I'm a Lecturer in Exercise Physiology within the School of Biosciences and Medicine, and I'm also the Programme Leader for the BSc (Hons) Sport and Exercise Science course.
I received my masters in movement sciences in 2003 from the Faculty of Health, Medicine and Life Sciences at Maastricht University, in the Netherlands. I then went on to complete a PhD focusing on the insulinotropic and anabolic properties of dietary protein in type 2 diabetes.
I've been a Post-doctoral Researcher at Maastricht University and KU Leuven, in Belgium, focusing on the beneficial health effects of exercise training and dietary modulation in type 2 diabetes and the elderly. I've also been a Visiting Researcher at Prof Martin Gibala’s lab at MacMaster University in Canada.
Alongside my research, I've also supervised several amateur and professional athletes, with regards to performance and nutrition.
Areas of specialism
University roles and responsibilities
- Admissions Tutor for BSc (Hons) Sport and Exercise Science
- Programme Leader for BSc (Hons) Sport and Exercise Science
- Radiation Protection Supervisor FHMS
In the media
My ongoing research interests are in the field of exercise training, nutrition, and energy and substrate metabolism. I'm investigating their roles in improving health in (sub)clinical populations, and how these factors can improve exercise capacity and performance in athletes.
These effects are investigated on a whole-body, tissue and cellular level using biochemical and histochemical analysis of skeletal muscles biopsies and stable isotope methodology to determine substrate metabolism and whole body and skeletal muscle protein synthesis.
With the use of continuous glucose monitoring devices (CGMS) the impact of different exercise and dietary modulations on the level of glycemic control in (pre) diabetic populations as well as in athletes are studied.
My current research projects include:
- INTense Exercise foR surVivAL Among Men With Metastatic Castrate-Resistant Prostate Cancer (INTERVAL)
- The interrelationship between Vitamin D, Bone, Illness, Injury and its Impact on Exercise Performance (The D-BIICEP
- Performance nutrition for injury and recovery in elite rugby union
- TrueNTH Exercise and Diet Project
- A Multimodal Approach to Improve Fitness and Surgical Outcomes for Patients Undergoing Pancreatic Resection
- PARTNER study : PARents Together in Nutrition Exercise inteRconception Study
- Nutritional supplementation in overcoming anabolic resistance in the elderly
- Exercise interventions aimed at improving glycemic control in type 2 diabetes patients
Postgraduate research supervision
I supervise on the PhD Biosciences and Medicine course. My current PhD students include:
- Saskia Louise Wilson-Barnes: The interrelationship between Vitamin D, Bone, Illness, Injury and its Impact on Exercise Performance (The D-BIICEP Study).
Postgraduate research supervision
- Victoria Anne Benford: Performance nutrition for injury and recovery in elite rugby union
I've been involved in undergraduate and postgraduate exercise, nutrition and health education for over 10 years at well-known universities in the Netherlands, Belgium and the UK.
I'm the Programme Leader for the sports and exercise science course, which was recently developed with colleagues from the School of Biosciences and Medicine and Surrey Sports Park.
I teach on the following courses:
Find out more about BSc (Hons) Sport and Exercise Science research projects, in an interview with some of my final-year students.
Rees Jordan L., Chang Courtney R., François Monique E., Marcotte-Chénard Alexis, Fontvieille Adeline, Klaprat Nika D., Dyck Rebecca A., Funk Deanna R., Snydmiller Gary, Bastell Kent, Godkin Florence E., Dubé Marie-Christine, Riesco Eléonor, McGavock Jon M., Yardley Jane E., Sigal Ronald J., Gibala Martin J., Weisnagel S. John, Prado Carla M., Jung Mary, Manders Ralph, Lee Terry, Singer Joel, Boulé Normand G., Little Jonathan P. (2019) Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study, Acta Diabetologica 56 (7) pp. 755-765 Springer Verlag
Darling A. L., Manders R. J. F., Sahni S., Zhu K., Hewitt C. E., Prince R. L., Millward D. J., Lanham-New S. A. (2019) Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years, Osteoporosis International 30 (4) pp. 741-761 Springer London
Faithfull Sara, Turner Lauren, Poole Karen, Joy Mark, Manders Ralph, Weprin Jennifer, Winters-Stone Kerri, Saxton John (2019) Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes, European Journal of Cancer Care e13023 pp. 1-22 Wiley
Assessing fitness and promoting regular physical activity can improve health outcomes and early recovery in prostate cancer. This is however, underutilised in clinical practice. The cardiopulmonary exercise test (CPET) is increasingly being used pre-treatment to measure aerobic capacity and peak oxygen consumption (VO2peak - a gold standard in cardiopulmonary fitness assessment). However, CPET requires expensive equipment and may not always be appropriate. The Siconolfi step test (SST) is simpler and cheaper, and could provide an alternative.
The aim of this study was to evaluate the validity and reliability of SST for predicting cardiopulmonary fitness in men with prostate cancer. Men were recruited to this two-centre study (Surrey and Newcastle, United Kingdom) after treatment for locally advanced prostate cancer. They had one or more of three risk factors: elevated blood pressure, overweight (BMI Ã 25), or androgen deprivation therapy (ADT). Cardiopulmonary fitness was measured using SST and cycle ergometry CPET, at two visits three months apart. The validity of SST was assessed by comparing it to CPET. The VO2peak predicted from SST was compared to the VO2peak directly measured with CPET. The reliability of SST was assessed by comparing repeated measures. Bland-Altman analysis was used to derive limits of agreement in validity and reliability analysis.
Sixty-six men provided data for both SST and CPET. These data were used for validity analysis. 56 men provided SST data on both visits. These data were used for reliability analysis. SST provided valid prediction of the cardiopulmonary fitness in men Ã 60 years old. The average difference between CPET and SST was 0.64 ml/kg/min with non-significant positive bias towards CPET (P = 0.217). Bland-Altman 95% limits of agreement of SST with CPET were ± 7.62 ml/kg/min. SST was reliable across the whole age range. Predicted VO2peak was on average 0.53 ml/kg/min higher at Visit 2 than at Visit 1 (P = 0.181). Bland-Altman 95% limits of agreement between repeated SST measures were ± 5.84 ml/kg/min.
SST provides a valid and reliable alternative to CPET for the assessment of cardiopulmonary fitness in older men with prostate cancer. Caution is advised when assessing men 60 years old or younger because the VO2peak predicted with SST was significantly lower than that measured with CPET.
Prehabilitation is increasingly being used to mitigate treatment?related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post?treatment and considers the utility of prehabilitation before cancer treatment.
A database search was conducted for articles published with prehabilitation as a pre?cancer treatment intervention between 2009 and 2017. Studies with no 30 days post?treatment data were excluded. Outcomes post?prehabilitation were extracted for physical function, nutrition and patient?reported outcomes.
Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi?modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post?treatment but was not consistent across studies.
When combined with rehabilitation, greater benefits were seen in 30?day gait and physical functioning compared to prehabilitation alone. Large?scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long?term cancer patient outcomes.
To assess the feasibility and acceptability of a community pharmacy lifestyle intervention to improve physical activity and cardiovascular health of men with prostate cancer. To refine the intervention.
Phase II feasibility study of a complex intervention.
Nine community pharmacies in the UK.
Community pharmacy teams were trained to deliver a health assessment including fitness, strength and anthropometric measures. A computer algorithm generated a personalised lifestyle prescription for a homebased programme accompanied by supporting resources. The health assessment was repeated 12 weeks later and support phone calls were provided at weeks 1 and 6.
116 men who completed treatment for prostate cancer.
The feasibility and acceptability of the intervention and the delivery model were assessed by evaluating study processes (rate of participant recruitment, consent, retention and adverse events), by analysing delivery data and semi-structured interviews with participants and by focus groups with pharmacy teams. Physical activity (measured with accelerometry at baseline, 3 and 6 months) and patient reported outcomes (activation, dietary intake and quality of life) were evaluated. Change in physical activity was used to inform the sample size calculations for a future trial.
Out of 403 invited men, 172 (43%) responded and 116 (29%) participated. Of these, 99 (85%) completed the intervention and 88 (76%) completed the 6-month follow-up (attrition 24%). Certain components of the intervention were feasible and acceptable (eg, community pharmacy delivery), while others were more challenging (eg, fitness assessment) and will be refined for future studies. By 3 months, moderate to vigorous physical activity increased on average by 34 min (95% CI 6 to 62, p=0.018), but this was not sustained over 6 months.
The community pharmacy intervention was feasible and acceptable. Results are encouraging and warrant a definitive trial to assess the effectiveness of the refined intervention.
To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol.
Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring.
Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI ? 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from ? 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (? 1.56 mmol/L; 95% CI ? 2.18, ? 0.95, p Â 0.001).
Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed.
Vitamin D deficiency (Â25nmol/L) and insufficiency (Â50nmol/L) has become an increasingly popular topic. Current research focusses upon the potential ergogenic effects of vitamin D (vitD) in sporting performance; however, the relationship between vitD (dietary intake and nutritional status) and bone health within a University athlete cohort remains under-investigated. Therefore, the aims of this Thesis were to (1) examine vitD status longitudinally across the University competitive seasons and; (2) examine the implications that vitD deficiency/ insufficiency may have upon physical performance parameters or bone health.
In the first study, fifty-seven competitive University level- athletes from varied sports were observed from autumn to spring. Radial bone mineral density (BMD) and physical performance parameters were investigated; for the analysis of vitD and parathyroid hormone, blood samples were collected. Within the cohort 7% presented with deficiency during the autumn; increasing to 44% during spring. However, this did not have a significant effect upon physical performance and bone health despite an average status of 31.5±16.4 nmol/L in spring.
In the second study, 34 University athletes and sixteen sedentary students were recruited and followed from spring to summer. Whole body, hip and tibial scans were conducted to determine BMD and bone mineral content (BMC). Physical performance parameters including jump height, aerobic fitness, muscular strength and blood biochemistry were also collected. During the summer term, 26% of the cohort were vitD insufficient. Moreover, an insufficient vitD status was associated with a lowered jump height (p=0.015) but not aerobic fitness (p=0.07). There was also a significant positive relationship between vitD status, femoral neck BMC (r=0.685; pÂ0.02) and BMD (r=0.679; pÂ0.02). Our results show that BMD was higher in weight bearing athletes. The final study found that racket sport athletes had a significantly superior bone profile in their dominant arm when contrasted to controls.
Overall, these findings suggest that an insufficient vitD status was associated with lower indices of muscular power and aerobic fitness in University students. Therefore, being vitD replete may not only play an important role in musculoskeletal health but could also be a key determining factor in athletic performance.
Rees, J.L., C.R. Chang, M.E. Francois, A. Marcotte-Chenard, A. Fontvieille, N.D. Klaprat, R.A. Dyck, D.R. Funk, G. Snydmiller, K. Bastell, F.E. Godkin, M.C. Dube, E. Riesco, J.M. McGavock, J.E. Yardley, R.J. Sigal, M.J. Gibala, S.J. Weisnagel, C.M. Prado, M. Jung, R. Manders, T. Lee, J. Singer, N.G. Boule, and J.P. Little, Minimal effect of walking before dinner on glycemic responses in type 2 diabetes: outcomes from the multi-site E-PAraDiGM study. Acta Diabetol, 2019.
Lemanska, A., K. Poole, B.A. Griffin, R. Manders, J.M. Saxton, L. Turner, J. Wainwright, and S. Faithfull, Community pharmacy lifestyle intervention to increase physical activity and improve cardiovascular health of men with prostate cancer: a phase II feasibility study. BMJ Open, 2019. 9(6): p. e025114.
Lemanska, A., K. Poole, J.J. Aning, B.A. Griffin, R. Manders, J.M. Saxton, J. Wainwright, and S. Faithfull, The Siconolfi step test: a valid and reliable assessment of cardiopulmonary fitness in older men with prostate cancer. Eur Rev Aging Phys Act, 2019. 16: p. 1.
Faithfull, S., L. Turner, K. Poole, M. Joy, R. Manders, J. Weprin, K. Winters-Stone, and J. Saxton, Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care (Engl), 2019: p. e13023.
Darling, A.L., R.J.F. Manders, S. Sahni, K. Zhu, C.E. Hewitt, R.L. Prince, D.J. Millward, and S.A. Lanham-New, Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years. Osteoporosis International, 2019.
Chalil, S., N. Pierre, A.D. Bakker, R.J. Manders, A. Pletsers, M. Francaux, J. Klein-Nulend, R.T. Jaspers, and L. Deldicque, Aging related ER stress is not responsible for anabolic resistance in mouse skeletal muscle. Biochem Biophys Res Commun, 2015. 468(4): p. 702-7.
Chalil, S., R.T. Jaspers, R.J. Manders, J. Klein-Nulend, A.D. Bakker, and L. Deldicque, Increased endoplasmic reticulum stress in mouse osteocytes with aging alters Cox-2 response to mechanical stimuli. Calcif Tissue Int, 2015. 96(2): p. 123-8.
Manders, R.J., D. Hansen, A.H. Zorenc, P. Dendale, J. Kloek, W.H. Saris, and L.J. van Loon, Protein co-ingestion strongly increases postprandial insulin secretion in type 2 diabetes patients. J Med Food, 2014. 17(7): p. 758-63.
Little, J.P., M.E. Jung, A.E. Wright, W. Wright, and R.J. Manders, Effects of high-intensity interval exercise versus continuous moderate-intensity exercise on postprandial glycemic control assessed by continuous glucose monitoring in obese adults. Appl Physiol Nutr Metab, 2014. 39(7): p. 835-41.
Van Dijk, J.W., R.J. Manders, E.E. Canfora, W.V. Mechelen, F. Hartgens, C.D. Stehouwer, and L.J. Van Loon, Exercise and 24-h glycemic control: equal effects for all type 2 diabetes patients? Med Sci Sports Exerc, 2013. 45(4): p. 628-35.
Van Dijk, J.W., R.J. Manders, K. Tummers, A.G. Bonomi, C.D. Stehouwer, F. Hartgens, and L.J. van Loon, Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia, 2012. 55(5): p. 1273-82.
Manders, R.J., J.P. Little, S.C. Forbes, and D.G. Candow, Insulinotropic and muscle protein synthetic effects of branched-chain amino acids: potential therapy for type 2 diabetes and sarcopenia. Nutrients, 2012. 4(11): p. 1664-78.
Manders, R.J., J.W. van Dijk, F. Hartgens, C.D. Stehouwer, S.F. Praet, and L.J. van Loon, Postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients. Diabetes Res Clin Pract, 2011. 93(1): p. 31-7.
Manders, R.J., J.W. Van Dijk, and L.J. van Loon, Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc, 2010. 42(2): p. 219-25.
Weseler, A.R., L. Geraets, H.J. Moonen, R.J. Manders, L.J. van Loon, H.J. Pennings, E.F. Wouters, A. Bast, and G.J. Hageman, Poly (ADP-ribose) polymerase-1-inhibiting flavonoids attenuate cytokine release in blood from male patients with chronic obstructive pulmonary disease or type 2 diabetes. J Nutr, 2009. 139(5): p. 952-7.
Manders, R.J., S.F. Praet, M.H. Vikstrom, W.H. Saris, and L.J. van Loon, Protein hydrolysate co-ingestion does not modulate 24 h glycemic control in long-standing type 2 diabetes patients. Eur J Clin Nutr, 2009. 63: p. 121-6.
Manders, R.J., B. Pennings, C.P. Beckers, T.I. Aipassa, and L.J. van Loon, Prevalence of daily hyperglycemia in obese type 2 diabetic men compared with that in lean and obese normoglycemic men: effect of consumption of a sucrose-containing beverage. Am J Clin Nutr, 2009. 90(3): p. 511-8.
Manders, R. and L.J. Van Loon, Protein supplementation as a dietary strategy to improve glycemic control in type 2 diabetes mellitus Netherlands Journal of Diabetologia, 2009(2).
Hansen, D., P. Dendale, R.A. Jonkers, M. Beelen, R.J. Manders, L. Corluy, A. Mullens, J. Berger, R. Meeusen, and L.J. van Loon, Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients. Diabetologia, 2009.
Manders, R.J., R. Koopman, M. Beelen, A.P. Gijsen, W.K. Wodzig, W.H. Saris, and L.J. van Loon, The muscle protein synthetic response to carbohydrate and protein ingestion is not impaired in men with longstanding type 2 diabetes. J Nutr, 2008. 138(6): p. 1079-85.
Praet, S.F., R.J. Manders, R.C. Meex, A.G. Lieverse, C.D. Stehouwer, H. Kuipers, H.A. Keizer, and L.J. van Loon, Glycemic instability is an underestimated problem in type 2 diabetes. Clin Sci (Lond), 2006. 111(2): p. 119-26.
Praet, S.F., R.J. Manders, A.G. Lieverse, H. Kuipers, C.D. Stehouwer, H.A. Keizer, and L.J. van Loon, Influence of acute exercise on hyperglycemia in insulin-treated type 2 diabetes. Med Sci Sports Exerc, 2006. 38(12): p. 2037-44.
Manders, R.J., S.F. Praet, R.C. Meex, R. Koopman, A.L. de Roos, A.J. Wagenmakers, W.H. Saris, and L.J. van Loon, Protein hydrolysate/leucine co-ingestion reduces the prevalence of hyperglycemia in type 2 diabetic patients. Diabetes Care, 2006. 29(12): p. 2721-2.
Manders, R.J., R. Koopman, W.E. Sluijsmans, R. van den Berg, K. Verbeek, W.H. Saris, A.J. Wagenmakers, and L.J. van Loon, Co-ingestion of a protein hydrolysate with or without additional leucine effectively reduces post-prandial blood glucose excursions in Type 2 diabetic men. J Nutr, 2006. 136(5): p. 1294-9.
Koopman, R., L. Verdijk, R.J. Manders, A.P. Gijsen, M. Gorselink, E. Pijpers, A.J. Wagenmakers, and L.J. van Loon, Co-ingestion of protein and leucine stimulates muscle protein synthesis rates to the same extent in young and elderly lean men. Am J Clin Nutr, 2006. 84(3): p. 623-32.
Koopman, R., R.J. Manders, R.A. Jonkers, G.B. Hul, H. Kuipers, and L.J. van Loon, Intramyocellular lipid and glycogen content are reduced following resistance exercise in untrained healthy males. Eur J Appl Physiol, 2006. 96(5): p. 525-34.
Kaastra, B., R.J.F. Manders, E. van Breda , A. Kies, A.E. Jeukendrup, H.A. Keizer, H. Kuipers, and L.J. van Loon, Effects of increasing insulin secretion on acute postexercise blood glucose disposal. Med Sci Sports Exerc, 2006. 38(2): p. 197-403.
van Loon, L.J., R.J. Manders, R. Koopman, B. Kaastra, J.H. Stegen, A.P. Gijsen, W.H. Saris, and H.A. Keizer, Inhibition of adipose tissue lipolysis increases intramuscular lipid use in type 2 diabetic patients. Diabetologia, 2005. 48(10): p. 2097-107.
Punyadeera, C., A.H. Zorenc, R. Koopman, A.J. McAinch, E. Smit, R. Manders, H.A. Keizer, D. Cameron-Smith, and L.J. van Loon, The effects of exercise and adipose tissue lipolysis on plasma adiponectin concentration and adiponectin receptor expression in human skeletal muscle. Eur J Endocrinol, 2005. 152(3): p. 427-36.
Manders, R.J., A.J. Wagenmakers, R. Koopman, A.H. Zorenc, P.P. Menheere, N.C. Schaper, W.H. Saris, and L.J. van Loon, Co-ingestion of a protein hydrolysate and amino acid mixture with carbohydrate improves plasma glucose disposal in patients with type 2 diabetes. Am J Clin Nutr, 2005. 82(1): p. 76-83.
Koopman, R., A.J. Wagenmakers, R.J. Manders, A.H. Zorenc, J.M. Senden, M. Gorselink, H.A. Keizer, and L.J. van Loon, Combined ingestion of protein and free leucine with carbohydrate increases postexercise muscle protein synthesis in vivo in male subjects. Am J Physiol Endocrinol Metab, 2005. 288(4): p. E645-53.
Koopman, R., R.J. Manders, A.H. Zorenc, G.B. Hul, H. Kuipers, H.A. Keizer, and L.J. van Loon, A single session of resistance exercise enhances insulin sensitivity for at least 24 h in healthy men. Eur J Appl Physiol, 2005. 94(1-2): p. 180-7.
Koopman, R., R.J. Manders, R.A. Jonkers, G.B. Hul, H. Kuipers, and L.J. van Loon, Intramyocellular lipid and glycogen content are reduced following resistance exercise in untrained healthy males. Eur J Appl Physiol, 2005: p. 1-10.
van Loon, L.J., R. Koopman, R. Manders, W. van der Weegen, G.P. van Kranenburg, and H.A. Keizer, Intramyocellular lipid content in type 2 diabetes patients compared with overweight sedentary men and highly trained endurance athletes. Am J Physiol Endocrinol Metab, 2004. 287(3): p. E558-65.