|
 
 |
| REVIEW ARTICLE |
|
| Year : 2020 | Volume
: 20
| Issue : 3 | Page : 59-63 |
|
Exercising with face mask during the pandemic: A qualitative analysis
Muhammad Shahidul Islam1, Mohammad Hamidur Rahman2, Anup De3
1 Office of Physical Education, Shahjalal University of Science and Technology, Sylhet, Bangladesh
2 Department of Physical Education and Sports Science, Jashore University of Science and Technology, Jashore, Bangladesh
3 Department of Physical Education and Sport Science, Visva-Bharati University, Santiniketan, West Bengal, India
| Date of Submission | 10-Dec-2020 |
| Date of Acceptance | 05-Jan-2021 |
| Date of Web Publication | 02-Mar-2021 |
Correspondence Address:
Mr. Muhammad Shahidul Islam
Assistant Director, Office of Physical Education, Shahjalal University of Science and Technology, Sylhet
Bangladesh
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjsm.sjsm_37_20
A new respiratory virus known as coronavirus disease (COVID-19) (2019 novel coronavirus) is causing a respiratory disease epidemic worldwide. Many patients with COVID-19 had mild-to-severe respiratory failure and recovered without medical care. However, this respiratory infection can spread very rapidly by infected droplets when an individual is in close contact with others. A face mask is simple protective equipment that can minimize the transmission of infectious viruses, even though that person is asymptomatic. This study illustrates the benefits and drawbacks of having a face mask during the COVID-19 disease outbreak at athlete's workouts. After critically reviewing the various research papers (most of the research papers published in the year 2020), we considered the social distance to be the alternative for preventing severe acute respiratory syndrome CoV-2 droplets. Face masks could be one way to minimize infected droplet entry. In this connection, previous researchers have found that exercise with a face mask requires adaptation time that can improve respiratory muscle strength. The present study recommends that athletes should wear a face mask while training at the open space if there is someone near the athlete. Keywords: COVID-19, epidemic, exercise, face mask, infected droplets, novel coronavirus
How to cite this article:
Islam MS, Rahman MH, De A. Exercising with face mask during the pandemic: A qualitative analysis. Saudi J Sports Med 2020;20:59-63 |
How to cite this URL:
Islam MS, Rahman MH, De A. Exercising with face mask during the pandemic: A qualitative analysis. Saudi J Sports Med [serial online] 2020 [cited 2023 Dec 4];20:59-63. Available from: https://www.sjosm.org/text.asp?2020/20/3/59/310620 |
| Introduction | |  |
In 1965, the existence of humanoid coronaviruses started when Tyrrell and Bynoe discovered they could passageway a virus known as B814. It was found in the trachea of human embryos organs grown from an adult's respiratory tract in the common cold.[1],[2] Although the research was underway to investigate human coronaviruses' pathogenicity and epidemiology, the quantity and significance of animal coronaviruses were quickly expanding. Coronaviruses have been described as causing disease in several species of pets like animals.[2]
Bearing in mind the variety of animal coronaviruses wasn't surprised when a very new, severe acute cause came in 2002–2003, respiratory syndrome, called SARS, arose as a coronavirus, spreading in southern China, Hong Kong and throughout the world.[3],[4],[5] Besides, SARS-CoV has a zoonotic basis and seems to be the natural reservoir for horseshoe bats. At the onset of the 2002–2003 outbreaks, animal-to-human inter-species transmission was potentially active, supplying the origins of an agent that would eventually adapt to effective transmissions from humans to humans.[6]
A novel form of SARS-CoV-2 Coronavirus was first reported in Wuhan in December 2019, a town in China's Hubei province with 11 million inhabitants, without an established cause after such an outbreak of pneumonia. Now, the virus has spread to over 210 countries and territories worldwide, and the World Health Organization (WHO) characterized it as a pandemic on 11 March 2020.[7],[8] However, pneumonia, now known as coronavirus disease 2019 (COVID-19), is a typical feature of the SARS-CoV-2-infected patient indicated by computer tomographic scan or X-ray chest.[9],[10],[11],[12] According to the United Nations Development Programme, the COVID-19 pandemic is today's distinguishing worldwide public health issue and the worst part people have faced since World War Two. The virus has spread across every continent since its emergence in Asia in late 2019.[13]
According to Worldometers, COVID-19 affects 218 countries and regions worldwide. By December 31, 2020 (as on 05:37 GMT), there were 83,067,119 total cases of Coronavirus out of which 58,868,961 were total cases of recovery, and 1,812,189 were total deaths. Although contamination is often symptomless or is allied only with minor symptoms in many persons,[14],[15],[16] the easy capacity to spread makes the virus a threat to life.[17]
Research currently demonstrates the novel coronavirus (SARS-CoV-2) spreads mostly through airborne droplets. Wearing face masks in public is the most effective way of avoiding the person-to-person transmission of coronavirus, having added that this is the key way to avoid airborne transmission of the virus.[18] Although the theory is not conclusive about the effectiveness of face masks, such materials generally help to protect against coronavirus (SARS-CoV-2).
There is a growing consensus that social distancing and travel restrictions are advantageous in controlling the spread. When practiced in isolation, the acts of washing hands, using hand sanitizers, wearing gloves, and even the practice of social distancing[19] are the various options for combating the new coronavirus. Similarly, to fight against the SARS-CoV-2 face mask can be another option. Wearing a face mask may help prevent the progression of SARS-CoV-2, the virus that causes COVID-19, together with other precautionary actions. There are various kinds of masks available for individuals to wear during the current pandemic.
There are two main points of view about wearing a sportsman's face mask. The first statements claim that exercising with a face mask is harmful to health and the second claim is that exercising with a face mask can help protect airborne viruses when players do the workout.
| Development of Immune System in the Pandemic | | |
Exercise improves both the immune and metabolic systems, researchers have discovered. Regular exercise also increases the body's development of antibodies and T-cells.[20] Since COVID-19 does not provide specialized treatment, there are some things people can do to improve their immune system against the coronavirus.[21] The daily activity of sufficient intensity is suggested as a supplementary strategy for achieving and strengthening the immune system for the COVID-19 virus.[22] Besides, at a low level, physical exercise is observed to preserve muscle mass, cardiovascular function, and reduce bone loss during the lockdown time.[22] Similarly, medium to vigorous training is recommended for the improvement of the immune system.[23] However, for the sportsperson, the temporary arrangements for coordinated athletic events and competitions must be established based on the mechanisms of social isolation and quarantine introduced during the pandemic.[24]
| Sports Culture During the SARS-COV-2 Pandemic | | |
The study indicates that SARS-CoV-2 spread by cough droplets, sneezing, and infectious secretions.[25] Therefore, the effective step to avoid infection spread is thoroughness of personal hygiene, i.e., washing hands regularly and diligently, coughing and sneezing in the arm-fold, use of hand sanitizer and in most cases, use of face masks.[26]
COVID-19 affects athletes; for case, soccer/football competitions and the 2020 Olympic Games in Tokyo have been canceled or delayed. In addition, joint work is difficult, and some nations have banned outdoor exercise. Where this is the case, particularly athletes such as swimmers, cyclists, and team athletes can experience tremendous detraining effects.[27] COVID-19 has already revised the sports schedule, with major teams halting their operations anywhere to restrict the transmission of the virus and the Summer Olympics, which is usually one of the most watched sports events in the world, is moved back a year.[28] Consequently, government sports departments, regulatory bodies, and leagues took tough but appropriate steps to close down or regulate professional and amateur sporting practices. This suggests that people have fewer chances to be socially involved and to experience the sport offering social contact.
The Norwegian Football Association's (soccer) rules illustrate certain standards:[24]
- Maximum 5-person in a group
- An adult in each group must be present
- 2-m gap person-to-person
- No physical contact between one another
- There should be no handling or heading of balls
- After each session balls are to be cleaned.
| Introducing Face Mask in the COVID-19 Pandemic | | |
The present COVID-19 pandemic (caused by SARS-CoV-2 coronavirus), the instructions and general face mask protocols used by the general population differ widely.[29] Related experimental results show that the masks can both protect the user from different infections.[30] The degree to which homemade face masks (usually made from cotton, tea cloth, or other polyester fibers) can protect against droplets and transmission of viruses is largely unknown[29],[31] but the medical masks have been theoretically extremely useful in manikin based experiments as both cause protection and main avoidance under tidal respiration and coughing situations.[30],[32] Although in order to avoid the transmission of COVID-19 viruses, cough etiquette and respiratory hygiene are regulatory points.
One single cough can create as much as 3,000 droplets. There are concerns that the virus may also spread only by talking. New research found that we spray into the air thousands of droplets invisible to the naked eye only by saying “stay healthy.”[33] To fight against these droplets, facemasks are broadly used as a prevention measure by the general population to avoid inhalation of bacterial diseases from regular, swine, and other strains of influenza, from SARS, etc.[30] Various types of masks provide differing degrees of security. Operational grade N95 respirators provide the best degree of protection against contamination with COVID-19 followed by surgical grade masks.[34]
| Exercising With Face Mask and its Physiology | | |
Exercising with a tight face mask leads to a hypercapnic hypoxia condition meaning insufficient oxygen (O2).[3],[36],[37] The decreased supply of Oxygen (O2) and Carbon dioxide (CO2) would exponentially increase heart rate and blood pressure even at low loads of activity.[38] On the other hand, there is no evidence that a mask reduces the oxygen content in the blood of a human. However, when a person wears a mask, particularly if they have an N95 mask, it can make feel like it is harder to catch a breath. Instead of a mask which decreases blood's oxygen content, a mask gives some resistance to the normal way of breathing, making it more difficult to catch a breath.[39] Breathing is easier but tougher when playing sport than at rest, thereby raising the chance of passing on the illness. A mask, however, makes it more difficult to inhale the amount of air needed to work at the maximum rate. Wearing a surgical mask improves airflow resistance. Exercise often leads to quicker and deeper breathing, so wearing a mask during exercise imposes an extra pressure on ventilation.[40]
| Effectiveness of Using Face Mask During Pandemic | | |
An athlete should not change the oxygen saturation with his fabric mask of the air; still only breathe less of the oxygen because of the forced resistance by the mask. Pressure tolerance thus rises, and an adaptation of the timeframe is required. That means the muscles in the lungs must exert more energy to get the same amount of air a person usually takes without the mask.[41] This process strengthens the respiratory muscles. Moreover, the Coronavirus is transmitted through droplets in these pandemic days and affects the upper respiratory tract with Acute Respiratory Distress Syndrome infections. Respirator facemasks (N95) serve as personal protective equipment capable of absorbing and stopping tiny airborne particles from impacting the respiratory system.[42],[43] Exercising with masks, however, raises physiological demands, so exercises should be tailored to meet an individual's ability.[44],[45]
| Drawbacks of Using Face Mask | | |
Chandrasekaran and Fernandes (2020)[43] conclude that training with a face mask could increase the pathophysiological risks associated with continuing disease, including cardiovascular and metabolic risks. Humidity, on the other hand, is caused by breathing on the masks, which rises resistance to the air intake. Humid masks also decrease antimicrobial capacity.[41],[46] Another research suggested that people participating in high-intensity sports, such as running, may not be able to wear a mask as it creates respiratory problems.[47] According to the WHO, the essential prevention measure during exercise is to retain at least 1 m of physical distance from others.[48] Similarly, Dr. Leong Hoe Nam, an communicable disease expert at Mount Elizabeth Novena Hospital specified that “When you put on a mask, there is resistance in breathing, making the exercise more strenuous and it can trigger a heart attack,” Dr. Leong further clarified that instead of wearing a mask, protecting yourself by maintaining a distance of 10 meters from other people is much more effective.[49] Another conception is that our muscles produce lactic acid when we do heavy exercise that triggers the burning feeling. Then, it is transformed to carbon dioxide. This carbon dioxide can be captured by a face mask during the sports training, which could decrease the overall mental abilities.[40] On the other hand, masks with one-way valves permit air to be exhaled through a valve, leading to expelled respiratory particles that can reach others.[50] Thus, in the COVID-19 pandemic, a valve mask cannot be beneficial for exercising; it does not protect the people surrounding the wearer of the valve mask.
| Can Training Mask be Helpful For Sports Training in the COVID-19 Pandemic? | | |
Exercise (training) masks are typically made from neoprene and feature a pair of customizable levers to change the volume of air supply to the lungs.[51] The altitude training masks configured to purposely minimize the amount of oxygen that the player inhales in the air.[52] However, training masks do not do much to limit droplets, and it is also not able to help COVID-19 from spreading. The open-air valves of the masks provide the wearer with an unregulated airway which ensures that they cannot do anything to stop any unintended spray of saliva from spreading across the area of exercise.[51] Therefore, a cloth face mask may work better than a training mask.
| Conclusion | | |
For all counts and with verified findings, it is no wonder that the face mask makes it increasingly challenging to inhale the volume of air required to perform at the elite athletic level in case that the athlete does not become habituated to a prolonged mask-wearing. During the pandemic, keeping social distance may be the better option for exercising. Nevertheless, exercising with a face mask after a certain amount of time may improve the ability of the lung muscles. In the idea of the hasty spread of the COVID-19 globally, the face mask is one of the options to guard against the pandemic.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Tyrrell DA, Bynoe ML. Cultivation of viruses from a high proportion of patients with colds. Lancet Lond Engl 1966;1:76-7.  |
| 2. | Kahn JS, McIntosh K. History and recent advances in coronavirus discovery. Pediatr Infect Dis J 2005;24:S223-7. |
| 3. | Drosten C, Günther S, Preiser W, van der Werf S, Brodt HR, Becker S, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 2003;348:1967-76. |
| 4. | Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348:1953-66. |
| 5. | Peiris JS, Lai ST, Poon LL, Guan Y, Yam LY, Lim W, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet Lond Engl 2003;361:1319-25. |
| 6. | Boncristiani HF, Criado MF, Arruda E. Respiratory viruses. In: Schaechter M, editor. Encyclopedia Microbiology. 3 rd ed.. Oxford: Academic Press; 2009. p. 500-18. |
| 7. | |
| 8. | |
| 9. | Zhong NS, Zheng BJ, Li YM, Null P, Xie ZH, Chan KH, et al. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003. Lancet Lond Engl 2003;362:1353-8. |
| 10. | Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33. |
| 11. | Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23. |
| 12. | Zheng J. SARS-CoV-2: An emerging coronavirus that causes a global threat. Int J Biol Sci 2020;16:1678-85. |
| 13. | |
| 14. | Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020;323:1406-7. |
| 15. | Qiu J. Covert coronavirus infections could be seeding new outbreaks. Nature 2020. [doi: 10.1038/d41586-020-00822-x.] |
| 16. | Worby CJ, Chang HH. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020;11:4049. |
| 17. | Johnson CY, Sun LH. The biggest questions about the new coronavirus and what we know so far. Washington Post 2020. |
| 18. | |
| 19. | Humphreys J. The importance of wearing masks in curtailing the COVID-19 pandemic. J Fam Med Prim Care 2020;9:2606. |
| 20. | |
| 21. | |
| 22. | da Silveira MP, da Silva Fagundes KK, Bizuti MR, Starck É, Rossi RC, de Resende e Silva DT. Physical exercise as a tool to help the immune system against COVID-19: An integrative review of the current literature. Clin Exp Med 2020;21:15-28. [doi: 10.1007/s10238-020-00650-3]. |
| 23. | Dixit S. Can moderate intensity aerobic exercise be an effective and valuable therapy in preventing and controlling the pandemic of COVID-19? Med Hypotheses 2020;143:109854. |
| 24. | Timpka T. Sports health during the SARS-Cov-2 pandemic. Sports Med 2020;50:1413-6. https://doi.org/10.1007/s40279-020-01288-7. |
| 25. | Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20. |
| 26. | |
| 27. | Wackerhage H, Everett R, Krüger K, Murgia M, Simon P, Gehlert S, et al. Sport, exercise and COVID-19, the disease caused by the SARS-CoV-2 coronavirus. Dtsch Z Für Sportmed J Sports Med 2020;71:E1-12. |
| 28. | |
| 29. | Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, et al. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020;5:293-308. |
| 30. | Lai AC, Poon CK, Cheung AC. Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations. J R Soc Interface 2012;9:938-48. |
| 31. | Chua MH, Cheng W, Goh SS, Kong J, Li B, Lim JY, et al. Face masks in the new COVID-19 normal: Materials, testing, and perspectives. Research (Wash D C) 2020;2020:7286735. |
| 32. | Patel RB, Skaria SD, Mansour MM, Smaldone GC. Respiratory source control using a surgical mask: An in vitro study. J Occup Environ Hyg 2016;13:569-76. |
| 33. | |
| 34. | Devlin HS. What kind of face mask best protects against coronavirus? Guardian 2020. |
| 35. | Sheikh K. Talking can generate coronavirus droplets that linger up to 14 minutes. N Y Times 2020. |
| 36. | Roberge RJ, Coca A, Williams WJ, Powell JB, Palmiero AJ. Physiological impact of the N95 filtering facepiece respirator on healthcare workers. Respir Care 2010;55:569-77. |
| 37. | Lavery GG. Fear of hypercapnia is leading to inadequate oxygen treatment. BMJ 1999;318:872. |
| 38. | Vn M, Ve D, Tg K, Ns C, Sg K. Baseline values of cardiovascular and respiratory parameters predict response to acute hypoxia in young healthy men. Physiol Res 2017;66:467-79. |
| 39. | |
| 40. | |
| 41. | Santos-Silva PR, Greve JMD, Pedrinelli A, Santos-Silva PR, Greve JMD, Pedrinelli A. During the coronavirus (COVID-19) pandemic, does wearing a mask improve or worsen physical performance? Rev Bras Med Esporte 2020;26:281-4. |
| 42. | Sakaguchi H, Wada K, Kajioka J, Watanabe M, Nakano R, Hirose T, et al. Maintenance of influenza virus infectivity on the surfaces of personal protective equipment and clothing used in healthcare settings. Environ Health Prev Med 2010;15:344-9. |
| 43. | Chandrasekaran B, Fernandes S. Exercise with facemask; Are we handling a devil's sword? – A physiological hypothesis. Med Hypotheses 2020;144:110002. |
| 44. | Wong AY, Ling SK, Louie LH, Law GY, So RC, Lee DC, et al. Impact of the COVID-19 pandemic on sports and exercise. Asia Pac J Sports Med Arthrosc Rehabil Technol 2020;22:39-44. |
| 45. | Wang J, Pan L, Tang S, Ji JS, Shi X. Mask use during COVID-19: A risk adjusted strategy. Environ Pollut 2020;266:115099. |
| 46. | |
| 47. | |
| 48. | |
| 49. | |
| 50. | Thebault R, Fritz A. Face masks with valves or vents do not prevent spread of the coronavirus, CDC says. Washington Post 2020. |
| 51. | |
| 52. | Lipman GS, Kanaan NC, Phillips C, Pomeranz D, Cain P, Fontes K, et al. Study looking at end expiratory pressure for altitude illness decrease (SLEEP-AID). High Alt Med Biol 2015;16:154-61. |
| This article has been cited by | | 1 |
Effect of wearing medical protective masks on treadmill running performance in the postpandemic era: a randomised trial |
|
| I-Lin Wang, Yu Su, Shun Yao, Yu-Hong Jiang, Hao-Yu Li, Chien-Ying Lai | | BMC Sports Science, Medicine and Rehabilitation. 2023; 15(1) | | [Pubmed] | [DOI] | | | 2 |
The Physiological Effects of Face Masks During Exercise Worn Due to COVID-19: A Systematic Review |
|
| Iván Asín-Izquierdo, Eva Ruiz-Ranz, Marta Arévalo-Baeza | | Sports Health: A Multidisciplinary Approach. 2022; : 1941738122 | | [Pubmed] | [DOI] | | | 3 |
Maximal exercise outcomes with a face mask: the effects of gender and age differences on cardiorespiratory responses |
|
| Busra Alkan, Sevgi Ozalevli, Ozlem Akkoyun Sert | | Irish Journal of Medical Science (1971 -). 2021; | | [Pubmed] | [DOI] | | | 4 |
ANALYSIS OF HEMATOLOGICAL VARIABLES AMONG COMPETITORS IN VARIOUS GAMES |
|
| Aminur Rahaman | | International Journal of Research -GRANTHAALAYAH. 2021; 9(5): 360 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
Search Pubmed for