‘The people who do best are the ones who start off the weakest’

Watching about 50 older people with chronic health conditions enthusiastically participate in a series of exercises in a large light-filled sports hall at Tallaght Leisure Centre in Dublin is impressive and inspirational.

The group – most of whom are aged between 50 and 80 – arrive at the class in various states of health. Some stand tall, others are overweight and less nimble, while some have the support of a rollator to help them walk. Yet when they join in the stretching, balancing and cardio exercises their differing physical abilities disappear as their desire to do as much as they can takes over.

“Our model is to have one programme for people with all illnesses. It’s inspiring to see people with different conditions to our own. It can be a little unhelpful to just focus on your own illness,” says Dr Noel McCaffrey, the founder of Exwell Medical.

Set up as a not-for-profit company in 2019, Exwell Medical has a team of 24 physiotherapists and sports scientists who run community-based medically-supervised exercise classes in over 20 centres throughout Ireland.

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Following a referral from their GP or hospital physician – and a baseline assessment of their physical strength and flexibility - the participants join two 50-minute classes a week. Some classes are funded by the HSE while others are paid for on a monthly basis. Clinicians at Tallaght University Hospital work closely with Exwell in the Tallaght area.

The rationale behind these exercise classes is that a large proportion of disability and unwellness in long-term illnesses is caused by becoming de-conditioned and unfit.

“These classes are about the restoration of mobility, hope, joy, resilience and getting out to meet people. Disability can also result in social isolation and psychological loneliness and these classes fix both,” says Dr McCaffrey.

The specialist in sports and exercise medicine developed and directed the Dublin City University MedEx programme before leaving the university to roll out his rebranded Exwell Medical programme countrywide in 2019. “Exercise is the single biggest intervention that enhances healthy ageing. It’s cheap and it works. Our aim is to make it available anywhere it’s needed in Ireland,” adds Dr McCaffrey, who in 2022 was named by the United Nations as one of the 50 world leaders in healthy ageing.

Cliona McGowan, an athletic therapist who works full-time with Exwell, says that it can be a bit daunting coming to a new class. “The key is that everyone works within their limits and the focus is on basic exercises – no gymnastics or trampolines here. Falls are the main risk for participants yet building up strength in your muscles and bones is the best way to reduce your risk of falls.”

There are exercise booklets and videos for those who can’t make it along to the classes.

Dr McCaffrey says that everybody in the classes has an amazing story to tell. “We see people running who haven’t run in 30 years. Everybody who comes is so appreciative. The people who do best are the ones who start off the weakest.”

And at the end of their 50-minute workout some of the participants are keen to talk about what it means to them to come to these classes.

Rose Rath joined the classes when she was recovering from breaking a bone in her foot. “I also have problems with my left leg but I’m more flexible since I came here. The classes are better than painkillers. They are my anti-inflammatories.”

Betty Leech, who has been coming to the classes for three years since she had a heart attack, adds, “It’s the best thing the doctor recommended. I also walk and cycle a lot.”

David Hennessy, who has developed Parkinson’s in the last 12 months, comes for the social outlet. “I was sitting around too much. I found it hard in the beginning but now I’m happy to meet people and do the exercises.”

Noel Doyle, who was diagnosed with cancer almost a year ago, only started the classes four weeks before the session we attend following a recommendation from his physiotherapist. “I was in hospital three or four times and I need to get my muscle strength back. There are such long waiting lists for physiotherapy at the hospital but this is a super outlet for me. I get a great buzz and boost from coming here.”

A small group of social prescribers are sitting watching the class when we visit. These HSE-funded workers in Tallaght, Clondalkin, Ballyfermot and Chapelizod are here to see if they can get more recruits for the classes. “We can prescribe it to people diagnosed with long term conditions who are looking for ways to be more active,” says Elizabeth Marnell, who works in a GP practice and the Fettercairn Community Centre in Tallaght.

As our population ageing it’s wonderful to see such proactive initiatives to help people with chronic health conditions improve their physical, psychological and social health.