Centre for Musculoskeletal Ageing Research

Lead Research Organisation: University of Birmingham
Department Name: Institute of Inflammation and Ageing

Abstract

Research context: We are living longer but not healthier, with adults in the UK on average now spending the last decade of life in poor health. Decline in our musculoskeletal system (muscle, bone, cartilage and tendon), and diseases of the joints such as Osteoarthritis (OA) and Rheumatoid Arthritis (RA), are major contributors to ill health in old age. The annual cost to the NHS of musculoskeletal decline is over £5 billion. Doing nothing about the current situation is an expensive and untenable option.
The Centre for Musculoskeletal Ageing Research aims to understand the age-related loss of musculoskeletal function and the role played by lifestyle (physical inactivity and obesity) in influencing this process. Physical activity and diet-based interventions are tested by the Centre to ensure these are effective in older adults. The Centre also includes motivational psychology research to develop approaches that encourage people to adopt healthy lifestyles.

Aims and objectives:
In the second 5 years of the Centre the research will expand to investigate the processes that cause a person to progress from healthy old age to developing arthritis. This will open up new ways to prevent and treat arthritis.
The objectives of the Centre are:
1. To increase understanding of the processes influencing the rate of ageing of the musculoskeletal system and how these increase susceptibility to frailty and disease;
2. To develop and test interventions to improve musculoskeletal health;
3. To develop strong national and international networking to create a significant Healthy Musculoskeletal Ageing research, training and dissemination facility;
4. To increase use of existing patient cohorts and data to support our aims;
5. To work with key policy and health practice influencers, industry and PPI groups to find routes to translation of our research in to health benefits.

Potential applications and benefits:
The potential benefits of the research carried out by the Centre are sigificant as age-related loss of musculoskeletal function has major health consequences and reduced ability to stay in employment and maintain independence. Applying the knowledge we acquire to understanding the link between ageing and the development of arthritis will increase the impact of our work further, potentially revealing novel routes to the prevention or treatment of arthritis. Applying our exercise interventions to those with established disease can help reduce pain and fatigue and improve quality of life.

Contribution to the Arthritis Research UK strategic focus (2015-2020).
The research in CMAR will contribute to the strategic focus of Arthritis Research UK, helping to understand the link between ageing and arthritis and how lifestyle and pharmacological approaches can delay the former to prevent the latter. For example, if Centre research reveals that the processes that drive normal ageing also contribute to the development of arthritis, then some of the new drugs being tested to slow the ageing process may also help prevent development of arthritis, bringing us closer to a Cure. Work on the benefits of exercise for reducing pain and fatigue in adults with OA or RA will transform patient quality of Life. Together the Centre's research programme will thus help meet ARUK's "Prevent, Transform, Cure" strategy.
This summary was drafted with patients in our arthritis PPI group R2P2. They were supportive of research that could give advice on how to exercise safely, fear of making their pain or disease worse with exercise was common. They were supportive of any treatments that could delay or prevent disease, especially drug repurposing. Overall they were supportive and thought it made sense to expand our programme toward disease pathogenesis and to work with other centres to share knowledge. On the subject of PPI group involvement, they suggested that the group supporting the Centre should include healthy elders too, so we will do this

Technical Summary

Poor musculoskeletal health has a significant impact upon the economy, society and the individual. The Centre for Musculoskeletal Ageing Research (CMAR) integrates the work of world class researchers, clinicians and health professionals at the Universities of Birmingham, Nottingham and Oxford to focus on understanding:
1. The age-related loss of musculoskeletal mass and function, including the role played by lifestyle (diet, physical inactivity) in influencing the trajectory of this process. Mechanisms such as anabolic resistance, autophagy, neuromuscular decline and cell senescence are key mechanisms being investigated;
2. How ageing influences musculoskeletal disease pathogenesis and frailty. This will include determining: whether ageing is accelerated in Rheumatoid arthritis (RA) and other chronic inflammatory conditions using epigenetic marks indicative of biological ageing, the role of the gut microbiome in musculoskeletal health and disease, the role of anti-inflammatory pathways and their dysregulation in ageing and RA, the factors driving the sarcopaenia secondary to common chronic inflammatory diseases (COPD, IBD) and physical trauma.
3. Physical activity and diet-based interventions will continue to be assessed and validated in healthy elders and patients, ensuring protocols are tailored to adults of differing ability. Metabolomics will be used to help RA patient stratification for therapy and biomedical engineers and neuroscience researchers will test novel methods to improve tissue regeneration and motor control respectively. CMAR will continue to apply its internationally recognised expertise in motivational psychology to develop programmes achieving good adherence in adults, including patients with arthritis and chronic inflammatory conditions.
CMAR will also place emphasis on collaborative working, supporting students and early career researchers to make collaborative visits of up to 1 year to other centres of excellence in the UK or overseas.

Planned Impact

Life expectancy in the UK is increasing at a rate of approximately two years per decade; with 1 in 3 children born now expected to reach 100 years. This would be a cause for celebration if it were not for the fact that increases in health span, the years spent in good health, are not keeping pace with lifespan changes. Estimates from the WHO show a 10 year difference between health span and lifespan in the UK. Supporting the continued need for a Centre of Excellence focused on research into musculoskeletal ageing are the dramatic statistics concerning age-related compromise to the musculoskeletal system: 740,000 adults are admitted to A&E each year after a fall, which resulted in 89,000 hip fractures in 2015; 20% of the population consults their GP about a musculoskeletal problem each year and the NHS spends >£5 billion on MSK health; low muscle mass predicts all-cause mortality in older people; arthritis affects over 10 million people in the UK and there are >175,000 joint replacements annually as a result; the indirect cost to the economy of arthritis, in terms of working time lost, is estimated at £14 billion. These figures make it clear that the opportunity to improve the musculoskeletal health of our ageing population is a critical need for a range of key stakeholders.

Academic researchers across a wide variety of disciplines have the opportunity to benefit not only from the new multidisciplinary knowledge produced across our themes of "Mechanisms of musculoskeletal ageing"; "Ageing and the progression to disease and frailty" and "Interventions to improve musculoskeletal health and function", but to access the technical facilities, well-defined patient cohorts and training courses that the Centre will offer.

There will be significant patient benefit from these themes in terms of tackling the conditions outlined above, which do not only affect the elderly but also a significant proportion of younger people, particularly those who have suffered traumatic inju. The approach of the Centre offers not only the potential to develop new approaches to diet and exercise and measure their efficacy in specific populations, where possible directly consulting with patients and using their input to inform developments, but also to develop new pharmaceutical therapies where needed and to work with charities and policymakers to provide the critical evidence and expertise to inform future policy and patient care, as well as to ensure that consistent and well-informed messages are delivered through mainstream media where possible.

Opportunities for economic outputs will arise from the Centre's innovative research programmes, which already benefit from significant industry engagement. New ideas around potential pharmaceutical or dietary approaches can be protected and discussed with industry partners, who can then resource them to reach wider consumers and patients, while smaller firms may wish to partner around the dissemination of new exercise programmes targeted to organisations such as care homes and health services as well as directly to individuals.

Publications

10 25 50

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BLACKWELL J (2018) Short-Term (<8 wk) High-Intensity Interval Training in Diseased Cohorts in Medicine & Science in Sports & Exercise

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Boereboom CL (2019) Short-term pre-operative high-intensity interval training does not improve fitness of colorectal cancer patients. in Scandinavian journal of medicine & science in sports

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Brook MS (2017) Nutrient modulation in the management of disease-induced muscle wasting: evidence from human studies. in Current opinion in clinical nutrition and metabolic care

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Crossland H (2017) A novel puromycin decorporation method to quantify skeletal muscle protein breakdown: A proof-of-concept study. in Biochemical and biophysical research communications

 
Description Care Home staff training workshops
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description House of Lords Inquiry
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Participation in a strategy setting workshop on age-related physical decline by the Physiology Society
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description FOREUM
Amount € 599,881 (EUR)
Organisation Foreum 
Sector Charity/Non Profit
Country Switzerland
Start 03/2018 
End 03/2021
 
Description HEFCE CCF SPINE Network
Amount £4,900,000 (GBP)
Organisation NIHR/HEFCE Higher Education Fund for England 
Sector Public
Country United Kingdom
Start 10/2018 
End 10/2020
 
Description MNTRF
Amount £10,000 (GBP)
Organisation Midland Neuroscience Teaching and Research Fund 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2017 
End 01/2018
 
Description NIHR BRC in Inflammation
Amount £12,800,000 (GBP)
Organisation National Institute for Health Research 
Department NIHR Biomedical Research Centre
Sector Public
Country United Kingdom
Start 04/2017 
End 03/2022
 
Description Responsive mode
Amount £1,100,000 (GBP)
Funding ID BB/R003971/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 01/2018 
End 12/2020
 
Description Royal Society Leverhulme Senior Research Fellowship
Amount £54,000 (GBP)
Organisation The Royal Society 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2017 
End 09/2019
 
Description The impact of trauma and related inflammation on skeletal muscle fuel and protein metabolism.
Amount £275,685 (GBP)
Organisation Defence Science & Technology Laboratory (DSTL) 
Sector Public
Country United Kingdom
Start 02/2017 
End 07/2018
 
Description 'Put Pep in Your Step' DVD 
Organisation Move it or Lose It
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We produced and released our own DVD, launched on October 1st 2013 on World Older Adults Day, comprising a staged exercise programme based on the PEPPI programme validated by Prof Bill Evans but also employing factors revealed by our motivational psychology team to enhance self determination to lifestyle change. These include the use of music and using demonstrators of the appropriate age group, we thus used members of the Birmingham 1000 Elders as the actors on the DVD
Collaborator Contribution Industrial Partner
Impact The DVD is available to buy. Importantly local Age Concern groups and the Birmingham Later Life forum have both bought the DVD to use in their befriending schemes to reduce isolation and improve health in older adults. We have also developed a training course for physical activity trainers in the use of our DVD and exercise programme and we deliver this as a 2-day VTCT accredited course 3 times a year beginning in March 2014. We have also run 2 full day workshops for older adults on healthy ageing with 200 attendees in total.
Start Year 2013
 
Description Centre for Healthy Ageing, Copenhagen 
Organisation University of Copenhagen
Department Center for Healthy Aging
Country Denmark 
Sector Academic/University 
PI Contribution This partnership is to carry out PhD student training and research in the area of musculoskeletal ageing. Our role is to co-organise and part fund the first training workshop and conference in May 2020. This is planned to be a regular event going forward.
Collaborator Contribution Our partners are hosting the first meeting, they co-organised the speakers and programme and they are part funding the event.
Impact None as yet.
Start Year 2019
 
Description Collaboration with KCL on cyclists cohort 
Organisation King's College London
Country United Kingdom 
Sector Academic/University 
PI Contribution This collaboration is with Prof Stephen Harridge who has a cohort of master cyclists aged over 55 years. Our contribution is to work with him to determine the impact of lifelong physical activity on body systems, with our team looking at immune function. We also provided data from an age matched inactive control cohort.
Collaborator Contribution The KCL team did the analysis of major body systems including muscle and bone and also managed the cohort.
Impact We have so far published 4 papers from this collaboration. It is multidisciplinary involving metabolic physiologists and immunologists.
Start Year 2012
 
Description Hertfordshire Ageing Cohort 
Organisation University of Cambridge
Department MRC Epidemiology Unit
Country United Kingdom 
Sector Academic/University 
PI Contribution We have worked with the Hertfordshire Ageing Cohort to analyse stored serum samples to determine the impact of systemic inflammation and HPA axis changes with age on muscle and bone mass and function and physical frailty
Collaborator Contribution HAS supplied the samples and associated clinical and physiological data and helped with statistical analysis of the data.
Impact The collaboration has produced 4 papers to date with more in the pipeline.
Start Year 2012
 
Description House of Lords Inquiry in to Ageing: Science, Technology and Healthy Living 
Organisation House of Lords
Country United Kingdom 
Sector Public 
PI Contribution I have been appointed as the Specialist Adviser to the S7T committee inquiry in to Ageing: Science, Technology and Healthy Living. I work with the panel to hear oral evidence for witnesses, read written evidence and will help to draft the report from the inquiry that will be presented to the Minister for Health and debated in the House of Lords.
Collaborator Contribution The House of Lords set up, funds and administers the inquiry.
Impact None as yet.
Start Year 2019
 
Description Kennedy Institute for Rheumatology 
Organisation University of Oxford
Department Kennedy Institute of Rheumatology
Country United Kingdom 
Sector Academic/University 
PI Contribution Professor Chris Buckley, a theme lead in this award, has set up a collaboration with the KIR to accelearte the development of new drugs for Rheumatoid Arthritis. As a result he will now be funded 0.5FTE by the Kenendy Foundation and has received £7m in funding from them for this collaboration, £3.7m of which will come to Birmingham.
Collaborator Contribution The Kennedy Foundation have supported this link and the researchers at the KIR will work with Prof Buckley to develop the new research programme across both sites.
Impact £7m funding from the Kennedy Foundation
Start Year 2017
 
Description Active Ageing 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham themed talk on Control of Movement
Year(s) Of Engagement Activity 2016
 
Description Agewell 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This was a workshop lasting one day to convey the results of studies in the area of ageing and health and to allow older adults to interact directly with researchers.
Year(s) Of Engagement Activity 2018,2019
 
Description BBC Midlands Today News 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact BBC Midlands Today News local news report about robot-assisted training research for stroke survivors
Year(s) Of Engagement Activity 2016
 
Description BBC Science How to Stay Young 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This was a 2 part programme for BBC Science called "How to Stay Young". In one whole episode the MRC-ARUK Centre demonstrated a simple test for physical functioning and healthy ageing, this was then tried by the commentator Angela Rippon. The filming also involved the general public and older adults. 6 of the older adults gaining low scores then worked with our SME partner Move it or Lose It doing an exercise routine and then 8 weeks later they were re-tested and all but one improved. It will broadcast april 2016.
Year(s) Of Engagement Activity 2016
 
Description BBC TV broadcast 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact BBC TV visited the David Greenfield Human Physiology Unit at the University of Nottingham to film this BBSRC funded bed-rest study.
Year(s) Of Engagement Activity 2018
 
Description BBC news item and press media coverage on master cyclists 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This was a news item on the BBC and over 30 associated press articles internationally reporting our recent publications showing that lifelong physical activity not only prevented musculoskeletal decline but also protected the immune system.
Year(s) Of Engagement Activity 2018
 
Description Exercise and vitamin D supplementation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact Invited speaker at a local National Osteoporosis Society meeting
Year(s) Of Engagement Activity 2017
 
Description Falls prevention project with Birmingham libraries 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This activity was done with Move it ro Lose It. 100 books and 100 "Put Pep in your Step" DVDs developed with our Centre input were placed in 4 libraries across Birmingham.
Those who borrow the book/DVD are given a voucher for a free Move it or Lose it class. 2 x 12 week programmes are running at Northfield Library and West Heath Medical Centre to test falls risk using a QTUG and then follow strength and balance classes to reduce frailty. We will evaluate progress and signpost to other community classes.This is funded by RoSPA and Birmingham South Central CCG
Year(s) Of Engagement Activity 2017
 
Description How to Stay Young 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This was a programme made by BBC Science, in 3 parts in season 1 (2016) and 2 parts in season 2 (2017). The Centre's researchers and our PPI group featured in both and showed how to assess how well you are ageing and the benefits of physical activity.
Year(s) Of Engagement Activity 2016,2017
 
Description Item for local TV news 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The team were interviewed for BBC West Midlands about the work of the project looking at the very early response to injury. The research team and the air ambulance crews were interviewed.
Year(s) Of Engagement Activity 2017
 
Description Nottingham Living Well Ageing Well 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact This was an evening event at Nottingham County Hall consisting of 4 short talks on the subject of Healthy Ageing attended by 200 people. There were 2 speakers from each of the MRC-ARUK Musculoskeletal Ageing Research Centres covering why we age and how lifestyle can prevent many of the aspects of physical frailty. The event was videoed and is available online.
Year(s) Of Engagement Activity 2015
URL http://www.birmingham.ac.uk/generic/mrc-aruk/news/2015/Living-Well-Ageing-Well.aspx
 
Description Princes Teaching Institute 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact This activity relates to 5 talks given at a series of workshops for secondary school science teachers organised by the Princes Teaching Institute. We have given the talks, covering Human musculoskeletal ageing, Immune ageing and The Response to Trauma to workshops around the UK. As a result we have been invited to give these talks to school pupils in the schools the teachers belong to. The original session and the ones in schools have triggered lively discussion of the topics and been very enjoyable as well as raising awareness of the two topic areas.
Year(s) Of Engagement Activity 2014,2015,2016,2018,2020
 
Description TV programme - Care homes for 4 years oalds 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact This was a TV programme involving a centre member that had pre-school children visiting care home residents and then monitoring the improved mental health and physical functioning of the older adults.
Year(s) Of Engagement Activity 2018
 
Description Talks to older adults groups such as PROBUS 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This represents a series of talks to audiences of older adults varying from 30 to 150 attendees.
Year(s) Of Engagement Activity 2018
 
Description U3A talks 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This is one of my regular talks to local older peoples groups, they are well attended and I do 3 or 4 a year. This is to tell them about our work and the immune and musculoskeletal systems are major focus.
Year(s) Of Engagement Activity 2017
 
Description University of Birmingham Arts and Science Festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact The event was entitled 'stop sitting, start moving'. It included talks about research on ageing and sedentariness followed by an exercise (seated yoga) class. The event was in collaboration with the University of Birmingham Sport and Fitness Centre.
Year(s) Of Engagement Activity 2018