Dakar, Senegal — The sun hasn’t yet risen in Senegal’s capital, Dakar, but about 100 people in swimsuits and life jackets have already gathered on a section of the beach, ready for an aquagym class.

Across the chilly Atlantic, 63-year-old Aminata Saal Soon is harmonising with others, foam noodles tucked under her arms. At the beach, people with limited mobility are buried in sand up to their knees and their torsos are gently rotated in therapy sessions to reduce pain.

Saul’s doctor once warned her that she might lose the ability to walk within five years due to rheumatoid arthritis, an autoimmune disease which causes pain, stiffness, and swelling in the joint lining and can lead to serious damage if left untreated.

“The shock was huge,” he said. “I stayed at home for almost a year, doing nothing.” Then one morning, she wandered down a beach in the Ngor neighbourhood of Dakar and saw people exercising in the water.

“I asked what they were doing, and they told me to try,” she said. “I’m still walking.”

Senegal’s first AquaGym program, with its low-impact exercises,

has won praise from health professionals for helping people with reduced mobility due to chronic diseases such as heart disease, stroke, and arthritis.

As life expectancy continues to increase rapidly across Africa, these diseases have become more common, often leaving older adults with pain and limited mobility. But prevention, diagnosis, and rehabilitation services have largely lagged behind on the young continent, whose public health systems prioritise infectious diseases, maternal care, and children.

Many older people have little access to geriatricians or other doctors and refuse diagnosis or treatment to cut costs.

AquaGym emerged less than a decade ago as a rare, low-cost option for pain relief and improved mobility.

After Sal was diagnosed with her autoimmune condition, she said her doctor told her she would need surgery costing approximately $10,000, which she could not afford. She was given an anti-inflammatory drug, but it was later taken off the market due to complications.

“That’s when I started losing hope,” she expressed. “Some mornings, a blocked vertebra or swollen ankle leaves me unable to walk all day.”

Most medical care in Senegal is self-funded. Public insurance coverage is limited, and private plans are unaffordable for many people. Expensive procedures like surgery are often not covered.

“Many people don’t come to us until things get really bad, and by then it becomes much harder and more expensive to treat them,” said Dr Seydina Ousmane Ba, director of the National Orthopaedic Prosthetics and Rehabilitation Center in Dakar.

Khadijah Wade, 76, has spinal stenosis, a degenerative condition that can compress and irritate the nerves in the spinal cord. She was diagnosed three years ago and her condition worsened after her husband died earlier this year.

“I became very sedentary. I could have gone a whole month at home without going for a walk,” Wade said.

Many suggested she see a specialist in Italy or France, but for many Senegalese, visas are difficult to obtain and treatment abroad is expensive.

Last month, Wade started AquaGym classes on the recommendation of his doctor. She said she’s already seeing results.

“I came to my first session with a stick, but now I can walk without it,” she said.

People with reduced mobility in West Africa face particularly enormous barriers, said Clement Fillit, director of Handicap International in Senegal. Public spaces and transportation are often inaccessible, he said, and specialised healthcare and rehabilitation services are scarce.

“Aquagym has benefits you don’t always get on land,” Ba said. “Water supports your body, reduces pain and makes movement easier, allowing patients to exercise more comfortably.”

The program’s founder and head coach, Ndiame Samb (69), worked as a firefighter specialising in underwater operations before becoming a lifeguard in 1988 and teaching swimming to older people.

The Samba are members of the Lebou, considered the indigenous people of the Dakar Peninsula, who have maintained strong cultural and spiritual ties with the sea.

While training in Paris, Samb discovered aquagym and its benefits. Samb’s classes in Dakar are unique in the world as they take place in the ocean rather than a pool. Public pools are rare, and the sea is free.

“Earlier, only eight or 10 people used to come to the class,” Samb said. “But now, sometimes we get 200 people per session and around 600 students in total.”

Volunteer instructors lead the low-cost Aquagym classes, which cost 300 CFA francs ($0.50) per session. This fee is used to keep the centre running and purchase equipment, along with a $3,000 subsidy given by the city this year.

Samb’s 60-year-old brother, Alassane, a lifeguard and licensed massage therapist, guides new participants and said some people even come from France and the United States for treatment.

As the day’s session ends, Sal emerges from the water smiling. She attends three times a week.

“What keeps me coming back is seeing other people not giving up,” he said.

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