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

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.

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

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)