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'You are never too old, too ill or too unfit to start exercising' - how keeping fit can bring joy to those with chronic illness

Exercise won't cure a chronic illness, Dr Noel McCaffrey of ExWell tells Eva Hall, but it can increase mobility, reduce pain and boost mental health - and the less active you are before you start, the bigger the benefits

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Adrian O’Keeffe  pictured out for a walk in Kilkenny. Photo: Dylan Vaughan

Adrian O’Keeffe pictured out for a walk in Kilkenny. Photo: Dylan Vaughan

Dylan Vaughan

Clare Quinn pictured in her Swords home. Photo: Gerry Mooney

Clare Quinn pictured in her Swords home. Photo: Gerry Mooney

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Adrian O’Keeffe pictured out for a walk in Kilkenny. Photo: Dylan Vaughan

Clare Quinn is counting down the days until gyms reopen. She does exercises you have possibly never heard of: chair aerobics, weights with a rollator, stretches targeting specific feet muscles.

She's now doing these at home via online classes. But it's not the same when your gym buddies - people who have overcome as much as Clare - aren't by your side.

Clare isn't training for a marathon or triathlon. Rather, she's training her brain to help her live with a chronic illness, as are all of her classmates in ExWell Medical's group sessions.

Clare was diagnosed with Parkinson's in 2018, and referred to ExWell by one of the many neurologists she's seen since then.

Founded and run by former Dublin GAA All Star Dr Noel McCaffrey, ExWell specialises in exercise for medical purposes. Clients must be medically referred and usually have a long-term illness, such as Parkinson's, diabetes or a heart condition.

"Chronic illness affects 40pc of the population and affects 80pc of people over 65," says Dr McCaffrey. "Long-term illnesses are extremely common and they tend to cause people to become less physically active.

"There's no reason for people with long-term illnesses not to exercise. Being physically inactive contributes to a great deal of your unwellness."

Clare, diagnosed with Parkinson's at just 56, wasn't entirely sold on the idea of group exercise at first.

"When I was diagnosed, I was shocked," the mum-of-two says. "You hear people say 'my granny had that' - Parkinson's seemed to be an older person's illness. I didn't really know what it involved or what my life was going to be like."

Parkinson's disease is a progressive nervous system disorder that affects mobility. There is no cure.

Used to an active lifestyle - "spontaneously getting on the bus, going places" - Clare was getting used to her new normal. "I had slight tremors in my fingers and sometimes experienced internal tremors. My posture was off, my foot was dragging and I had no swing in my right arm."

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Clare Quinn pictured in her Swords home. Photo: Gerry Mooney

Clare Quinn pictured in her Swords home. Photo: Gerry Mooney

Clare Quinn pictured in her Swords home. Photo: Gerry Mooney

The medical assessment of Clare was swift when she first presented with symptoms. But an official diagnosis took about 12 months and the acceptance of having a chronic illness took even longer.

"I didn't want to see anybody. There are other people worse off than me but at that moment I didn't feel that way. I withdrew from going out as symptoms became more evident."

She first met Dr McCaffrey at an ExWell induction in DCU. The not-for-profit social enterprise, which is funded through the Social Innovation Fund Ireland, has a team including physiotherapists, physicians and athletic trainers, as well as a specialist advisory board.

"I thought 'how could I do exercise, I have a stick?'"

Clare took a seat at the back and noticed one person in a wheelchair. Dr McCaffrey told the group of about 20 people that chronic illness is not a barrier to exercise and that any exercise can be adapted to suit a person's needs. He says this applies to anyone, even those without illness.

ExWell focuses on three core elements: aerobics, strength work and balance and core stability. "All three are important," Dr McCaffrey says. "No matter what your level of mobility is, everybody can do something.

"It's never too late to get started. We've seen people in their 90s starting a strength programme and the gains they make are in the thousands of percent, so it's true to some extent to say that the frailer you are, the greater the gains you'll make."

As well as the physical improvements, Dr McCaffrey says the mental benefits of exercising are even greater.

"For lots of people with illness, they've forgotten about the joy of exercising."

Clare is testament to this. When she heard that exercise was just as important to Parkinson's as medication, she perked up.

"I was going to get rid of it in my mind," says Clare," who attends classes in Santry four times a week. "But then when a cure wasn't happening I had to realise I am living with Parkinson's. Exercise is helping me live with it and make my quality of life better.

"[Prior to Covid-19] the only thing I was doing was ExWell. Confidence was a big thing. But I always felt good there. Could I call them another family?

"If I do a session a day now it gives me a lift as well as flexibility. My legs can be very rigid, so when I do certain exercises I notice my perseverance going a little bit further than it did before. The balance exercises are particularly helpful because I'm inclined to fall sideways."

Business coach Adrian O'Keeffe describes the circuit programmes he practises at ExWell in The Watershed in Kilkenny as "a dream come true".

After having a stent inserted to correct blockages in an artery two years ago, grandfather Adrian got stuck back into work straight after the procedure.

"I was completely stressed and extremely worried, I didn't want to walk up stairs for fear I'd have a heart attack," recalls Adrian, 69.

He had approached gyms before but found that they were ill-equipped to deal with "a man of my age".

"I hadn't a clue what ExWell was. When I was told a Dr Noel McCaffrey was coming down, I was expecting the usual consultant in a pinstripe suit to give me a lecture on something nice and easy, such as pass the parcel. When this fine specimen of a man, in shorts, a sweatshirt and runners walked in, it was totally unexpected," says Adrian.

"ExWell is a course developed specifically for a guy like me. None of us know what's going on in our bodies and I realise now that psychologically I wasn't doing as well as I was physically."

Adrian does a range of aerobics exercises using a treadmill, plus strength and conditioning with weights and boxing and even basketball.

He has learned how to monitor his heart rate and what his limits are for working out, and why certain exercises work different muscles around the body.

Dr McCaffrey says people with chronic illness are often under the impression working out will make their condition worse.

"If you don't exercise, your muscles waste and get weaker, and over time your fitness will reduce," he says. "The impact of that is that you lose mobility, you become socially isolated, you lose motivation and your mental health deteriorates."

When a patient is referred to ExWell, a number of self-administered tests to measure strength, aerobic fitness and quality of life are carried out at home. An exercise programme is designed around these results, and the patient joins group classes.

Each patient will have a regular check-in with a staff member to discuss progress. The patients are monitored, and after three months are retested.

"We expect to see an improved function within six weeks," says Dr McCaffrey. "A recent survey we did showed that 60pc of people in our class experience some pain every day. In 25pc of those cases, the pain improved since they started the exercise programme. Having aches and pains is not a barrier to taking part in regular exercise. We don't want to give you pain that's getting worse or that keeps you awake at night, but we can't take the approach that if you have pain that means you shouldn't exercise, because that's not true.

"Everybody can do it - we can transform your life without fixing the illness."

For more info see www.exwell.ie

‘Every little bit of exercise is helpful’ - Dr Noel McCaffrey’s tips on getting started

1. Should I start an exercise programme?

Definitely yes. It is the best thing you could possibly do to improve your physical and mental health.

2. Does it matter if I have a long-term illness?

No. In fact, it is even more important for people with a chronic illness to remain (or become) physically active.

3. How much exercise should I do?

Every little bit is really helpful. Even if you simply avoid sitting down all the time, this is profoundly beneficial. Aim to build up to doing 30-40 minutes on most days of the week.

4. What type of exercise should I do?

Try to include the three key exercise components throughout the week:

  • aerobic exercise
  • strength work
  • core stability / balance

(you don't have to do all three every day)

5. How hard should the exercise be?

There are many ways to judge the right exercise intensity.

For aerobic exercise, we know that you are at the right intensity for yourself if, during the exercise:

  • you have a red face
  • you are slightly breathless
  • you are sweating a little
  • you are able to carry on a conversation with someone close by

For strength work, a good rule of thumb is to do 10-12 repetitions of any given strength exercise per set. If the weight you are lifting is correct for you, you should find that the last 2-3 repetitions (per set) feel a little difficult. If these final repetitions feel easy, the weight is too light. If the first few repetitions feel difficult, the weight is too heavy.

6. How should I get started?

  • Ease into the exercise programme. There's no rush.
  • At the start of your programme, take a day's break after each session.
  • Every two weeks, make it a little more difficult, by either adding an extra session per week or by making each session a little longer.

7. What if I have pain?

Pain is a common complaint in most people aged over 60, and the commonest cause of pain is wear and tear (arthritis) in the painful area. Pain in an arthritic joint may get worse after exercise. As a general rule, you can ignore this pain provided:

  • it is not very severe
  • it settles fully after each session

We recommend this approach because the benefits of regular exercise are so important that they outweigh discomfort of a modest pain flare-up.

It is different if the flare-up is very severe, does not settle fully after each session or if you develop pain that keeps you awake at night.

If any of these situations arises, you should stop the exercise and consult your doctor.

8. Any safety tips?

If you notice any of the following, do not start an exercise session or, if you have started, stop the session immediately and consult your doctor:

Breathlessness at rest

  • Chest pain (or jaw pain or shoulder / arm pain) brought on by exercise, which goes away when you stop the exercise
  • Dizziness or faintness during exercise
  • Severe or unusual headache

9. What if my motivation isn't great?

Regular exercise is a habit. So is not exercising - and like any habit, it is hard to stop once you get used to it. The big challenge is switching from being inactive to become active. The bottom line is you must be willing to give this lifestyle change a try.

Here are some tips to help in the critical 'getting started' phase:

  • Do a type of exercise that you enjoy
  • Try to exercise with a partner
  • Set yourself some simple goals

10. Measure your progress

There are simple ways to measure your aerobic fitness (eg, how long does it take me to complete a loop walk in the park?) and your strength (eg, how many sit-to-stand repetitions can I complete in 30 seconds, standing up from a kitchen chair?).

Irish Independent