Data shows recreational exercise when wearing a face mask is safe, with some caveats


March 22, 2022

2 minute read



Lott A, et al. Poster 0731. Presented at the annual meeting of the American Academy of Orthopedic Surgeons; March 22-26, 2022; Chicago.

Disclosures: Carter reports no relevant financial information.

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CHICAGO — In a review of studies that looked at performance and safety when participants wore COVID-19 face masks while exercising, researchers found that exercise was safe and did not affect or cause significant physiological changes in athletes.

At the annual meeting of the American Academy of Orthopedic Surgeons, Cordelia W. Carter, MD, FAAOS, FAOA, associate professor of orthopedic surgery at the NYU School of Medicine, and colleagues presented their research on the safety of mask-wearing during exercise and the ways, if any, that mask-wearing affects performance.

Carter told Healio: “What we are comfortable saying after this comprehensive review is that it is safe to exercise with a mask on and that is, for the vast majority of people. population, without decrease or significant physiological changes.”

Cordelia W. Carter

Cordelia W. Carter

Of 56 full-text articles identified in a search of the MEDLINE, Embase, Cochrane CENTRAL, and CINAHL databases conducted in February 2021, researchers identified 22 studies related to exercise and physical activity performed with a oronasal mask.

From these studies, two co-authors independently extracted data related to measures of physiological parameters, such as respiratory rate, heart rate, oxygen saturation, and rating of perceived exertion, when participants performed a physical activity while wearing a mask.

Depending on the context of the study, the researchers found that in healthy volunteers, the use of surgical masks during exercise had no significant effect on these physiological parameters.

Numerous studies have demonstrated no difference in parameters when exercise was performed with or without a mask, according to Carter.
nk is also one of the main takeaways from the study,” she said. “Using an N95 [mask]which is the most protective mask but also the one that is probably the most restrictive, is the one in which, at very high physical performance, we start to see a certain decrease in terms of maximum power and maximum output, as well as small, but real, changes in cardiovascular parameters, like respiratory rate and heart rate,” she said.

The study data showed that two of the studies of N95 masks in a healthy adult population reported modest, but statistically significant, changes in physiological measures. This indicated a decrease in athletic performance, such as respiratory rate and peak power output, when participants exercised with maximal effort.

Carter cautioned that this data should be applied to recreational athletes, not elite athletes. “Then you also have to distinguish between training and competition, and there are no studies on this in competition.”

A weakness of these results, she said, is the heterogeneity of the studies studied, which included diverse populations, such as children and pregnant women. Also, some of the studies were done in an exercise physiology lab.

“Nine of the 22 studies did not include any women at all. Of the total 853 subjects included in all included studies, only 184 of them were women,” Carter said.

Future research in this area should include higher quality studies with diverse study populations, Carter said. “I think we want to develop new a priori questions” that focus on the assessment of perceived exertion, sports performance with a mask in a variety of sports and settings, and include endurance sports, short, high-intensity activities and other specific sports activities, she says.

Summarizing the results, Carter said: “Performance, certainly for recreational athletes, is not impaired, the caveat being that with the use of an N95 and exercising to exhaustion, there are demonstrated decreases in peak output and peak power.”

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