Have you tried doing outdoor exercises lately, like brisk walking, jogging or biking, while wearing a face mask? Did the breathing get laborious at some point that you have to remove the mask in order to get some air? After a while, did the mask get wet with sweat or moisture from exhaled breath that it hugged your face, making breathing even more uncomfortable?
These are pretty much the reasons the World Health Organization (WHO) released guidelines on not wearing a mask when exercising.
According to WHO, aside from reducing a person’s ability to breathe comfortably, a wet mask also promotes growth of microorganisms. Instead of wearing a mask, the organization stressed on the importance of maintaining a physical distance of at least one meter from others as a preventive measure to control the spread of coronavirus.
However, there is always the issue of source control. This is a term used to describe measures intended to prevent infected individuals from spreading disease.
A commentary by Dr. Dina Janse van Rensburg, a Fellow of the American College of Sports Medicine, published on the British Journal of Sports Medicine, pointed out that wearing a mask remains an important measure to prevent the spread of coronavirus. “It is much easier to reduce droplet spread by blocking larger droplets as they come out of a person’s mouth, than it is to block them as they have dissipated and become much smaller,” the health expert explained.
She added that compulsory wearing of face masks is observed in countries like South Africa, Taiwan, Japan, and the Czech Republic, and has been attributed to reduced rates of transmission.
But due to issues of potential breathing restriction and discomfort, particularly when doing physical exercises, wearing a face mask “becomes an act of balancing benefits versus possible adverse events.”
Dr. Janse van Rensburg, who also holds a Master of Science degree, raised important points in her commentary, which are based on scientific studies.
First: viral transmission from infected but asymptomatic or pre-symptomatic individuals is possible. “Due to the increased rate and force associated with breathing during exercise, the risk of aerolisation and the spread of virus-containing droplets could theoretically be higher than when at rest.”
Second: airflow-restricting masks can increase the rate of exertion and decrease performance during resistance training. The health expert said wearing surgical masks may cause dyspnea (difficult or labored breathing), though negative effects on aerobic performance have not been demonstrated in the studies.
Third: while there is no evidence showing the effects of cloth masks or buffs, this could potentially increase the breathing effort and cause accumulation of CO2. “Wearing a mask may, in fact, simulate the physiological effect of altitude training, albeit on a smaller scale. This is unlikely to be an issue for most people but could present a problem at higher intensities of exercise, particularly for those with underlying health concerns,” she stressed.
She thus advised people with existing heart or lung conditions to exercise at a lower intensity than usual while wearing a mask, to prevent any adverse events. “People must be cognizant of their breathing during exercise and somewhat slow down or take a break if they feel that their work rate is too high or if [they are] experiencing dizziness or light-headedness,” Dr. Janse van Rensburg pointed out.
Choosing the right face mask
A more breathable material will aid in comfort but may be less effective viral source control, Dr. Janse van Rensburg noted. “Two layers of material are considered sufficient to balance efficacy and comfort. Not having a tight seal around the sides of your face also allows for better air movement, but will subsequently increase the risk of droplet spread.”
“Due to the accumulation of moisture from our exhaled breath, cloth masks or buffs are likely to get wet during exercise. Breathing through dry cloth is easier as opposed to damp cloth. Hot and humid conditions can worsen the effect of strenuous breathing. Moisture-wicking material, such as polyester, is a good option but may cause skin irritation in sensitive individuals,” said the doctor.
She advised taking a second mask/buff along during exercise sessions for replacement of the damp one, though she cautions about accidentally touching the face while doing so. To maintain good hand hygiene, she advised taking along travel-sized sanitizers before and after putting on and removing face mask.
Dr. Janse van Rensburg also gave emphasis on ensuring that the face covering is comfortable and secure before leaving the house, to limit the need to readjust it and touch the face.
Although everything regarding COVID-19 is not clear yet, the rule not to exercise when suffering from fever remains, due to the cardiorespiratory complications that may occur.
The health expert also reiterated previous advisories to reserve filtering facepiece respirators (FFRs) such as N95, FFP1, and FFP2 for specific work environments such as front-line healthcare workers. “These should not be used by the public and also not for exercise purposes,” she said.
Wearing a mask is everyone’s social responsibility
Dr. Gia Sison, an Occupational Medicine expert, emphasized that it’s everyone’s social responsibility to lessen the chances of virus transmission. She strongly advises wearing a face mask when doing exercises outdoors, but to do only the low intensity ones such as brisk walking. “Being outdoors also help in your overall well-being, so I’m all for that as well.”
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However, if you wish to do high intensity exercises, better do it in your homes, so you won’t need to wear a face mask. “The higher the intensity of your exercise, the extra breathing effort you have to make. So when there’s a barrier, a face mask, you’ll have to double your breathing effort.”
Sison especially cautions about the dangers of wearing a face mask when doing high intensity workouts for those with respiratory and heart conditions. “If you have an asthma, the increased effort in breathing can trigger an attack,” she said. “Before, when there was no COVID yet, we have to monitor their condition, all the more that we have to do that now.”
Dr. Sison, who has a heart condition herself, is restricted by her cardiologist to do high intensity exercises. “I do brisk walking. There is also an app I downloaded that I do everyday—which is mostly stretching. I do 30 minutes max everyday—so that it’s doable and sustainable.”