Swollen legs, difficulty breathing, hearing loss: These obstacles did not stop them from exercising

SINGAPORE – Doctors recommend exercise to manage chronic health conditions and for prehabilitation before surgery, to make it easier for patients to return to health.

Yet how do you exercise when ill or facing other challenges to physical activity? This is how three people worked around their conditions.

Strength training with swollen legs

Exercise used to be a way of life for Ms Fatima Megala Nathan Arokianathan, a research manager at a local university. She used to swim regularly and do high-intensity workouts like CrossFit.

“I was passionate about exercise,” says the 40-year-old.

Her life changed in 2022, when she woke up one day with legs swollen to three times their usual size. She felt a burning sensation in her lower limbs and could barely get out of bed, let alone walk.

“There was no known cause for this,” she says. “I was a very healthy individual. I don’t have any other chronic conditions.”

Apart from the inflammation and pain, she developed gut issues and could not digest solid food. Her weight dropped from 55kg to 35kg. She is 166cm tall.

Daily life became a challenge. She found it difficult to walk and take the stairs. Her legs were so stiff that it was hard to move. She had issues maintaining her balance as well.

Multiple rounds of hospital tests could not explain what caused her symptoms.

Her condition is rare. She was given a diagnosis of undifferentiated connective tissue disease, as some of her symptoms and blood test results suggested systemic autoimmune disease, says her doctor at Tan Tock Seng Hospital.

However, adds associate professor Madelynn Chan Tsu-Li, the results are insufficient to define a more specific connective tissue disease, such as lupus.

“At present, it is not clear what the cause of her weight and muscle mass loss is, and we are still investigating this,” says the senior consultant at the hospital’s department of rheumatology, allergy and immunology.

It may seem counterintuitive, but exercise is recommended for people like Ms Nathan. Strength training can maintain muscle mass. Exercise can also help manage pain and fatigue.

Ms Nathan knows this, and took up yoga to improve her flexibility.

In 2025, she signed up with a gym that has experience training people with different physical conditions.

“I knew I couldn’t exercise on my own,” she says.

Indeed, Dr Chan recommends that patients consult a physiotherapist or other health professional to design an exercise programme that is safe and manageable.

Mr David Hoi, an exercise physiologist at UFIT Singapore, says when Ms Nathan joined the gym programme, she was unsteady while walking and easily fatigued.

He and the physiotherapist work together to help her maintain muscle mass without exacerbating her symptoms. On days when her legs are swollen or stiff, the physiotherapist works on flexibility and pain-relieving techniques. She can take a rest day or switch to upper body exercises.

This approach has helped her. She now has 16.6kg of muscle mass, compared with 15.9kg when she started. She can do lunges, rows and walk while carrying weights.

Ms Nathan recalls: “When I started, I couldn’t even do a lunge properly. Lifting anything overhead left me dizzy. Anything with weights was an issue.”

She is now able to squat with a weight of 20kg and deadlift 30kg.

Best of all, she can climb a flight of stairs without tripping. She can walk for longer distances, and do things like shop for and carry groceries.

“All these things are much more achievable now,” she says. “Previously, I could barely get out of bed.”

She aims to do yoga three times a week and strength-train twice a week, subject to her body’s limits.

“I know there are days when it’s okay to not be okay,” she says. “This disease has taught me when I can do things and when I can’t.”

Brisk walking when it is hard to breathe

In 2024, Madam Nancy Lim Mui Luang, a homemaker, found it harder to breathe while singing in church. She consulted a general practitioner, who said her symptoms were part of ageing and recommended that she exercise more.

Her weekly routine then included at least three sessions of physical activity such as swimming, playing squash, doing pilates or brisk walking. “I would get chest congestion during exercise, but it came and went. It wasn’t painful,” recalls the 56-year-old. “I thought it was stress-related.”

In 2025, she found it unusually hard to catch her breath while hiking in Melbourne.

During a general health check done as part of the national preventive health initiative, Healthier SG, a shadow was seen in her chest X-ray. Further investigations identified a giant leiomyoma, or benign tumour, of the oesophagus. It was pressing on her heart and lungs.

The size and position of the tumour made it rare, says Dr Edward Cheong, who removed it through keyhole surgery in December 2025.

While damage to the oesophagus was minimised, Madam Lim was on a feeding tube while the organ recovered, and had to have saliva and gastric fluids removed through another tube.

Before and after the surgery, Dr Cheong insisted that Madam Lim do aerobic activity such as brisk walking. “Prehabilitation before any major operation prepares a patient physically, medically and mentally,” says the senior consultant upper gastrointestinal surgeon with PanAsia Surgery.

Before the surgery, he would text her regularly to check that she had walked. “I had to huff and puff and sweat, not just enjoy a nature stroll,” she says.

Madam Lim worked with a friend who was a yoga teacher to develop an exercise programme that would allow her to maintain or improve her fitness and not hurt herself.

She did breathing exercises to prepare her lungs before walking.

Her target was to hit between 50 and 70 per cent of her maximum heart rate based on her age. To avoid strain, she alternated bouts of brisk walking with regular walking.

She used the talk test when walking with friends. If she could keep the conversation going without gasping, she was walking at a sensible pace.

She also relied on her smartwatch for a record of her pace and distance.

“Having this plan gave me something to work towards before surgery. It was something within my control that I could do for my health,” she says.

Post-surgery, Dr Cheong walked with Madam Lim around the hospital and encouraged her to continue exercising.

She now swims twice a week for 30 minutes, with rest breaks. She also goes on hour-long brisk walks thrice a week.

She almost overdid it recently by trying kettlebells. “It was too painful,” she says. “My body is not ready yet.”

She is also avoiding her former sport, squash, thinking it better to stick to her doctor’s prescription of “walk, walk, walk”.

“Daily brisk walking strengthened my lungs, set my heart to fight, and gave me resilience to bounce back after surgery,” she says. “I feel so much better now.”

Lifting heavy with hearing aids

National weightlifter Chua Jiin-Linn, 27, has worn in-ear hearing aids since her childhood.

She lost about 60 per cent of her hearing by Primary 1 because of bouts of Bell’s palsy from age two.

Bell’s palsy causes paralysis of the facial nerve and occurs in about 0.02 per cent of the population, according to national digital health platform HealthHub.

Her family realised she had hearing problems only when she made errors such as hearing the name “Clement” as “Lemon”.

Ms Chua started using in-ear hearing aids, as these are more discreet. Her parents worried she would be singled out or constantly answering questions if her hearing aids were obvious to the eye.

“Without my hearing aids, I hear sounds, but not clearly,” Ms Chua says. “When I take them off to sleep, no one can disturb me.”

She works as a revenue management analyst and trains three days a week after work, usually at the Singapore Weightlifting Federation space in Bedok.

She wears hearing aids while training and working with her coach. “I need to hear the explanation as my coach guides me through techniques and certain movements,” she says.

She also wears her hearing aids when she runs outdoors, for safety. “Sound is important. Sound is how I acquire information,” she says.

She says having in-ear hearing aids gave her the confidence to try new sports and activities. She used to dance and swim, and competed in dragonboat races.

“Without hearing aids, I wouldn’t have the confidence to go out and try things,” she says. “If not for my hearing aids, I probably wouldn’t be where I am today.”