CHICAGO, March 22, 2022 /PRNewswire/ — Millions of athletes around the world have grappled with the challenges of training under stay-at-home orders and evolving COVID-19 mandates and are concerned about wearing a face mask if training in public or outdoors. To date, no systematic review of the existing literature provides a clear consensus on whether wearing a face mask has a significant impact on physical performance, particularly with respect to physiological parameters including heart rate, respiratory rate, oxygen saturation and perceived exertion. A new study presented at the 2022 annual meeting of the American Academy of Orthopedic Surgeons (AAOS) found that despite frequently cited concerns about decreases in safety and performance when wearing masks, healthy people can perform intense exercise while wearing masks with minimal physiological changes.
“As mask mandates came into effect during the COVID-19 pandemic, our patients and the general population wanted to know how masks impact performance outcomes since, theoretically, anything that covers the mouth and /or the nose could increase the resistive work of breathing,” said Cordelia W. Carter, MD, FAAOS, pediatric orthopedic sports surgeon and director of the Center for Young Athletes at NYU Langone’s Hassenfeld Children’s Hospital in New York City.
With limited scientific information to provide guidance, Dr. Carter reached out to Ariana Lott, MD, orthopedic surgery resident at NYU Langone Health, to help uncover evidence that could provide data-based guidance on the impact wearing a mask on sports performance.
Drs. Carter and Lott followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for available studies on mask use during exercise in their study, “Mask Use for Athletes, A Systematic Review of Safety and Performance Outcomes”. They sought to identify studies that described the effects of using an oronasal mask (covers nose and mouth), if any, on sports/exercise/physical activity for any age, sex or sport level. Articles describing the use of the mask to improve athletic performance were also included. Articles describing the effects of mask without exercise, those that measured the effects of full-face masks, review articles, and those published before 1980 were excluded. Additionally, non-English studies were excluded when reviewing the full text.
Of all the records that were identified for possible inclusion, 22 articles met the inclusion criteria. These articles studied a variety of populations, including healthy adult volunteers, elite athletes, children, pregnant women, and patients with pulmonary comorbidities including asthma and chronic obstructive pulmonary disease (COPD). . The team analyzed these papers and extracted data focused on physiological parameters measured during physical activity performed while wearing an oronasal face mask.
The analysis found that healthy people can perform moderate to vigorous exercise while wearing a face mask without experiencing changes in heart rate, respiratory rate and oxygen saturation that would compromise individual safety or athletic performance. Of the studies of N95 respirators in the healthy adult population, two reported modest changes in respiratory rate (up to 10 breaths per minute during maximal exercise)I and peak power output indicating decreased athletic performance when subjects exercised at maximal effort. Similar findings related to N95 respirator use have been observed in studies of subpopulations including children and pregnant women.
Interestingly, girls were noted to have higher peak output during exercise when wearing a mask,ii and there was no difference in fetal heart rate for pregnant women exercising while wearing a mask.iii
“While current mask mandates are being relaxed, there are still vulnerable populations who prefer to wear a mask during exercise to protect themselves or others from illness,” Dr. Lott said. “Given the myriad benefits of exercise and participation in sports, it was important for us to create a comprehensive review of the existing literature to ensure that athletes could still exercise in safely with a mask. While most of the studies we reviewed were not conducted during the COVID-19 pandemic, we anticipate that more literature will be published in the coming years that may advance our research.”
With over 39,000 members, the American Academy of Orthopedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality and most comprehensive training to help orthopedic surgeons and allied health professionals at all career levels to best treat patients in their daily practices. The AAOS is the source for information about bone and joint conditions, treatments, and related musculoskeletal health issues, and it leads the discussion about healthcare to advance quality.
I Jones JG. The physiological cost of wearing a disposable respirator. Am Ind Hyg Assoc J. 1991 Jun;52(6):219-25.
ii Tompuri TT, Lintu N, Soininen S. Comparison between maximum cycle ergometer test parameters first without breath gas analysis and then with breath gas analysis in healthy prepubertal children. Appl Physiol Nutr Metab. 2016 Jun;41(6):624-30.
iii Roberge RJ, Kim JH, Powell JB. Use of the N95 respirator during advanced pregnancy. Am J Infect Control. 2014 Oct;42(10):1097-100.
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SOURCE American Academy of Orthopedic Surgeons