Penang went through some of the toughest COVID waves in Malaysia, with ICU beds at Penang General Hospital and private hospitals stretched thin during the worst months. Most people recovered from the acute infection within a couple of weeks. But for a significant number – estimates range from 10% to 30% of those infected – symptoms like breathlessness, fatigue, and exercise intolerance lingered for months or even years. If that sounds like you, physiotherapy can help.
What Happens to Your Body After COVID
COVID-19 primarily attacks the lungs, but it also affects the heart, muscles, brain, and nervous system. Even people who had mild infections sometimes develop long COVID symptoms. The most common ones we see in Penang patients are:
- Shortness of breath with activities that used to be easy (climbing stairs, walking to the shops)
- Crushing fatigue that doesn’t improve with rest
- Reduced exercise tolerance – you gas out much faster than before
- Brain fog and difficulty concentrating
- Muscle weakness and joint pain
- Persistent cough
These symptoms happen because COVID can cause lung scarring (even in mild cases), deconditioning from prolonged rest, dysfunction in how your autonomic nervous system regulates heart rate and breathing, and ongoing low-grade inflammation.
Breathing Exercises for Breathlessness
Breathing retraining is one of the most effective tools for post-COVID breathlessness. Many people develop dysfunctional breathing patterns during and after COVID – they breathe too fast, too shallow, or use their neck and shoulder muscles instead of their diaphragm.
Diaphragmatic breathing: Lie on your back with your knees bent. Place one hand on your chest and one on your belly. Breathe in slowly through your nose, letting your belly rise while your chest stays relatively still. Breathe out gently through pursed lips. Start with 5 minutes, twice a day. This retrains your diaphragm, which is your primary breathing muscle.
Box breathing: Breathe in for 4 counts, hold for 4 counts, breathe out for 4 counts, hold for 4 counts. Repeat for 5 minutes. This helps regulate your breathing rate and calm an overactive nervous system.
Pursed lip breathing: Breathe in through your nose for 2 counts, then breathe out slowly through pursed lips (like you’re blowing through a straw) for 4 counts. Use this technique whenever you feel short of breath during daily activities.
Blow-as-you-go: When doing something that makes you breathless – like climbing the stairs in your Tanjung Bungah apartment or walking uphill from the Penang Road hawker stalls – breathe in before the effort, then blow out slowly during the effort. This prevents breath-holding, which makes breathlessness worse.
Energy Management: The Pacing Approach
Post-COVID fatigue is different from normal tiredness. Pushing through it often makes things worse – a pattern called post-exertional malaise, where overdoing it on Monday leaves you wiped out until Wednesday. The solution isn’t rest (which leads to further deconditioning) but pacing.
Pacing means planning your day to balance activity and rest. Break tasks into smaller chunks with rest periods in between. If cooking dinner exhausts you, try prepping ingredients in the morning, then cooking in the evening. Prioritise what matters and let go of what doesn’t.
Keep a simple diary tracking your activity levels and energy. You’ll start to see patterns – maybe mornings are your best time, or maybe you crash every time you go to the wet market in the heat. Use these insights to plan your week. Gradually extend your activity periods as your tolerance improves, but increase by no more than 10-15% per week.
Rebuilding Fitness Safely
The urge to jump back into your old exercise routine is understandable, but doing too much too soon is the most common mistake we see. A graded return to activity, guided by a physiotherapist, protects you from setbacks.
Start with gentle walking on flat ground – the Esplanade or a shopping mall with air-conditioning are good options in Penang’s heat. Begin with 10-15 minutes and monitor how you feel the next day. If you’re fine, gradually increase duration before increasing intensity.
Add light resistance exercises using your body weight or resistance bands. Focus on major muscle groups – squats, wall push-ups, seated rows. Two to three sessions per week is enough initially. Your physiotherapist will progress your programme based on your response.
Monitor your heart rate during exercise. A rough guide: stay below 60-70% of your maximum heart rate initially (roughly 220 minus your age, then multiply by 0.6). If your heart rate spikes abnormally or takes a long time to settle after activity, slow down and discuss it with your physiotherapist.
When to Seek Help
See a physiotherapist if:
- You’re still breathless or fatigued more than 12 weeks after your COVID infection
- You can’t return to your previous activity levels
- You feel dizzy or your heart races with light activity
- Your symptoms are affecting your work or daily life
See a doctor urgently if you experience chest pain, a heart rate over 100 at rest, new or worsening breathlessness at rest, or coughing up blood.
Many post-COVID patients in Penang find home visit physiotherapy especially practical because the fatigue itself makes travelling to a clinic exhausting. A physiotherapist can assess your breathing, design a tailored exercise programme, and guide your return to normal life – all in the comfort of your home. Reach out via WhatsApp to discuss how we can help with your post-COVID recovery.
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Reviewed by
M. Thurairaj
Registered Physiotherapist