Background High blood pressure (BP) affects more than one in four adults in England and only one in three patients are being treated effectively. Treatment of high BP includes changes to lifestyle such as more physical activity and/or taking medication. However, low adoption and high attrition are common with the large amounts of exercise currently recommended (>150 minutes moderate exercise per week plus 2 strength sessions). Evidence suggests that isometric exercise (IE), holding a fixed body position for a period of time, for example a wall squat, results in greater long term BP reductions, with less time and effort, than other recommended exercise. This ISOFITTER study aims to evaluate the effectiveness of IE to help reduce BP in hypertension in a real world setting. Methods A multi-centre, randomised, controlled trial of an isometric exercise wall squat intervention for hypertension employing an effectiveness-implementation hybrid type-1 design. Adults (n = 542) with Stage 1 or Stage 2 hypertension, on no more than one antihypertensive, and no other medical contra-indications will be randomised to either a standard care plus IE intervention group or standard care control group. Blood pressure readings, fidelity measurements, medications, adverse events, quality of life, participant satisfaction and health service use will be collected at baseline, week 4, month 3 and month 6 with a subgroup (n = 50) of the IE arm invited to continue for 12 months. Qualitative participant focus groups and interviews with wider stakeholders will collect implementation data. Results The ISOFITTER study will establish effectiveness of a self-administered, home-based IE intervention in lowering blood pressure in people with uncomplicated stage 1 and 2 hypertension. Implementation evidence will support patient delivery, context for scaling up of the intervention and intervention cost. Conclusion Lifestyle changes for the treatment of hypertension in the absence of other risk factors should not be overlooked. For long term hypertension management, easily adopted, evidenced exercise interventions are needed. This study will help to address this evidence gap.

Background High blood pressure (BP) affects more than one in four adults in England and only one in three patients are being treated effectively. Treatment of high BP includes changes to lifestyle such as more physical activity and/or taking medication. However, low adoption and high attrition rates are common with current large targets for recommended exercise (>150 minutes moderate exercise per week plus 2 strength sessions). Evidence suggests that isometric exercise (IE), holding a fixed body position for a period of time, for example a wall squat, lowers BP a greater amount, with less time and effort, than other recommended exercise. This ISOFITTER study will provide robust effectiveness evidence of IE for hypertension. Methods A multi-centre, randomised, controlled trial of isometric exercise wall squat intervention for hypertension: an effectiveness-implementation hybrid type-1 design. Adults (n=542) with Stage 1 or Stage 2 hypertension, on no more than one antihypertensive, and no other medical contra-indications will be randomised to either a standard care plus IE intervention group or standard care control group. Blood pressure readings, fidelity measurements, medications, adverse events, quality of life, participant satisfaction and health service use will be collected at baseline, week 4, month 3 and month 6 with a subgroup of n=50 invited up to month 12. Qualitative participant focus groups and interviews with wider stakeholders will collect implementation data. Results The ISOFITTER study will establish effectiveness of a self-administered, home IE intervention in lowering blood pressure in people with uncomplicated stage 1 and 2 hypertension. Implementation evidence will support patient delivery, context for scaling up of the intervention and intervention cost. Conclusion Lifestyle changes for the treatment of hypertension in the absence of other risk factors should not be overlooked. For long term hypertension management, easily adopted, evidenced exercise interventions are needed. This study will help to address this evidence gap.

Background There is growing recognition of the value of self-directed, co-produced resources in supporting recovery from mental health conditions. This paper reports on the co-production and development of a novel self-help manual. The Peace of Mind (PoM) manual provides practical steps to support recognition of relapse signatures, relapse prevention planning, mental health recovery, goal-setting and successful living, authored by an individual with over 30 years of lived experience. Methods The manual was developed through personal experiential reflection and informal peer engagement, incorporating practical relapse prevention strategies, behavioural tools, and motivational guidance. Detailed comments on the manual were gained from patients with previous inpatient experience, carers and mental health peer workers at an NHS mental health trust. Online feedback was then sought from a Patient Public Involvement (PPI) group at the Centre for Health Services Studies, University of Kent, to assess acceptability and perceived usefulness ahead of future formal evaluation. Results Preliminary feedback indicated high levels of engagement and appreciation for the manual’s purpose, general accessibility, relatable tone, and emphasis on empowerment from a lived experience perspective. PPI reviews affirmed the relevance and clarity of the manual and endorsed its potential value in inpatient and community mental health settings. Patients, carers and peer workers provided critical constructive comments on content, structure, format, tone, language and usefulness which was used to refine the intervention for further usability and implementation in an NHS setting. Conclusions This co-produced intervention shows promise as a recovery-oriented tool for individuals with mental health conditions. Positive initial feedback highlights its face validity and potential to support self-management. Feedback gained from those with lived experience and a PPI group enabled refinement to enhance usefulness and usability. Future research will focus on review by mental health professionals before piloting in a clinical setting to formally evaluate outcomes and implementation feasibility.

Background High blood pressure (BP) affects more than one in four adults in England and only one in three patients are being treated effectively. Treatment of high BP includes changes to lifestyle such as more physical activity and/or taking medication. However, low adoption and high attrition rates are common with current large targets for recommended exercise (>150 minutes moderate exercise per week plus 2 strength sessions). Evidence suggests that isometric exercise (IE), holding a fixed body position for a period of time, for example a wall squat, lowers BP a greater amount, with less time and effort, than other recommended exercise. This ISOFITTER study will provide robust effectiveness evidence of IE for hypertension. Methods A multi-centre, randomised, controlled trial of isometric exercise wall squat intervention for hypertension: an effectiveness-implementation hybrid type-1 design. Adults (n=542) with Stage 1 or Stage 2 hypertension, on no more than one antihypertensive, and no other medical contra-indications will be randomised to either a standard care plus IE intervention group or standard care control group. Blood pressure readings, fidelity measurements, medications, adverse events, quality of life, participant satisfaction and health service use will be collected at baseline, week 4, month 3 and month 6 with a subgroup of n=50 invited up to month 12. Qualitative participant focus groups and interviews with wider stakeholders will collect implementation data. Results The ISOFITTER study will establish effectiveness of a self-administered, home IE intervention in lowering blood pressure in people with uncomplicated stage 1 and 2 hypertension. Implementation evidence will support patient delivery, context for scaling up of the intervention and intervention cost. Conclusion Lifestyle changes for the treatment of hypertension in the absence of other risk factors should not be overlooked. For long term hypertension management, easily adopted, evidenced exercise interventions are needed. This study will help to address this evidence gap.

OBJECTIVES:The aim of this study was to determine the feasibility of delivering personalised isometric exercise (IE) for people with stage 1 hypertension. Is it feasible to deliver an isometric wall squat intervention in the National Health Service and what sample size is required to conduct an appropriately powered effectiveness randomised controlled trial (RCT)? DESIGN:Randomised controlled open-label multicentre feasibility study of IE compared with standard care in unmedicated people with stage 1 hypertension. SETTING:Initially, the study aimed to recruit through primary care, but this process coincided with the advent of the COVID-19 pandemic. Therefore, we shifted focus to direct-to-public advertising and delivery in secondary care. PARTICIPANTS:People with unmedicated stage 1 hypertension aged over 18 able to perform IE were included. Patients were excluded if average home systolic blood pressure (sBP) <135 mm Hg; were unable to undertake the study intervention; had a previous history of diabetes mellitus, ischaemic heart disease, moderate-severe valvular heart disease, arrhythmia, stroke or transient ischaemic attack, aortic aneurysm, peripheral arterial disease and uncorrected congenital heart condition; stage 3b chronic kidney disease or worse; heart failure; enrolled in another clinical trial; pregnant or breastfeeding. 41 participants (57±15 years), 59% women, were randomised.Intervention participants were randomised (1:1) to either standard lifestyle advice or an individualised isometric wall squat prescription, performed 4×2-min bouts three times a week for 6 months. PRIMARY AND SECONDARY OUTCOME MEASURES:We assessed deliverability, attrition, adherence and variance in blood pressure (BP) change. RESULTS:IE was found to be easily deliverable to all participants. At 6 months, 34% had withdrawn. Of those who completed IE, 85% of their sessions were at the correct intensity, meeting our retention criterion for success. Variance in BP change was 14.4 mm Hg. The study was not powered to show a difference in BP between groups; however, BP reductions were seen in the intervention group at all study time points compared with baseline. There were no adverse events related to study participation. CONCLUSIONS:We met our a priori recruitment criteria which allowed us to calculate a sample size (n=542) for a full RCT. The results demonstrate good acceptability and adherence rates to the treatment protocol. Our results show a signal towards a consistent sBP reduction in the IE group compared with baseline. TRIAL REGISTRATION NUMBER:NCT04936022 (https://classic. CLINICALTRIALS:gov/ct2/show/NCT04936022?cond=isometric+exercise&draw=2&rank=7); registry identifier: ISRCTN 13472393.

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.

BACKGROUND: Hypertension affects 1:4 adults and increases the risk of CV disease. Management aims to reduce blood pressure to a level that minimizes risk; up to 50% of people don't achieve blood pressure targets often due to insufficient treatment or poor adherence. Exercise has a role to play in the management of hypertension. The impact of isometric exercise on hypertension in healthcare settings is poorly understood. METHODS: Randomized controlled open-label multicentre feasibility study of isometric exercise compared to standard care in unmedicated hypertensives. Participants received an individualised isometric wall squat prescription and performed 4 x 2-minute bouts thrice weekly for 6-months. We assessed recruitment, deliverability, attrition, adherence, and variance in blood pressure change. RESULTS: 41 participants (56 +/- 15 years), 59% women, were randomized. Isometric exercise was found to be easily deliverable to all participants. At 6-months 34% withdrew, of those who completed isometric exercise 87% of their sessions were at the correct intensity. Variance in blood pressure change was 14.4 mmHg. The study was not powered to show a difference in blood pressure between groups, however blood pressure reductions were seen in the intervention group at all study time points compared to baseline. CONCLUSIONS: The results have allowed us to calculate a sample size (n=542) for a full randomised controlled trial. The results demonstrate good acceptability and adherence rates to the treatment protocol. Our results show a signal towards a consistent systolic blood pressure reduction in the isometric exercise group compared to baseline. REGISTRATION: NCT04936022 https://classic.clinicaltrials.gov/ct2/show/NCT04936022cond=isometric+exercise&draw=2&rank=7 Registry Identifier: ISRCTN:13472393

ObjectivesInterventions for carers of patients with severe mental illness (SMI) are effective in improving patient outcomes. This review examined the effectiveness of psychological interventions or support designed to help carers of patients with SMI.DesignA systematic review of randomised controlled trials (RCTs) was conducted. Study selection, data abstraction and risk of bias assessments were independently conducted and duplicated. The reporting of this review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Data sourcesCINAHL, CENTRAL, EMBASE, Medline and PsycINFO were searched from inception to 30 April 2024.Eligibility criteriaOnly studies using an RCT were considered. All other research designs were excluded. The included population was carers over 18 caring for a patient with SMI. Any psychological, psychosocial or psychoeducational interventions were included. Patients under 18, diagnosed with dementia or learning disabilities comorbidity, were excluded.Data extraction and synthesisStudy characteristics and outcome data (mean and SD) for each included study were collected. Review Manager (RevMan) was used to manage the data. Meta-analysis was not considered appropriate due to the heterogeneity of the included studies. The results were presented as a narrative synthesis.ResultsThis review included 3869 participants from 32 RCTs and demonstrated a beneficial effect of psychological interventions for carers. Psychoeducation was widely used and the most evaluated intervention for carers.ConclusionsPsychological interventions for carers are beneficial in helping to reduce negative outcomes and enhance positive outcomes. Future research could focus on exploring the impact of interventions on less evaluated outcomes such as depressive and anxiety symptoms.PROSPERO registration numberCRD42021233181.

BackgroundHealthy lifestyle changes for patients with stage 1 hypertension are recommended before antihypertensive medication. Exercise has antihypertensive benefits; however, low adoption and high attrition are common. Patients need easily adoptable, effective and manageable exercise interventions that can be sustained for life. We present participant and stakeholder perceptions of an isometric exercise intervention for stage 1 hypertension delivered in the National Health Service (NHS, UK).MethodsAn embedded qualitative study within a randomised-controlled feasibility study included intervention arm participants (n = 10), healthcare professionals from participating NHS sites (n = 3) and non-participating NHS sites (n = 5) taking part in semi-structured interviews to explore feasibility of delivering an isometric exercise intervention within the study design and an NHS context. Data was analysed using reflective thematic analysis.ResultsThree themes were identified: study deliverability; motivators and barriers; support for study participation. Findings indicated that the study was well designed. Health benefits, unwillingness to take medication, altruism and interest in the study helped motivation and adherence. Study support received was good, but healthcare professionals were insecure in intervention delivery with regular training/supervision needed. Perception of health improvement was mixed, but, in some, uptake of wider lifestyle changes resulted from participation. Stakeholders felt that current service challenges/demand would make implementation challenging.ConclusionsDespite participant positivity, delivery of an isometric intervention in an NHS setting was considered challenging given the current service demand, although possible with robust effectiveness evidence. Findings support further effectiveness data and implementation development of the isometric exercise intervention.Trial registrationISRCTN, ISRCTN13472393. Registered 18 September 2020.

Objective: Isometric exercise training (IET) is consistently shown to reduce blood pressure (BP). We recently investigated the feasibility of delivering a personalised isometric wall-squat protocol to patients with Stage-1 hypertension within a free-to-access healthcare setting. Whist healthcare professionals (HCP) and patients thought the intervention was feasible, any exercise prescription requiring HCP input and specific resource allocation was not deemed viable. This study aimed to examine the effect of a low resource IET prescription using rating of perceived exertion (RPE) versus HCP prescription and control group upon BP. Design and method: 30 participants with normal to high-normal BP were randomised into either a (heart rate) HR-Exercise (HR-EX), RPE-Exercise (RPE-EX) or control (CON) group. IET groups undertook a 4-week home-based wall-squat programme with intensity prescribed either directly by a HCP using our established HR method (HR-EX), or self-prescribed using a RPE selection protocol (RPE-EX). The CON group maintained their normal lifestyle. Clinic BP was measured at baseline and post-IET. Results: Clinic systolic (SBP) and diastolic (DBP) were significantly reduced (p < 0.001) in both intervention groups following IET compared to baseline. Group mean reductions for the HR-EX (SBP: -14 ± 6, DBP: -6 ± 4 mmHg) and RPE-EX (SBP: -9 ± 6, DBP: -6 ± 4 mmHg) were greater (p < 0.001) than CON (no differences) group. There were no differences between intervention groups in the magnitude of the BP reductions; however, at baseline HR-EX had greater SBP (p < 0.001) results compared to RPE-EX, but following the IET there were no significant differences between these groups. Conclusions: RPE prescribed wall-squat IET provides an efficacious method for reducing BP at home, delivering reductions comparable to the HR-based prescription method. This new RPE-based method, developed because of difficulties in delivering IET prescription in a general healthcare setting, demonstrates great potential as an effective lifestyle intervention to lower BP mainly due to improved access. It requires minimal resource to deliver and implement in any environment and could be provided entirely online.

Objective: Adherence is low to the lifestyle changes recommended by NICE for patients with hypertension. More easily adopted, effective and manageable exercise interventions are needed. This study determined the feasibility of personalised isometric exercise (IE) for patients with Stage (grade) 1 hypertension in the National Health Service (NHS) in England. Design and method: We conducted a multicentre randomised controlled feasibility study delivered through NHS primary/secondary care. Patients included were 18+, with clinic systolic BP (SBP)140-159mmHg, not on anti-hypertensive medication and without significant medical contraindications. Participants were randomised to standard lifestyle advice (control) or standard lifestyle advice plus wall squat IE for a 6-month period (intervention). After excluding people with average home systolic <135mmHg, 41 participants were included (control n=19, IE n=22) (aged 57 ± 15.15yrs). Participants were followed up at 4-weeks, 3-months, and 6-months. Results: Healthcare professionals were able to deliver the intervention with high fidelity (100% passed independent delivery check and 84.6% of participants recorded at least 2/3 of exercise heart rates within their target range over 6 months). A sample size for an efficacy trial (primary objective), was determined n= 542, based upon the 35% attrition rate and 14.4mmHg SD of change of SBP from baseline. Qualitative work provided valuable insights into acceptability, feasibility, delivery, and implementation in an NHS setting and for improved follow-on studies. Whilst the study was not powered to detect BP changes, reductions in SBP were observed at all time points. Figure 1. Marginal means and 95% CI from ANCOVA (Per-protocol population) Difference between means at each time point were: 4-weeks -2.31 mmHg (95% CI -11.29 to 6.67), 3 months -4.07 mmHg (95% CI, -10.28 to 2.15) 6 months -2.35 (95% CI -11.70-6.99). Pilot economic analyses suggested the intervention is cost-effective. Conclusions: Feasibility of IE has been demonstrated, but deliverability without significant modifications to the wall squat IE prescription protocol due to current NHS constraints would not be possible. Findings support investigating effectiveness of the intervention and justify a full RCT. A sample size of n=542 is needed to establish effectiveness.

The COVID-19 pandemic has significantly impacted on the delivery of clinical trials in the UK, posing complicated organisational challenges and requiring adaptations, especially to exercise intervention studies based in the community. We aim to identify the challenges of public involvement, recruitment, consent, follow-up, intervention and the healthcare professional delivery aspects of a feasibility study of exercise in hypertensive primary care patients during the COVID-19 pandemic. While these challenges elicited many reactive changes which were specific to, and only relevant in the context of ‘lockdown’ requirements, some of the protocol developments that came about during this unprecedented period have great potential to inform more permanent practices for carrying out this type of research. To this end, we detail the necessary adaptations to many elements of the feasibility study and critically reflect on our approach to redesigning and amending this ongoing project in order to maintain its viability to date. Some of the more major protocol adaptations, such as moving the study to remote means wherever possible, had further unforeseen and undesirable outcomes (eg, additional appointments) with regards to extra resources required to deliver the study. However, other changes improved the efficiency of the study, such as the remote informed consent and the direct advertising with prescreening survey. The adaptations to the study have clear links to the UK Plan for the future of research delivery. It is intended that this specific documentation and critical evaluation will help those planning or delivering similar studies to do so in a more resource efficient and effective way. In conclusion, it is essential to reflect and respond with protocol changes in the current climate in order to deliver clinical research successfully, as in the case of this particular study.

Background Open Dialogue is an internationally developing approach to mental health care based on collaboration between an individual and their family and social network. Our quest for better approaches to Mental Health Care with improved carer and service user experience led us to develop and test a model of Peer Supported Open Dialogue (POD). There is no research currently looking at the implementation and effectiveness of a standalone POD team in the NHS so we evaluate its implementation, clinical outcomes and value to service users and their families. Method A before-after design was used. 50 service users treated by the POD Team were recruited and participants from their family and wider social network. Service user self report questionnaires covering wellbeing, functioning, satisfaction were collected and one carer self report measure; at baseline, three and six months. A clinician reported measure was collected at baseline and six months. Clinicians perceptions of practice were collected following network meetings. Results 50 service users treated were recruited with a mean age of 35 years with slightly more males than females. Service users reported signficant improvements in wellbeing and functioning. There was a marked increase in perceived support by carers. Over half the meetings were attended by carers. The Community Mental Health Survey showed high satisfaction rates for service users including carer involvement. Conclusions The study indicated it was possible to transform to deliver a clinically effective POD service in the NHS. This innovative approach provided continuity of care within the social network, with improved carer support and significant improvements in clinical outcomes and their experiences. Trial registration ( isrctn.com/ISRCTN36004039 . Retrospectively registered 04/01/2019.

Abstract Background The value of establishing roles for people with lived experience of mental distress within mental health services is increasingly being recognised. However, there is limited information to guide the introduction of these roles into mental health services. Aims This study details the development and evaluation of a new mental health peer worker role, the Lived Experience Practitioner (LXP), within an NHS Trust. Methods A three-phase exploratory mixed-methods approach was used. Qualitative data were collected and analysed in the first phase. The qualitative findings were then translated into the formal procedures for introducing LXPs into the Trust, with the approach examined quantitatively in the third phase. Results The qualitative analysis identified five themes; role design, training, piloting, career pathways and communication. These formed the basis for working groups (workstreams) which developed policies and procedures for introducing the LXP role into the Trust. Twenty-eight applicants commenced a training programme with 10 successful completions. Seven LXPs were employed by the Trust and were still in their posts after 2 years. Conclusion In this study, three areas were viewed as important when introducing LXP roles into mental health services; organisational support, the training programme and employment procedures.

BACKGROUND:Relationships are vital to recovery however, there is uncertainty whether users have different types of social networks in different mental health settings and how these networks may impact on users' wellbeing.AIMS:To compare the social networks of people with long-term mental illness in the community with those of people in a general adult in-patient unit.METHOD:A sample of general adult in-patients with enduring mental health problems, aged between 18 and 65, was compared with a similar sample attending a general adult psychiatric clinic. A cross-sectional survey collected demographic data and information about participants' social networks. Participants also completed the Short Warwick Edinburgh Mental Well-Being Scale to examine well-being and the Significant Others Scale to explore their social network support.RESULTS:The study recruited 53 participants (25 living in the community and 28 current in-patients) with 339 named as important members of their social networks. Both groups recorded low numbers in their social networks though the community sample had a significantly greater number of social contacts (7.4 vs. 5.4), more monthly contacts with members of their network and significantly higher levels of social media use. The in-patient group reported greater levels of emotional and practical support from their network.CONCLUSIONS:People with serious and enduring mental health problems living in the community had a significantly greater number of people in their social network than those who were in-patients while the in-patient group reported greater levels of emotional and practical support from their network. Recommendations for future work have been made.

Homelessness is linked to poor mental health and an increased likelihood of offending. People often lose accommodation when they enter prison and struggle to find accommodation upon release leading to an increased likelihood of relapse and reoffending. The RESET intervention was developed to support prisoners with mental health needs for 12 weeks after release to coordinate their transition into the community and obtaining secure housing. The primary objective of the study was to assess the participants housing situation. A prospective cohort design followed up 62 prisoners with mental health needs for 9 months post-release. Data were collected at three time points regarding accommodation, reoffending and contact and engagement with services. Inferential statistics using Chi-squared tests and t tests were used to examine differences in scores between the two groups at each time point. The RESET group was significantly more likely to have secure housing at all three time points being housed for approximately twice as many days than the comparison group (244 vs 129 days at 9 months: p ≤ 0.01). The RESET group also had a significantly greater level of contact with GPs and significantly more received benefits at all three time points. This is the first study to focus on reducing homeless for recently released prisoners with mental health needs. The RESET intervention was successful in achieving its main objective; accommodating participants in permanent housing and reducing homelessness. There was also an association between receiving the intervention and greater engagement with other services. This supports the view that secure housing is important in ensuring a positive transition from prison to the community for prisoners with mental health needs.

Abstract Background Hypertension (HTN) affects approximately 25% of the UK population and is a leading cause of mortality. Associated annual health care costs run into billions. National treatment guidance includes initial lifestyle advice, followed by anti-hypertensive medication if blood pressure (BP) remains high. However, adoption and adherence to recommended exercise guidelines, dietary advice and anti-hypertensive medication is poor. Four short bouts of isometric exercise (IE) performed 3 days per week (d/wk) at home elicits clinically significant reductions in BP in those with normal to high-normal BP. This study will determine the feasibility of delivering personalised IE to patients with stage 1 hypertension for whom lifestyle changes would be recommended before medication within NHS primary care. Methods This is a randomised controlled feasibility study. Participants were 18+ years, with stage 1 hypertension, not on anti-hypertensive medication and without significant medical contraindications. Trial arms will be standard lifestyle advice (control) or isometric wall squat exercise and standard lifestyle advice. Primary outcomes include the feasibility of healthcare professionals to deliver isometric exercise prescriptions in a primary care NHS setting and estimation of the variance of change in systolic BP. Secondary outcomes include accuracy of protocol delivery, execution of and adherence to protocol, recruitment rate, attrition, perception of intervention viability, cost, participant experience and accuracy of home BP. The study will last 18 months. Sample size of 100 participants (50 per arm) allows for 20% attrition and 6.5% incomplete data, based upon 74 (37 each arm) participants (two-sided 95% confidence interval, width of 1.33 and standard deviation of 4) completing 4 weeks. Ethical approval IRAS ID is 274676. Discussion Before the efficacy of this novel intervention to treat stage 1 hypertension can be investigated in any large randomised controlled trial, it is necessary to ascertain if it can be delivered and carried out in a NHS primary care setting. Findings could support IE viability as a prophylactic/alternative treatment option. Trial registration ISRCTN13472393, registered 18 August 2020