Nik Kudiersky: Aerobic Exercise and Mobilisation in Acute Stroke
After retiring from professional football due to a knee injury, Nik went on to complete degrees in Sport and Exercise Science, and Clinical Exercise Physiology. Nik first joined Sheffield Hallam University as a laboratory technician which opened the door to his PhD in stroke rehabilitation.
What is your PhD research focused on?
My research is focused on aerobic exercise training and mobilisation (out-of-bed activity) in the acute (early inpatient) phase of stroke.
The overarching aim of my research is to conduct a feasibility study to assess:
- the safety and acceptability of a five-session aerobic exercise training programme starting within the first seven days of stroke onset; and
- the feasibility of conducting a randomised controlled trial (e.g., recruitment and dropout rates, and participant burden).
An additional aim is to investigate the acute effects of aerobic exercise on cerebral blood velocity (using transcranial Doppler ultrasound) and brain-derived neurotrophic factor (a blood protein responsible for the growth and repair of the nervous system).
The final aim is to investigate the effects of mobilisation (e.g., standing up) on cerebral blood velocity, and determine if this physiological response has prognostic value (i.e. is it clinically meaningful?).
I conducted this research on two stroke wards at the Royal Hallamshire Hospital, and at Beech Hill Rehabilitation Unit in Sheffield.
Why is it an important area of study?
Stroke is a leading cause of adult disability, affecting over 100,000 people per year in the UK. Stroke can have a profound negative impact on quality of life, and often prevents people from working and taking part in society. The current economic toll of stroke in the UK is £26 billion per year, and this is estimated to rise to £75 billion over the next 20 years due to a combination of an ageing population and improved stroke survival rates.
The only effective way to reduce neurological injury after a stroke is to restore blood flow to the affected area by surgically removing the offending blood clot (reperfusion therapy). Currently, about 90% of stroke survivors do not receive reperfusion therapy, mainly due to arriving at the hospital too late. Therefore, research is needed to develop new interventions which improve brain recovery. Emerging evidence from animal studies suggests that aerobic exercise training, starting in the first few days after stroke onset, reduces brain damage and neurological disability. It is thought that during aerobic exercise, the increased activity of neurons in the brain enhances blood flow to the injured area, and supports clearance of inflammation and waste products, leading to an improved chance of neuronal survival and repair.
In contrast to aerobic exercise, standing up causes blood to shift away from the head toward the legs (orthostatic stress). In a healthy brain, blood vessels quickly respond to orthostatic stress by dilating, which diverts more blood to the brain. However, this mechanism can be impaired if the blood vessels are injured. Therefore, it is possible that regularly standing up early after a stroke may worsen the healing process.
My research will help bridge the gap between animal experimentation and clinical practice. The mechanistic studies will provide insight into how different stroke rehabilitation methods affect the brain. The feasibility study will help optimise the design of a future large-scale study, which will help streamline the implementation of the intervention within the NHS if proven to be effective.
Tell us about your career/academic journey so far
My career and academic journey began in professional sport. I graduated from the Burnley FC youth system and gained a professional contract but suffered recurrent knee injuries and subsequently retired. I then turned my focus to sport and exercise science. During my undergraduate studies at the University of Central Lancashire (UCLan), I completed placements at Wigan Warriors RLFC, Preston North End FC, Fleetwood Town FC, and West Ham United FC. This mainly involved monitoring athletes’ training load using GPS and heart rate devices. I got my first taste of research at UCLan, where I supported biomechanical analyses of different squat techniques and loads.
After observing a few cardiac rehabilitation classes at UCLan, I became interested in how I could apply my exercise science knowledge and experience to optimise outcomes for clinical populations. I then completed a master’s degree in clinical exercise physiology at Northumbria University alongside a part-time role as a personal trainer. For my MSc dissertation, I conducted a national survey of cardiac rehabilitation provision. This project was endorsed by the British Association for Cardiovascular Prevention and Rehabilitation.
My next move was to Leeds where I worked for the National Diabetes Prevention Programme and Leeds Community Healthcare NHS Trust Diabetes Service. For both of these positions, I facilitated group education sessions focused on healthy living, using behaviour change techniques.
My most recent move was to the Outdoor City. I obtained a role as a physiology laboratory technician at Sheffield Hallam University where I supported laboratory-based teaching, research and consultancy work. I developed a particular interest in cardiopulmonary exercise testing which led to my involvement in a stroke research project. This led to an opportunity to pursue a PhD in stroke rehabilitation. With the support of my academic colleagues, I applied for the Vice Chancellor’s scholarship and was successful.
My PhD has been a really enjoyable, challenging and rewarding journey. I have developed a wide range of skills such as venepuncture, blood sample analysis, muscle and vascular ultrasound, and electrocardiography. I have gained knowledge and experience in quantitative and qualitative research methodologies, patient and public involvement and grant writing. I am now approaching the end of my PhD and have recently started a job as a researcher at the AWRC.
Why did you choose to study with the AWRC/SHU?
I chose to do a PhD at SHU because:
– it is at the forefront of physical activity research;
– it has close ties with the NHS;
– it has first-class facilities;
– and has the Peak District on its doorstep.
What’s it like being a PhD colocator at the AWRC? What do you enjoy most?
The AWRC is a stimulating place to work and study. The labs are state-of-the-art. The people are friendly and passionate about making a difference. I mostly enjoy working in multi-disciplinary teams to solve problems and generate ideas.
What do you hope to do after your PhD?
I aim to obtain a fellowship to continue researching within the field of stroke rehabilitation. I would like to gain a deeper insight into how aerobic exercise influences the post-stroke brain, throughout all stages of recovery (early and long-term). I am keen to investigate if and how exercise equipment, digital technologies and educational interventions can be used to optimise rehabilitation ‘dose’, minimise sedentary time, and improve quality of life after stroke.
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