Publications by authors named "Lee Ingle"

Introduction: A health and lifestyle advisor service embedded within primary care was piloted in Kingston-upon-Hull from January 2021. We aimed to evaluate the first two years of service delivery by identifying patient demographics referred to the service, reason for referral, determine uptake and retention rates, and monitor individual lifestyle-related risk factor changes following discharge.

Methods: Anonymised data were extracted from the SystmOne database for all patients referred to the service between January 2021 and January 2023.

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Objective: To compare the characteristics of responders and nonresponders to 8 weeks of exercise training to determine differences in key cardiovascular disease outcomes in people with coronary artery disease (CAD).

Design: Secondary analysis of data from the HIIT or MISS UK trial.

Setting: Six outpatient National Health Service cardiac rehabilitation (CR) centers in the UK.

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Article Synopsis
  • Cardiopulmonary exercise testing (CPET) is crucial for evaluating heart and lung function, and inflections in oxygen pulse (O2Pulse) could indicate heart issues.
  • A study assessed how reliable and consistent different methods (subjective observation vs. an objective algorithm) are for identifying these O2Pulse inflections, finding almost perfect agreement between the algorithm and examiners.
  • The study concluded that both methods are reliable, but highlighted a systematic bias in novice examiners, suggesting that using a more objective algorithm may lead to better consistency and patient outcomes.
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  • A new high-intensity interval training (HIIT) program for patients with intermittent claudication (IC) was found to be feasible and beneficial, prompting researchers to gather patient feedback for further development.
  • Semi-structured interviews were conducted with patients who either completed the program, declined participation, or discontinued early; the analysis revealed three main themes: personal reflections, barriers and facilitators, and perceived benefits of the program.
  • Participants who completed the HIIT program reported positive experiences and health improvements, highlighting the need for program adjustments to address logistical and motivational challenges, which supports the idea of conducting further research through a larger randomized controlled trial.
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Objective: To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared with moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR).

Design: Secondary cost-effectiveness analysis of a prospective, assessor-blind, parallel group, multi-center RCT.

Setting: Six outpatient National Health Service cardiac rehabilitation centers in England and Wales, UK.

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Article Synopsis
  • A study explored the feasibility of a 6-week high-intensity interval training (HIIT) program as an alternative to standard supervised exercise programs (SEPs) for patients with intermittent claudication (IC).
  • Out of 280 screened patients, 40 were recruited, and 31 (78%) completed the HIIT program, indicating high adherence and no serious adverse events.
  • Results showed improvements in maximum walking distance and physical health scores, suggesting that HIIT is a tolerable, potentially safe, and effective option for patients with IC, warranting further research.
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Objective: To determine the acceptability and feasibility of delivering early outpatient review following cardiac surgery and early cardiac rehabilitation (CR), compared to standard practice to establish if a future large-scale trial is achievable.

Methods: A randomised controlled, feasibility trial with embedded health economic evaluation and qualitative interviews, recruited patients aged 18-80 years from two UK cardiac centres who had undergone elective or urgent cardiac surgery via a median sternotomy. Eligible, consenting participants were randomised 1:1 by a remote, centralised randomisation service to postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control), or postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention).

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Background: Low muscle mass disproportionately affects people with coronary heart disease compared to healthy controls but is under-researched and insufficiently treated. Inflammation, poor nutrition, and neural decline might contribute to low muscle mass. This study aimed to assess circulatory biomarkers related to these mechanisms [albumin, transthyretin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and C-terminal agrin fragment] and their relationship with muscle mass in people with coronary heart disease.

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Article Synopsis
  • There is a lack of global agreement on using high-intensity interval training (HIIT) for patients with coronary artery disease (CAD) in cardiac rehabilitation programs.
  • The study involved a randomized controlled trial with 382 patients comparing low-volume HIIT and moderate-intensity steady-state (MISS) exercise over 8 weeks, showing that HIIT significantly improved cardiorespiratory fitness more than MISS.
  • Results indicated that low-volume HIIT is a safe, effective alternative to traditional exercise methods in cardiac rehabilitation for improving fitness in stable CAD patients.
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Background: Peripheral artery disease affects over 236 million people globally and the classic symptom is intermittent claudication (IC) which is associated with reduction in physical activity. The evidence that supervised exercise programmes (SEPs) improve pain-free and maximal walking distance is irrefutable. However, adherence rates are low with exercise-related pain cited as a contributing factor.

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Purpose: To determine in people with a history of cancer, whether substituting sitting time with other daily activities (i.e., sleeping, walking, moderate and vigorous physical activity) was associated with changes in waist circumference (WC), an important surrogate marker of cardiometabolic risk.

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Background: Examining the reliability and validity of the second edition movement assessment battery test (MABC-2) in children with and without motor impairment.

Materials And Methods: In this prospective cohort study the MABC-2 test and developmental coordination disorder questionnaire 2007 (DCDQ'07) were completed by children and their parents. By using 95% confidence intervals, minimal detectable change (MDC95) was calculated, and concurrent validity was investigated.

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Purpose: Balance is a key component of movement for daily activities, especially in older adults. Previous studies examining aquatic therapy as an effective way for improving balance have yielded inconsistent findings. The current systematic review and meta-analysis investigated the effectiveness of aquatic therapy on balance among older adults.

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Background: Current guidelines for intermittent claudication advocate exercise at moderate to maximal claudication pain. However, adherence rates to supervised exercise programmes (SEP) remain poor and claudication pain is a contributing factor. Limited evidence suggests that moderate or pain-free exercise may be just as beneficial and may be better tolerated.

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Background And Aim: High levels of physical activity and cardiorespiratory fitness may protect against non-alcoholic fatty liver disease. We investigated whether different physical activity intensities and cardiorespiratory fitness were independent predictors of non-alcoholic fatty liver disease.

Methods: We included healthy adults with no prior diagnosis of liver dysfunction.

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Objectives: Supervised exercise programmes (SEPs) are a vital treatment for people with intermittent claudication, leading improvements in walking distance and quality of life and are recommended in multiple national and international guidelines. We aimed to evaluate the use and structure of SEPs in the United Kingdom (UK).

Design: We conducted an anonymous online survey using the Jisc platform comprising of 40 questions.

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Cardiovascular disease is the major cause of death worldwide. Extensive cardiovascular biomarkers are available using blood tests but very few, if any, investigations have described non-invasive tests for cardiovascular biomarkers based on readily available hair samples. Here we show, first, that human hair proteins are post-translationally modified by arginine methylation (ArgMe).

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Background: Lower limb disability is common in chronic stroke patients, and aquatic therapy is one of the modalities used for the rehabilitation of these patients.

Objectives: To summarize the evidence of the effects of aquatic therapy on lower limb disability compared to land-based exercises in post-stroke patients.

Methods: MEDLINE, PsycInfo, CENTRAL, SPORTDiscus, PEDro, PsycBITE, and OT Seeker were searched from inception to January 2019.

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Objective: Supervised exercise programs (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are suboptimal. Access to such programs has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programs (HEP).

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A systematic review was conducted to identify the range of terminology used in studies to describe maximum walking distance and the exercise testing protocols, and testing modalities used to measure it in patients with intermittent claudication. A secondary aim was to assess the implementation and reporting of the exercise testing protocols. CINAHL, Medline, EMBASE and Cochrane CENTRAL databases were searched.

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Background: Exercise prescription guidelines for individuals undergoing cardiovascular rehabilitation (CR) are often based on heart rate training zones and rating of perceived exertion (RPE). United Kingdom guidelines indicate that patients should exercise at an intensity of RPE 11 to 14.

Objectives: We aimed to determine the accuracy of this approach by comparing this RPE range with an objectively measured marker of exercise intensity, the ventilatory anaerobic threshold (VAT), and examine whether baseline directly determined cardiorespiratory fitness (CRF) affects the association between VAT and RPE.

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Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines.

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Purpose: This study assessed the feasibility, tolerability, safety, and potential efficacy of a novel, 6-wk, high-intensity interval training (HIIT) program for patients with intermittent claudication (IC).

Methods: Patients referred to a usual-care supervised exercise program were invited to undertake a HIIT program. All recruited patients performed a baseline cardiopulmonary exercise test (CPX) to inform their exercise prescription.

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Objectives: To develop normative reference standards for estimated cardiorespiratory fitness (eCRF) measured from treadmill-based incremental exercise testing in ~12 000 British men and women.

Methods: Cross-sectional study using retrospectively collected eCRF data from five preventative health screening clinics in the United Kingdom. Reference centiles were developed using a parametric approach by fitting fractional polynomials.

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