE intervention within immunotherapy services at The Clatterbridge Cancer Centre. This work is funded by The Clatterbridge Cancer Centre Innovation Fund.
MOTIVATE-CR+
Cardiac rehabilitation (CR) can reduce cardiovascular mortality and improve quality of life. However, patient uptake is low (52%) falling well short of NHS targets (85%). This project aims to bridge the gap between hospital discharge and the start of supervised CR with remote physical activity supported by mHealth technologies. It is hoped this approach will increase uptake of CR. To find out more see our MOTIVATE-CR+ protocol paper. This work is funded by Heart Research UK.
MAINTAIN
This project as a collaboration with Coventry University led by Prof Gordon McGregor. Long-term adherence to exercise following cardiac rehabilitation is often poor. This study aims to assess the feasibility of a remote cardiac rehabilitation intervention, facilitated by mHealth technologies, to support long-term maintenance of exercise and physical activity after cardiac rehabilitation. To find out more see our MAINTAIN protocol paper.
MOTIVATE-Sefton
This project is a collaboration with Sefton Borough Council to see if MOTIVATE could be effectively incorporated within the councils tier 2 weight management service. The work is funded by the Department of Health and Social Care.
MOTIVATE-RA
Rheumatoid Arthritis (RA) is a chronic inflammatory disease affecting ~1% of the UK population. It causes pain, stiffness, swelling and fatigue which can have debilitating effects on patients functional ability and quality of life. People with RA are recommended to exercise regularly but many struggle to achieve this. This project investigates the feasibility of the MOTIVATE intervention to promote uptake an adherence to walking in people with RA.
MOTIVATE-Lupus
This project as a collaboration with The University of Birmingham led by Dr Alex Wadley. Systemic lupus erythematous (SLE) is a chronic autoimmune disease. Fatigue, joint pain, sun sensitivity, and muscle pain/ weakness contribute to reduced quality of life and ability to perform daily activities. Despite exercise being advised for people with SLE only 10% of patients reach guideline levels. This project aims to assess the feasibility of MOTIVATE to promote moderate-to-vigorous intensity exercise in people with SLE. The project is funded by Lupus UK.
Staff: Dr Matthew Cocks, Prof Helen Jones, Dr Tori Sprung, Dr Gemma Miller, Dr Ben Buckley, Dr Anthony Crozier, Dr Daniell Bannell, Francesca Denton, Andy Davies
Collaborating Universities: University of Birmingham, University of Exeter, University of Lancaster, Coventry University, University of Liverpool, Loughborough University, University of British Columbia
Collaborating healthcare organisations: Alder Hey Children’s Hospital, The Clatterbridge Cancer Centre, Liverpool University Hospitals NHS Foundation Trust, Sefton Borough Council, The Exeter Clinical laboratory, University Hospitals Coventry and Warwickshire NHS Trust, North Tees and Hartlepool NHS Trust, Liverpool Heart and Chest NHS Trust, Betsi Cadwaladr University Health Board
Staff from RISES have led on the recognition and professional registration of the new health professional in the UK, Clinical Exercise Physiologists. Clinical Exercise Physiologists are university qualified health professionals who specialise in the prescription and delivery of evidence-based exercise interventions to optimise the prevention, treatment and long-term management of acute, sub-acute, chronic and complex conditions (NHS careers). We have also led on the establishment of a national educational routeway into this profession by developing a framework for Accredited Clinical Exercise Physiology Master's degrees. LJMU’s MSc in Clinical Exercise Physiology was the first MSc to be AHCS accredited in the UK.
As part of the recognition and professional registration of Clinical Exercise Physiologists, Clinical Exercise Physiology UK was created to promote and advocate for Clinical Exercise Physiologists in the UK this was led by Prof Helen Jones who is the current CEP-UK chair, Dr Gemma Miller from LJMU is chair or the advocacy and communication sub-group.
RISES staff are leading the way in promoting and advocating for the Clinical Exercise Physiologist profession nationally and internationally (see most recent published paper). We are undertaking research work to understand the UK profession and how it works as well as understanding the knowledge and skills required for a Clinical Exercise Physiologist to work in the UK to contribute to future iterations of the Clinical Exercise Physiologist curriculum framework.
We are also pioneering in helping to create new clinical exercise services to allow more people with long-term conditions get access to Clinical Exercise Physiologists services to improve their health and wellbeing. We have implemented and are evaluating new clinical exercise services for cancer patients undergoing immunotherapy using a remote CEP-lead solution. In collaboration with Clatterbridge Cancer Centre NHS Foundation Trust, we have created web-based exercise and physical activity content, resources and guidelines for all Clatterbridge Cancer Centre patients and staff.
We are also leading an innovative approach to exercise service provision assessing the feasibility and effectiveness of embedding Clinical Exercise Physiologists with primary care. We are conducting pilot trials with local primary care networks (PCN), where Clinical Exercise Physiologists are employed by the PCN to deliver evidenced based exercise interventions for patients with multiple long-term conditions.
Staff: Prof Helen Jones, Prof Keith George, Dr Gemma Miller, Dr Matthew Cocks
Dr Ellen Dawson is leading a ‘Thematic Doctoral Programme’ at LJMU crossing multiple disciplines and themes. Hypertension affects over 1.28 billion people globally, with high prevalence in regions like Cheshire and Merseyside. Despite efforts to manage the condition, myths hinder progress in three key themes: prevention, detection, and treatment. MITH aims to enhance hypertension management through targeted research and tailored interventions.
- Prevention: It challenges the belief that lifestyle interventions, such as exercise and diet, have minimal impact, showing they can reduce cardiovascular disease risk by 30-40%, especially in younger patients.
- Detection: It questions the reliance on office-based blood pressure measurements, proposing alternatives including blood markers and community screenings, and examines their feasibility and value.
- Treatment: It disputes the idea that certain groups, like the frail elderly, do not benefit from hypertension treatment, stressing the importance of tailored strategies and improving medication adherence, particularly in ethnic minorities and refugees.
Staff: Dr Ellen Dawson, Prof Gregory Lip, Prof Dick Thijssen, Prof Ian Jones, Prof Peter Penson, Dr Garry McDowell, Dr Sandra Ortega Martorell, Dr Ivan Olier-Caparroso, Dr Ben Buckley, Dr Robyn Lotto, Dr Alice McCloskey, Prof Attilio Lotto, Dr Alena Shantsilla (University of Liverpool), Dr Eduard Shantsilla (University of Liverpool) (plus other external partners).
Collaborating organisations: Liverpool John Moores University, University of Liverpool, Radboud University Medical Centre
Dr Ellen Dawson is part of a large EU consortium (TARGET) led by Dr Sandra Ortega-Martorell at LJMU, which aims to revolutionise the management of Atrial Fibrillation (AF) and AF-related strokes (AFRS). By developing novel virtual twin-based AI models, TARGET combines mechanistic and data-driven virtual twins with causal AI to bridge the gap between research and clinical practice. These models consider established risk factors, comorbidities, imaging, and biomarkers to create personalised approaches that optimise stroke management, rehabilitation treatments, and enhance patients' quality of life. The integration of these models into monitoring devices and rehabilitation tools accelerates clinical adoption, reducing healthcare costs and overcoming challenges faced by healthcare systems.
Staff: Dr Sandra Ortega Martorell, Dr Ivan Olier-Caparroso, Dr Robyn Lotto, Dr Ellen Dawson, Prof Ian Jones, Prof Costis Maganaris, Dr Garry McDowell, Prof Gregory Lip
Collaborating organisations: LJMU, Lunds University, University of Liverpool, Universitat Rovira I Virgil, Hospital Del Mar Research Institute Barcelona IMIM, Vrije Universiteit Brussel, Revalidatieziekenhuis Inkendaal, Institut National Polytechnique De Toulouse, Siemens SRL, Universitatea De Medicina Farmacie Stiinte Si Tehnologie Din Targu Mures, Isansys Lifecare Europe GmbH, Radboud University Medical Center, Liverpool Heart And Chest Hospital, Arrhythmia Alliance, Liverpool University Hospitals NHS Foundation Trust, Technische Universitaet Wien, SIEMENS Healthineers AG, Moverim Consulting SPRL, Centre For Research And Technology-Hellas.
