From Olympic glory to Long Covid recovery

The Olympic Games and the Covid-19 pandemic, both hugely significant and memorable life ‘events’ in 2021, that when visualised couldn’t paint a more different picture.

On the one side, you have elite athletes at the peak of physical fitness and at the top of their professional game. On the other, you have patients weak, hospitalised, or finding that just getting through simple day to day tasks as they recover from the illness is an almost insurmountable challenge.

What these events do have in common though is the positive impact that sport and exercise science is increasingly having on the lives of people experiencing the different extremes of physical health.

For academics setting out on their research careers, the goals of improving lives and even changing the rules we live by have become highly prized.

But how do we know when, how and why that work is making an impact?

Dr Ruth Ashton and Associate Professor Mark Faghy, both Sports and Exercise Science academics at the University of Derby, are currently leading an international study of the effects of ‘Long Covid’.

By putting patients through a series of physiological and mental function tests, their study could provide important answers to the many questions the virus is posing across the globe.

As Dr Ashton explains: “At the moment, we don’t really know how to look after people who still have symptoms six weeks-plus after having Covid-19.

“What we have seen is that those who have had Covid-19 and don’t get admitted to hospital tend to have symptoms for a lot longer than those who actually have been on ventilators in an ICU (intensive care unit).

“So, it’s looking at the difference between those two groups of people and, from there, making recommendations as to how we can best support them, because we don’t know how to support them if we don’t understand the symptoms that they are having post-Covid.”

It is hoped that the recommendations that do arise from the study, probably in mid-2022, could provide the basis for the way in which governments and health agencies respond to the issue.

Whether they include directives for physical activity and exercise as part of the recovery process remains to be seen. However, surprisingly, it is only quite recently that exercise has become accepted as something to be prescribed or recommended for our health in a systematic, structured way at a national level.

Dr Andy Smith MBE, an Honorary Fellow of the British Association of Sport and Exercise Sciences (BASES), the professional body for the discipline since the mid-1980s, says: “I think the peer reviewed sport and exercise science literature, which so many academics have contributed to, is now so strong that it has meant that policymakers now take physical activity seriously as a public health intervention.

“And they didn’t always do that - trust me. Exercise scientists have been making the case for health enhancing physical activity for decades, and it sometimes felt that we weren’t being listened to.

“Now, it’s taken as just common sense because institutions like the University of Derby did the hard yards and the research to show that walking and other forms of physical activity benefits health and can be used in the management of a number of diseases.”

It’s those ‘hard yards’ of gathering evidence to show how exercise can improve someone’s health that are still being run today.

Evidence is the key, but impact is not solely about influencing public policy, says Dr Katherine Pitrolino, Research Impact Officer for the School of Human Sciences at the University.

Her role is to cultivate the school’s research culture and prepare its academics for the next round of the Research Excellence Framework, which is an assessment of the quality of research carried out in each UK institution.

She explains: “When you do research, you can have layers of beneficiaries and layers of potential impact.

Changing public policy may be one layer. Another is having a direct impact on the people who you work with in your research studies – ‘co-produced impact’.

“If you’re designing a research study and identify the beneficiaries and try and work with them as early as possible, then that can really maximise your impact, and it also helps to evidence it as well,” says Katherine.

“It's important to have evidence that the impact is attributed to your research. You also need to have dialogue with the stakeholders and the beneficiaries to ask them what their benefit is and to have measures in place to assess it.”

It is a method that Dr Ashton has used both in her PhD study, working with prostate cancer patients, and now in her work with Associate Professor Mark Faghy at Derby on Long Covid.

“My research has focused on people with co-morbidities or people who have been diagnosed with significant illness. So, for me, I want to help them, and I will always think of research in terms of ‘Is this going to benefit the patient?’ I wouldn’t ever start a project if I didn’t think I was going to end up helping the people I wanted to help,” she says.

“With clinical populations we always do something called patient and public involvement at the start. So, if we have an idea for a project, we will go to either a group of patients or patient representatives who have that condition, and say, ‘Look, this is what we are planning to do, what do you think of it?’. And that’s what we’ve done with the Covid-19 research.”

Given the pandemic is not over, it may certainly be the case that research like that being carried out at Derby can make a significant difference.

“In the School of Human Sciences and Human Sciences Research Centre, we are privileged in that our research has meaning for so many people, spanning sport and exercise science, and biomedical and forensic science,” says Dr Sally Akehurst, Head of the School at the University of Derby.

“What I don’t want is for us to be carrying out research which has no impact. When we start a new research project we need to be asking ‘What is the meaning of the work we do?’

“We focus on personalised translational science for health and performance outcomes, and our sport and exercise science research ranges from individual health to elite sport performance. Importantly though, the key factor is the translational element, how our findings can translate into impact and have meaning for people in the community, and therefore result in larger and broader outcomes for society.”

That translational element will be essential to us all as we live longer, and attention turns to the concept of ‘healthy ageing’. The knowledge gleaned from the study of sport and exercise disciplines will have a considerable part to play in that process, such as helping to manage respiratory illness, and other common conditions related to the ageing process.

The School’s mission of ‘Unlocking Human Potential’ is integral to the work of its academics, Dr Akehurst explained, whether that work is with a top athlete who is aiming to achieve sporting success, or someone trying to negotiate their recovery from Long Covid.

“Both individuals can benefit from our human science research through translating what we know into having positive impact on the individual and helping them unlock their potential in health and performance,” she said.

Collaboration in research is very much the norm, not just with direct beneficiaries or across higher education institutions at home and abroad, but also with the agencies that are charged with ensuring that policy changes are implemented and followed.

Public Health England’s prominence in the public consciousness has also risen during the Covid-19 pandemic, leading delivery of the messaging to help tackle the virus.

But, as the name suggests, PHE’s remit is much wider than Covid, and when it sought academic support to draw a definitive picture of the inequality that exists across the country in access to physical activity, academics from the University of Derby secured the right to lead that study, which PHE published earlier this year.

Sport and Exercise Science lecturer Dr Clare Roscoe worked alongside Research Nurse Jessica Jackson and motor control and learning specialist Dr Niamh Mourton, to create a set of recommendations for local level commissioners of physical activities, based on their research.

Their findings included highlighting the urgent need for greater diversity in the physical activity workforce, giving individuals ownership of the activities being delivered in their communities and better understanding of local demographics to deliver a targeted and needs-driven range of activities.

The collaboration with PHE has not only helped the report get “some traction” and spread the message, says Dr Roscoe. That interest has led to an invitation for her to address a Health Inequalities Conference on the issue, raising the profile of her work and that of the University.

Crucially though, it is how it leads to action and change that will be a measure of its success.

“It not only shows the commissioners of physical activities at a local level what is required, but it has given us leverage for more research,” says Clare.

Those new angles for further research include working with 16-year-olds, and examining their experience of access to physical activity, and sub-dividing that into gender and LGBTQ+ groups.

“When we are pushing for policy change, then we need to look not just at the overall picture but in-depth too,” Clare adds.

Dr Andy Smith reflects that two global crises - the pandemic and climate change - have prompted BASES to think and act differently to ensure it has a positive impact.

“Partly, as a result of the pandemic, BASES realised that it needed to engage more with the external policy world and to do more work in the ‘public square’,” explains Andy.

“The first thing BASES has done is to create a Public and External Affairs Advisory Panel, whose work is to identify opportunities to influence government and public policy. Associate Professor Mark Faghy, from the University, is a founder member of that team and BASES are fortunate to be able to call upon his expertise and insight.

“It has also signed up to the United Nations Principles on Climate Change for Sport and to the Pledge to Net Zero. We are doing a lot of work now to make sure sport and exercise science has a role in helping to tackle the climate change emergency. This is important work not only because it impacts on the health of the planet and people but also because it is something we know students are passionate about.”

The metaphorical ‘hard yards’ so often talked about by elite athletes as the secret to their success are still being run by academics through research, presenting at conferences and publishing papers in journals, which has led to the acceptance of exercise and physical activity as an important component of any modern health care systems, he adds.

“It wasn’t always on the policy agenda or the minds of politicians, but it is now,” says Andy.

“That has been a generational thing, and the new generation of Sport and Exercise scientists, like those at the University of Derby and other universities, are taking that work to the next level.”

Written by Rob James