Community Wellness Programme (CWP)

Description

According to the Physical Activities Chronic Conditions report 70% of individuals with Chronic Illness are uncomplicated and can exercise in the community setting. This vulnerable cohort can benefit from individualised tailored programmes and promote long term adherence to health enhancing behaviours when the prescribed exercise is low intensity.

Maintenance Pulmonary Rehabilitation Programme (PRP) have been proven to:

• Effective in improving exercise capacity, dyspnoea and quality of life in individuals with COPD/Asthma compared to usual care
• Reduce healthcare utilization and costs by reducing hospitalizations and emergency department
• Provide ongoing support and education for patients to manage their respiratory disease
• The effects of maintenance programmes persist for at least 12 months compared to a short-term programmes whose benefit can start to reduce at 3 months

The evidence of Cardiac Rehabilitation is clear – it has consistently demonstrated to significantly reduce morbidity hospitalisations and mortality among patients with established CV disease while also increasing their Quality of Life (QOL). The social inclusion aspect is huge as anxiety and depression can often co-exist and have a significant impact on quality of life
In 2024 the CWP delivered 850 classes to the Community and due to its success other cohorts such as Cancer & Neurological conditions will be catered for. Research has shown that participation in Cardiac Rehabilitation is associated with fewer unplanned and costly readmissions. Cardiac rehabilitation programmes improve functional capacity and perceived Quality of life while also supporting early return to work and development of self-management skills.

The CWP is evidence based and measured –
A proof of concept has shown that participation in the programme can:

1.Maintain Function: Out of 17 patients no-one significantly decreased their functional capacity over 26months with three patients showing a minimal clinical important difference. 100% Satisfaction survey revealed programme is fit for purpose

Pulmonary rehabilitation is a globally recognized, individualized care programme for patients with COPD and Asthma. It is considered the gold standard for those who are medically stable but still experience shortness of breath during physical activity or have functional deterioration.

Decreasing health care utilization costs: A review of 10 patients compared exacerbation rate with regards to GP visits and Hospital 12months pre and post commencement of classes and found:

• 26% reduction in GP presentations with exacerbations of COPD; with total GP visits falling across the group from 34 to 25 visits
• hospital admissions dropped from 7 to 0 which lead to a significant cost benefit to the already burdened acute hospital system

Aim of Initiative

In 2024 the CWP delivered 850 specialised and targeted classes to the community engaging over 120+ older people. Due to the impressive results to date the programme will now be expanded to Cancer & Neurological conditions in 2025. The aims and objectives are to deliver individualised tailored programmes and promote long term adherence to health enhancing behaviours when the prescribed exercise is low intensity.

According to a recent Physical Activities Chronic Conditions report (2023)70% of individuals with Chronic Illness are uncomplicated and can exercise in the community setting.

Maintenance Pulmonary Programme has been proven:
• Effective in improving exercise capacity, dyspnoea and quality of life in individuals with COPD / Asthma
• Reduce healthcare utilisation and costs by reducing hospitalizations and emergency
department
• Provide ongoing support and education for patients
• The effects persist for at least 12 months compared to a short-term programmes
whose benefit can start to reduce at 3 months

Cardiac Rehabilitation
• This progress has reduced morbidity hospitalisations and mortality among patients with established cardiovascular disease while also increasing their Quality of life. The social inclusion aspect is huge as anxiety and depression can often co-exist and have a significant impact on quality of life.

A recent visit from Lord Mayor Emma Blain has highlighted the need for evidence based programmes in the Community. Linking in with Niall Moyna from Dublin City University has had a huge impact as a research student was appointed to commence in September 2025.

Who is it aimed at

Cardiac
● Acute cardiac event -MI
● Had or awaiting revascularization CABG/PCI
● Stable angina
● Heart failure
● Valve surgery
● Heart transplant
● ICD
● Congenital heart disease

Pulmonary
● Chronic Obstructive Pulmonary Disease
● Asthma

Due to the programmes success the CWP is expanding the referral pathway to Cancer and Multiple Sclerosis Rehabilitation.

3 Steps critical to success

1. Provide Evidence of Impact for funding purposes

   Cardiac Case Study 1

   Evidence of Impact 1 Year Heart Failure
   This female client has maintained her 6MWT distance (405 m) and has not regressed on her modified REP MAX strength test. After recently attending her Cardiac Consultant, she reports her ejection fraction has improved from 39% to 50% and has reported a reduction in consultant visits.

   Cardiac Case Study 2

   Evidence of impact 4 Months Myocardial Infarction
   This female client has recently joined the Cardiac Rehabilitation Programme after 15 weeks adherence has a significant improvement on 6 MWT (30 metres). The client has reported weight loss of 21 lb while attending the gym and hospital dietician. According to her GP cholesterol, levels have dropped and clients, overall confidence has soared.

   Respiratory Case Study 1 – Age 60

   Evidence of Impact COPD/Asthma
   This male client presented to his physiotherapist with COPD/Asthma, Obstructive Sleep Apnoea and Type II Diabetes, chronic low back and hip pain. He needed a walking stick to mobilize outdoors. After completing his pulmonary rehabilitation course in the Chronic Disease Hub1 (CDH1) in 2022, he was referred on to the maintenance pulmonary rehabilitation programme in St. Catherine’s Community Sports Centre. After attending twice a week for eight months there was a 48-meter increase in his 6-minute walk test (6MWT), which reached the a minimal clinical important distance (MCID) of 30m; he no longer needs his walking stick to mobilize outdoors.

2. Specialist Coaches with relevant qualifications- Picking the right person for the right job

   The development of a chronic disease programme and linking in with a multidisciplinary team responsible for delivering the different phases of Rehabilitation. Covid has accelerated all chronic illnesses so it is imperative to identify the needs and wants in the community and set high standards for service delivery for the prevention and treatment of illnesses. Communication is key and feedback is vital for lifestyle behaviour changes.

   For progression there should be pathways for clients to transfer to mainstream classes or exercise independently in the gym environment. The programme has Specialist coaches who have completed their education via The Wright Foundation in the UK.

   An Exercise Referral Diploma and Level 4 in Respiratory & Cardiac Rehabilitation has been completed. Education is key to development to identify independent and non-independent risk factors and target modifiable risks such as smoking, excessive alcohol and psychological factors.

3. Reducing Hospital and GP Visits – SELL THE BENEFITS

   Socio economic groups have the highest rate of chronic disease, poverty, lack of social contacts and lack of health initiatives. Poor lifestyle choices and unemployment can be demoralising .
   One of the unique selling points of the programme is how accessible it is for participants with chronic health conditions. The programme is currently delivered in St. Catherine’s Sports Centre, Marrowbone Lane, Dublin 8 and Glin Road, Coolock, Dublin 17 – two disadvantaged communities within the city. The social, economic, and physical conditions in the places where people are born and get older can affect their health, wellbeing and quality of life. Measuring change is an essential part of an intervention strategy .

   Some of the results include the following Maintain Function:

   Out of a review of 17 patients undertaking the Cardiac programme no-one significantly decreased their functional capacity over 26 months with three patients showing a minimal clinical important difference. 100% Satisfaction survey revealed programme is fit for purpose.

   Decreasing health care utilization costs: A review of 10 patients who participated in the Pulmonary programme compared exacerbation rate with regards to GP visits and Hospital 12months pre and post commencement of classes and found:

   • 26% reduction in GP presentations with exacerbations of COPD; with total GP visits falling across the group from 34 to 25 visits
   • hospital admissions dropped from 7 to 0 which lead to a significant cost benefit to the already burdened acute hospital system

3 Challenges in Planning / Delivery

1. Funding -Impact of not Securing Funding:
   Not securing funding for the Community Wellness Programme could lead to several significant disadvantages:

    Limit Access to Community Resource for Disadvantaged Groups:
    Increased Healthcare Costs
    Worsening Health Outcomes
    Loss of Trained Personnel

   In summary, failing to secure funding could severely limit people’s access to local amenities, reduce care quality, increase long-term healthcare costs, worsen health outcomes, and lead to a loss of trained personnel essential for program success.

2. Specialist Coaches – It is imperative to pick a coach with expert knowledge and empathy for a high service delivery programme. They must be competent in exercise prescription, medications, adhere to a strict inclusion/exclusion criteria. Exercise safety for vulnerable cohorts is paramount with gradual adaptions and progressions . Competent to deal with clients with multiple comorbidities and support through education will ensure long term adherence to health enhancing behaviours.
3. Education – is key to successful programme delivery .It is imperative to promote and educate on mobility and independence in the community and keep clients independent while living at home. Weight bearing exercises are important for bone density ,lowering the risk of osteoporosis and fractures. Strong legs reduce stress on hips knees, ankles, which also helps manage and prevent arthritis and joint pain.
   A lot of vulnerable cohorts do not have the confidence to enter a gym environment and felt it was an intimidating.

   A recent presentation by Professor Niall Moyna at the Age Friendly round table discussion highlighted the importance of the above topics and the importance of exercise and strenght training.

3 Outcomes / Benefits

1. Promoting Programme enhance participation- linking in with relevant stakeholders

   The CWP supports patients who completed their pulmonary and cardiac rehabilitation programs, promoting ongoing physical activity and healthier lifestyles. This collaboration has created a referral pathway linking DCC’s St. Catherine’s Community Sports Centre (SCCSC) with physiotherapists at CDH1 and St. James’s Hospital in Dublin South West, as well as Glin Road with CDH9 associated with Beaumont Hospital on the North Side.
   Flyers are available in James Pulmonary department and Cardiac unit. The Phase IV Cardiac programmes are linked in with league of Ireland clubs St. Patricks Athletic and Bohemians FC .The Cardiac programme is advertised via their match programme and social media platforms.

   The programmes are also promoted via local GPS and Health promotion staff. Age Friendly and Dublin City Sports Partnership have also taken an active interest in promoting both programmes. One of DCC key roles is to provide access and for physical activity across Dublin city with opportunities aligning with Active cities throughout plans and initiatives.

   A recent visit from Lord Mayor Emma Blain has highlighted the need for evidence based programmes in the Community. Linking in with Niall Moyna from Dublin City University has had a huge impact as a research student was appointed to commence in September 2025.

2. Social inclusion for vulnerable Cohort

   The local community is heavily involved in CWP Programme. The clients highly appreciate having a brand new designated area “safe space “away from the general public. Because they are a vulnerable cohort there is ambient air flow, a specialist instructor on site with relevant qualifications to cater to their specific needs.
   Hygiene standards are paramount and there is good communication between the staff and relevant consultants from local hospitals. There are many Community awareness and Education days so participants can build up good rapport and positive interactions with each other. Word of mouth has ensured consistency in approach in community building fit for purpose programmes with high service delivery.
   Chair yoga and balance classes also compliment the gym programmes which all participants have access to. An advanced Paramedic from Dublin Fire Brigade (DFB) will deliver educational talks on topics such as Blood pressure and modifiable risk factors. The Local league of Ireland St. Patricks Athletic will provide tickets to participants to local derbies and have visited with the FAI Cup.

   One of the unique selling points of the programme is how accessible it is for participants with chronic health conditions. The programme is currently delivered in St. Catherine’s Sports Centre, Marrowbone Lane, Dublin 8 and Glin Road, Coolock, Dublin 17 – two disadvantaged communities within the city. The social, economic, and physical conditions in the places where people are born and get older can affect their health, wellbeing and quality of life

   This programme can be life changing for participants. It allows people who have suffered a health setback in life (Cardiac, Pulmonary, Cancer etc.) to safely return to something positive such as exercise – which provides them with huge physical, mental and social benefits.
   Dublin City Council will support everyone in ensuring the “more active, more often” theme is activated and will drive action with internal and external partners to deliver world class programmes.

3. Delivering a low cost affordable programme for long term lifestyle change

   In 2024 the CWP delivered 850 specialised and targeted classes to the community engaging over 120+ older people. Due to the impressive results to date the programme will now be expanded to Cancer & Neurological conditions in 2025. The aims and objectives are to deliver individualised tailored programmes and promote long term adherence to health enhancing behaviours when the prescribed exercise is low intensity.
   According to a recent Physical Activities Chronic Conditions report (2023)70% of individuals with Chronic Illness are uncomplicated and can exercise in the community setting.

   The project fits firmly within the World Health Organisations eight domains – playing a pivotal role in a number of areas. The programme very much fits into the Community & Health Services domain – providing vital, supervised support as participants return to exercise from a chronic health condition. It provides a great social outlet for its participants and through its weekly physical and mental benefits very much assists in allowing people to ‘live in place’ as long as possible.

   Nationally the project would met some key objectives in the National Sports Policy and the governments Slaintecare initiative and has delivered results that are now informing future rollouts at a larger scale.