Return to training in the COVID-19 era: The physiological effects of face masks during exercise

Danny Epstein, Alexander Korytny, Yoni Isenberg, Erez Marcusohn, Robert Zukermann, Boaz Bishop, Sa'ar Minha, Aeyal Raz, Asaf Miller, Danny Epstein, Alexander Korytny, Yoni Isenberg, Erez Marcusohn, Robert Zukermann, Boaz Bishop, Sa'ar Minha, Aeyal Raz, Asaf Miller

Abstract

COVID-19 outbreak has a profound impact on almost every aspect of life. Universal masking is recommended as a means of source control. Routinely exercising in a safe environment is an important strategy for healthy living during this crisis. As sports clubs and public spaces may serve a source of viral transmission, masking may become an integral part of physical activity. This study aimed to assess the physiological effects of wearing surgical masks and N95 respirators during short-term strenuous workout. This was a multiple cross-over trial of healthy volunteers. Using a standard cycle ergometry ramp protocol, each subject performed a maximal exercise test without a mask, with a surgical mask, and with an N95 respirator. Physiological parameters and time to exhaustion were compared. Each subject served his own control. Sixteen male volunteers (mean age and BMI of 34 ± 4 years and 28.72 ± 3.78 kg/m2 , respectively) completed the protocol. Heart rate, respiratory rate, blood pressure, oxygen saturation, and time to exhaustion did not differ significantly. Exercising with N95 mask was associated with a significant increase in end-tidal carbon dioxide (EtCO2 ) levels. The differences were more prominent as the load increased, reaching 8 mm Hg at exhaustion (none vs N95, P = .001). In conclusion, in healthy subjects, short-term moderate-strenuous aerobic physical activity with a mask is feasible, safe, and associated with only minor changes in physiological parameters, particularly a mild increase in EtCO2 . Subjects suffering from lung diseases should have a cautious evaluation before attempting physical activity with any mask.

Keywords: Coronavirus disease 2019; face masks; personal distancing; physical activity; sport.

Conflict of interest statement

AR is a consultant and received research support from Medtronic (not related to this study). All the other authors declare that they have no conflicts of interest.

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Mean changes in physiological parameters throughout the exercise test performed by 16 subjects without a mask, with a surgical mask, and with N95 respirator. A, Heart rate (beats/min). B, Respiratory rate (breaths/min). C, Oxygen saturation (%). D, Rated Perceived Exertion (RPE) Scale (score). Error bars represent 95% confidence interval
Figure 2
Figure 2
Mean changes in end‐tidal carbon dioxide throughout the exercise test performed by 16 subjects without a mask, with a surgical mask, and with N95 respirator. Error bars represent 95% confidence interval. *indicate significant differences (P < .05)

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