Face Masks and the Cardiorespiratory Response to Physical Activity in Health and Disease
To minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease (COVID-19), the U.S. Centers for Disease Control and Prevention and the World Health Organization recommend wearing face masks in public. Some have expressed concern that these may affect the cardiopulmonary system by increasing the work of breathing, altering pulmonary gas exchange and increasing dyspnea, especially during physical activity.
These concerns have been derived largely from studies evaluating devices intentionally designed to severely affect respiratory mechanics and gas exchange. We review the literature on the effects of various face masks and respirators on the respiratory system during physical activity using data from several models: cloth face coverings and surgical masks, N95 respirators, industrial respirators, and applied highly resistive or high–dead space respiratory loads. Overall, the available data suggest that although dyspnea may be increased and alter perceived effort with activity, the effects on work of breathing, blood gases, and other physiological parameters imposed by face masks during physical activity are small, often too small to be detected, even during very heavy exercise.
There is no current evidence to support sex-based or age-based differences in the physiological responses to exercise while wearing a face mask. Although the available data suggest that negative effects of using cloth or surgical face masks during physical activity in healthy individuals are negligible and unlikely to impact exercise tolerance significantly, for some individuals with severe cardiopulmonary disease, any added resistance and/or minor changes in blood gases may evoke considerably more dyspnea and, thus, affect exercise capacity.
Pulmonologists, critical care specialists, translational researchers, and clinicians
At the conclusion of this activity, learners should be able to:
- Describe the effects of face masks on the respiratory responses to exercise.
- Predict the physiologic effects of face masks on healthy individuals.
- Describe the potential physiologic effects of face masks in individuals with underlying respiratory disease.
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Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Susan R. Hopkins, M.D., Ph.D. (University of California at San Diego, La Jolla, CA, USA) reported receiving grants from National Institutes of Health.
Paolo B. Dominelli, Ph.D. (University of Waterloo, Waterloo, Ontario, Canada) reported receiving grants from National Sciences and Engineering Research Council of Canada.
Christopher K. Davis, M.D., Ph.D. (University of California San Diego School of Medicine, San Diego, CA, USA) reported no relevant financial relationships.
Jordan A. Guenette, Ph.D. (University of British Columbia, Vancouver, British Columbia, Canada) reported no relevant financial relationships.
Andrew M. Luks, M.D. (University of Washington, Seattle, WA, USA) reported no relevant financial relationships.
Yannick Molgat-Seon, Ph.D. (The University of Winnipeg, Winnipeg, Manitoba, Canada) reported receiving grants from National Sciences and Engineering Research Council of Canada.
Rui Carlos Sá, Ph.D. (University of California at San Diego Health, La Jolla, CA, USA) reported receiving grants from National Institutes of Health and has been issued US patent 9,750,427.
A. William Sheel, Ph.D. (University of British Columbia, Vancouver, British Columbia, Canada) reported receiving grants from National Sciences and Engineering Research Council.
Erik R. Swenson, M.D. (University of Washington, Seattle, WA, USA) reported no relevant financial relationships.
Michael K. Stickland, Ph.D. (University of Alberta, Edmonton, Alberta, Canada) reported receiving grants from Canadian Institutes of Health Research and National Sciences and Engineering Research Council.
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The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.
The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.
AnnalsATS CME Planners
Alan M. Fein, M.D.
Podcast Editor, AnnalsATS
Dr. Fein reported that he has no financial relationships with ineligible companies.
Constantine Manthous, M.D.
Associate Editor, AnnalsATS
Dr. Manthous reported that he has no financial relationships with ineligible companies.
Gregory A. Schmidt, M.D.
Editorial Board, AnnalsATS
Dr. Schmidt reported payments for writing a textbook on critical care medicine (McGraw-Hill) and for writing contributions for UptoDate.
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