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Should you exercise with a mask on during the COVID-19 pandemic?

We've decided not to write about the safety of masks during exercise...masks in general are too much of a hot button topic and the last thing we need is more drama in our life ūüôā instead we are going to provide the links to the references we were going to use with a brief summary next to them:
First off though. The WHO (World Health Organization) does not recommend wearing a mask during exercise because it can make breathing more difficult. Additionally, sweat can make the mask wet, which impacts breathing and promotes the growth of microorganisms.
But what if your gym requires a mask for entry. Is it safe to wear one? The research is pretty conflicted as you will see. Here we go:
https://www.mdpi.com/1660-4601/17/21/8110. Found that exercise performance and blood and muscle oxygen levels are not affected for healthy individuals wearing a face mask during strenuous workouts.
https://onlinelibrary.wiley.com/doi/full/10.1111/sms.13832. In healthy subjects, short‚Äźterm moderate‚Äźstrenuous 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.
https://www.sciencedirect.com/.../pii/S0306987720317126. Exercising with facemasks may reduce available Oxygen and increase air trapping preventing substantial carbon dioxide exchange.

The hypercapnic hypoxia may potentially increase acidic environment, cardiac overload, anaerobic metabolism and renal overload, which may substantially aggravate the underlying pathology of established chronic diseases.

Further contrary to the earlier thought, no evidence exists to claim the facemasks during exercise offer additional protection from the droplet transfer of the virus.

Hence, we recommend social distancing is better than facemasks during exercise and optimal utilization rather than exploitation of facemasks during exercise.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598538/. In conclusion, our study demonstrates that ESE with a surgical facemask is a feasible procedure.

The use of a facemask does not negatively affect the functional capacity of our patients, nor the percentage of conclusive studies. This enables us to benefit from the information provided by the exercise stress modality, while reducing the risk of infection in healthcare personnel.

Given the current pandemic situation, and in view of the results of our study, we strongly recommend the systematic incorporation of the surgical facemask in ESE protocols.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494435/. All the studies published to date on face masks and face coverings, which produced broadly reassuring findings, have tested them in conditions of low to moderate exercise.

It is plausible that an athlete who is exercising intensively for a prolonged period, especially if wearing an overly tight face covering, could be at risk of physiologically significant hypercapnia and hypoxia.

This hypothesis needs to be urgently tested
http://www.scielo.org.za/scielo.php.... Definitely read this one. Presents a good summary of the do's and do nots of mask use during exercise
https://digitalcommons.daemen.edu/faculty_scholar/158/. In healthy populations, wearing a mask does not appear to cause any harmful physiological alterations, and the potentially life-saving benefits of wearing face masks seem to outweigh the documented discomforts.

While there are minimal physiological impacts on wearing a mask, theoretical evidence suggests that there may be consequential psychological impacts of mask wearing on the basic psychological needs of competence, autonomy, and relatedness.
https://www.preprints.org/manuscript/202004.0203/v1.... A more general mask usage article. The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts.

Public mask wearing is most effective at stopping spread of the virus when compliance is high. The decreased transmissibility could substantially reduce the death toll and economic impact while the cost of the intervention is low.
Thus we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies.

We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.
My suggestion for now....exercise outdoors as much as possible and set up a home gym.

About the author:

Matt Mosman (MS, CISSN, CSCS) is a research scientist, endurance athlete, and the founder and Chief Endurance Officer at EndurElite. Matt holds his B.S. in Exercise Science from Creighton University and his M.S. in Exercise Physiology from the University of California.  Matt and his family reside in Spearfish South Dakota, where they enjoy running, mountain biking, camping, and all the outdoor adventures Spearfish has to offer.

  1. Epstein, D., Korytny, A., Isenberg, Y., Marcusohn, E., Zukermann, R., Bishop, B., ... & Miller, A. (2020). Return to training in the COVID‚Äź19 era: The physiological effects of face masks during exercise.¬†Scandinavian journal of medicine & science in sports.
  2. Chandrasekaran, B., & Fernandes, S. (2020). ‚ÄúExercise with facemask; Are we handling a devil's sword?‚ÄĚ‚ÄďA physiological hypothesis.¬†Medical hypotheses,¬†144, 110002.
  3. Wong, A. Y. Y., Ling, S. K. K., Louie, L. H. T., Law, G. Y. K., So, R. C. H., Lee, D. C. W., ... & Yung, P. S. H. (2020). Impact of the COVID-19 pandemic on sports and exercise. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 22, 39-44.
  4. CARRIZAL, R. C., & RODR√ćGUEZ, C. C. (2020). Surgical facemask: an ally of exercise stress echocardiography during the COVID-19 pandemic?.¬†Revista Espanola De Cardiologia (English Ed.).
  5. Greenhalgh, T., Dijkstra, P., Jones, N., & Bowley, J. (2020). Exercising and face masks: an important hypothesis buried in a selective review. Medical Hypotheses.
  6. van Rensburg, D. C., Pillay, L., Hendricks, S., & Blanco, J. A. (2020). Year of the face mask: do's and don'ts during exercise. South African Journal of Sports Medicine, 32(1), 1-2.
  7. Scheid, J. L., Lupien, S. P., Ford, G. S., & West, S. L. (2020). Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 17(18), 6655.
  8. Shaw, K., Butcher, S., Ko, J., Zello, G. A., & Chilibeck, P. D. (2020). Wearing of Cloth or Disposable Surgical Face Masks has no Effect on Vigorous Exercise Performance in Healthy Individuals. International Journal of Environmental Research and Public Health, 17(21), 8110.
  9. Davis, B. A., & Tsen, L. C. (2020). Wearing an N95 Respiratory Mask An Unintended Exercise Benefit?. Anesthesiology: The Journal of the American Society of Anesthesiologists.
  10. Howard, J., Huang, A., Li, Z., Tufekci, Z., Zdimal, V., van der Westhuizen, H. M., ... & Tang, V. (2020). Face masks against COVID-19: an evidence review.

Matt Mosman, MS, CISSN, CSCS
Matt Mosman, MS, CISSN, CSCS

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