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Exercising With A Mask: A Brief Overview and Recommendations

Sep 1, 2020

Exercising With A Mask: A Brief Overview and Recommendations

By

Billy Pratt, BA, CPT, PAS, GIPS, CFMSP, Pn1

It is September 1st, 2020, and while the novel coronavirus influence on society & policy may be new, it may surprise some to know that mask wearing while working out is not. Athletes and noncompetitive exercisers have played with wearing Restrictive Breathing Masks (RBMs) for altitude acclimatization and allegedly improving oxygen utilization. While this may not be the topic of concern here I make that point both to illustrate that training with a mask is not necessarily very new and to help lead into a review of the results of some research that I’d like to touch upon, research which may help shed some light on whether or not you should exercise with a mask and if so what kind.

There are three categories of masks: Surgical Masks, N95 Respirators, and Face Coverings. According to the FDA surgical masks prevent the spread of large droplets and splashes but are not necessarily designed to filter small particles and droplets (like those which typically transmit viruses between people). N95 respirators are the most efficient portable form of airborne particle filtration but the CDC recommends their use only in healthcare settings. Face coverings (usually cloth) have been shown to slow transmission in a limited capacity. Before I go into some recommendations allow me to very briefly touch upon some research that has been done so we can follow the line of reasoning.

In 2016 a meta-analytical review of prior research (66 studies conducted some of which included field observations of both military and medical personnel) done on the effects of respirators on physical performance was published.1 A key point that us exercisers can take away from that analysis is that limiting the work time of respirator-wearers to between 5-20 minutes appears necessary to help with preventing overheating and dehydration. In July 2020 a (very small) study of 12 healthy males showed that exercising while wearing either surgical masks or N95s significantly impaired cardiopulmonary exercise capacity.2 In 2018 two studies conducted on the effects of RBMs on performance suggest that wearing those devices may not affect acute exercise volume but does influence exercise length & velocity.3,4 Single-joint movements (leg extensions) were not impacted but compound/multi-joint exercises (e.g. squats & leg press) are - this makes sense since compound exercises require a higher metabolic demand than single-joint ones. In 2015 a small study conducted on pregnant healthcare workers showed that exercising at moderate intensity significantly increased metabolic demands & workload for those who wore N95s.5

Note that all of the above studies only looked at the effects of exercising while wearing surgical masks, N95s, or RBMs. With the exception of the July 2020 study this makes sense since the concern was not so much on viral transmission but instead on the performance and safety of emergency personnel. Fast forward to post-shutdown and I came across a neat experiment conducted by international fencer and exercise science researcher Lindsay Bottoms.6 Dr. Bottoms strapped a portable gas analyzer to herself and measured the gas concentration of her breathing while running for three minutes on a treadmill at a 10 km/hr (6.2 mph) pace. Just wearing a fencing mask decreased her O2 concentration by ~1.5% while wearing a cloth face mask under the fencing mask lowered her oxygen level by 4% which she calculates is the equivalent of exercising at 1500m (0.9 miles) above sea level.

So what are we to take away from this research? Well, a very limited understanding unfortunately. As I mentioned above the majority of the research has been centered on the wearing of surgical masks and N95s with virtually no exploration of cloth face coverings. Even within that avenue much of the research is riddled with small sample sizes (n=<20) and some questionable methodologies. What I find particularly interesting though is the experiment Dr. Bottoms carried out on herself because I think that should pave the way towards a more comprehensive study of the real effects of exercising with various levels of mask-wearing. We have demonstrated that wearing surgical masks and N95s impair performance; and it is possible that exercising with face coverings may do the same.

So if some of the research is limited in scope, then what about the general guidelines? According to the World Health Organization people should not wear masks while exercising.7 Unfortunately they don’t provide any citations or definitions to help clarify the why behind their stance. The American Council on Exercise does a little better in citing their sources and recommends that if you must wear a mask then make sure to self-monitor for signs of excessive fatigue and lightheadedness.8

I have spoken with other trainers and trainees about their experiences working out with a mask and not surprisingly the feedback varies based on the person and the exercise intensity. Some find it doesn’t bother them much beyond some basic uncomfortability while others have experienced nausea & dizziness as a result and had to stop prematurely.

Okay okay, so enough with the boring research and conflicting guidelines right? What do I recommend? Based on what has been studied, what the current guidelines are, and (inter)personal experience here is what I suggest:

  1. To prevent potential viral transmission keep a 6-12 foot distance from others when exercising. With regards to droplet transmission the safest place to exercise is at home, the second safest is a private training studio that limits traffic & seems to already be built for times like these.
  2. If close contact & proximity is unavoidable then bring a face covering (see #6 below for specific recommendations). Anything that covers both mouth and nose while fitting snugly against the cheeks is okay.
  3. Self-monitor! People with underlying respiratory and pulmonary issues are particularly at risk for experiencing adverse side effects from exercising while wearing a mask. Make sure to pay attention to how you feel – if you feel lightheaded, dizzy, overheated, nauseous, or concerned in general take a break and lower the intensity.
  4. Going heavy is generally okay because the set won’t last very long (and as we saw before exercise length may be more adversely affected by masked exercising vs. exercise load). Heavy lifting for a set, take some time to breathe, next set. Taking adequate breaks and removing your mask temporarily to help recover may not pose a problem just so long as you self-monitor and observe appropriate distancing.
  5. For those who must wear a covering but are prone to adverse reactions during masked exercising you may have to resign yourself at first to not being able to train the way you want or need to for the time being. Instead of pushing yourself like you normally would with a lot of big movements you may want to change over to brief (approximately 30 seconds) sets of compound exercises and incorporate more single-joint exercises in your routine for the time being to decrease overall metabolic demand. A qualified fitness professional should be able to help you adjust your programming accordingly.
  6. Based on my own experience and those of others I have spoken with I have two recommendations for cloth face coverings which aren’t as stressful to wear when working out:
    1. Happi Mask makes a face covering which is made of multi-layered microfiber and fits the face well without pulling on the skin & ears (this is my go-to): https://www.happimaskco.com/shop
    2. Under Armour makes a mask for active people that I’ve heard good things about (but I haven’t tried myself): https://www.underarmour.com/en-us/p/ua-sportsmask/1368010.html

1 Johnson, Arthur T. 2016. “Respirator masks protect health but impact performance: a review.” J Biol Eng. 10:4

2 Fikenzer et al. 2020. “Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity” Clin Res Cardiol. 1-9

3 Andre et al. 2018. “Restrictive Breathing Mask Reduces Repetitions to Failure During a Session of Lower-Body Resistance Exercise” J Strength Cond Res. 32(8):2103-2108

4 Jagim et al. 2018. “Acute Effects of the Elevation Training Mask on Strength Performance in Recreational Weight Lifters” J Strength Cond Res. 32(2):482-489

5 Tong et al. 2015. “Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study” Antimicrob Resist Infect Control. 4:48

6 https://theconversation.com/why-it-could-be-dangerous-to-exercise-with-a-face-mask-on-140277, accessed on 9/1/20

7 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters, accessed on 9/1/20

8 https://www.acefitness.org/education-and-resources/professional/expert-articles/7578/exercising-with-a-face-covering-safety-do-s-and-don-ts/, accessed on 9/1/20

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