Exercise your way back to vital health

Dr Noel McCaffrey has received a United Nations award for his community-based exercise rehabilitation programmes. He's now on a mission to roll it out nationwide 

Dr Noel McCaffrey, founder of Ex-Well Medical. Picture: Moya Nolan

It’s a bright early morning, and we are jumping jacks and air boxing, running on the spot and skipping furiously with Dr Noel McCaffrey to the lyrics of the Lighthouse Family’s single, ‘High’.

The All-Star Gaelic footballer and sports medicine consultant exchanges the odd quip with his participants at the ExWell Medical class, but there’s not much breath for banter during a full hour of aerobics, strengthening with weights, and balancing exercises.

Slightly cocky about my fitness level, a few glimpses at Vera Mannion to my right softens my cough. She is approaching her 78th birthday and seems to be barely perspiring as she moves with ease through the circuit training.

Ditto for Cathy Walsh, ExWell’s secretary to my left, who starts her day several times a week at an advanced session led by McCaffrey in the Irish Wheelchair Association (IWA) gym in Dublin’s Clontarf.

Several other participants tailor their movements, and one or two use rollator support. When it comes to the core strengthening exercises, the best yoga training feels like poor preparation for the agonising minutes that McCaffrey has us suspending legs and arms out straight from the edge of a chair.

For the last segment, balancing on one leg, both eyes closed, is yet another challenge. The “eyes closed” bit can help recalibrate the body and brain. Sure enough, McCaffrey seems to be going for gold at ten seconds on each leg. But there’s a shared giggle when he gives a tiny wobble.

Within the hour, there will be a gentler class, led by Danny Fagan, ExWell’s head of operations and experienced exercise instructor who is one of 14 working with the community-based exercise rehabilitation programmes for people living with a longer-term medical condition.

“This is what I call exhilarating medicine,” McCaffrey says afterwards, explaining how ExWell Medical came about.

Dr Noel McCaffrey, founder of Ex-Well Medical, right, leading an excersise class in Clontarf for people who have experiened chronic illness. Picture: Moya Nolan

The consultant at the National Orthopaedic Hospital, Cappagh, set up the not-for-profit social enterprise in 2019 to improve quality of life through movement and make a significant dent in Ireland’s €20bn health bill.

He was recently named as one of the United Nations 2022 Healthy Ageing 50, a group of 50 individuals from around the world recognised as outstanding leaders with extraordinary achievements in this field. McCaffrey is Ireland’s only awardee.

“I had established a model in Dublin City University (DCU) called MedEx, but to roll it out nationally required me leaving that job,” he says, explaining the background of the organisation.

A passion for the benefits of exercise and a firm believer in the body’s power to heal itself convinced him that there was an urgent need – not just among people who have had serious health issues, but those in their 40s and 50s who may have slipped out of regular exercise.

“That cohort, as in those who haven’t yet got ill, are the hardest to convince, “he says, in spite of stark statistics for what could lie ahead without a preventative approach.

“So 84% of people over 65 have one chronic illness, ranging from arthritis, diabetes, heart disease, lung disease, multiple sclerosis, Parkinson’s disease,” he says. “And 65% of people aged over 65 have two conditions or more.

“When you think that chronic illness management takes up 75 to 80% of our entire health spend — and that proportion is probably going to grow —  you see how this makes sense,” he says.

Equity of access

The Government’s Sláíntecare strategy wants to move chronic illness management into community settings, and ExWell Medical aims to be a resource and support for the HSE.

“The HSE already has some really good structures, and we aim to be a bridge between that work and independent exercise,” he says.

“We partner with local organisations where possible,” he adds, listing off locations ranging from Dublin’s City West during Covid-19, Loughlinstown, Sligo, the Midlands and Carlow.

ExWell is starting a three-month HSE-funded project shortly at Tallaght University Hospital, championed by geriatric and stroke medicine consultant Prof Seán Kennelly, which will be free to participants. Next year, it will open in Cork, with support from geriatrician Dr Bart Daly.

“Equity of access for all is very important to us, though there are some centres where people pay — such as at the IWA. We are aware many people are above medical card qualification and still struggling to pay bills,” McCaffrey says.

Vera Mannion, who lives in Artane, spent almost three months in hospital after she sustained a hairline fracture in her hip socket during a hike in Kerry some years ago.

“I’ve been coming here for at least three years, three times a week, and all through those frosty mornings in the carpark during Covid,” she says.

“It wouldn’t be long before you’d be taking off your hat and gloves. The great thing is that you can track your progress, they send a report to my doctor, and I wouldn’t miss it,” she says.

ExWell is starting a three-month HSE-funded project at Tallaght University Hospital.

Yvonne Kennedy, who lives in Raheny and has recently retired, took up the classes at the IWA in March of this year and says it is “the best thing I ever joined”. She has primary biliary cholangitis, a liver condition, and was referred by consultant Prof Frank Murray.

“I hadn’t done a lot of exercise before, and at first I didn’t think I could skip or jump and then I realised I could,” she says.

Noel Hickey had put on weight when he stopped playing football in his 40s, but had set out to get fit again and was on his bike when he had a heart attack at the age of 56.

“I have known Noel McCaffrey from childhood through GAA in Clontarf, and about six weeks after my cardiac bypass he told me he had a place for me,” Hickey says.

“Noel likes to see a sweaty brow and red face, and when you see that little bit of sweat around his own t-shirt you know he’s getting stuck right in,” Hickey laughs.

Ageing population

“The way it works is that we take in people who may have had a cardiac event or other illness and are referred by a GP or consultant,” McCaffrey explains.

“They attend an induction talk, and we test to measure strength and aerobic fitness,” he says.

“The social interaction is almost as important, and we were deemed as essential during Covid-19 which meant we could continue classes out in the carpark at the IWA here.

“The biggest relative change occurs among those who start off the weakest and may lack confidence,” McCaffrey says.

In an ideal world, the State would fund all of the programmes run by ExWell, at a considerable saving, McCaffrey believes.

“With an ageing population, we realise this may not be practical — but even funding a three-month national project would be just great.”

• See: exwell.ie