TO MASK OR NOT TO MASK (DURING EXERCISE) IS THE QUESTION

In the year 2019, if someone had told you that a rectangular piece of cloth, which can barely cover your face, would become, not only the saviour of the world, the following year, but would also be a potent symbol of political division, within the United States, you would probably dismiss them, at best, and question their sanity, at worst.

But still, here we are in the middle of 2020, and that’s exactly what’s happened. This rectangular piece of cloth (which could be cotton, chiffon, silk, polyester, or the surgical variety of polypropylene), more correctly termed as a mask, is our defender-in-chief, against the dreaded coronavirus, technically known as SARS CoV-2, or better known as Covid-19. As we battle this pandemic, we have come to realise that it’s a virus like no other seen before, hence the term, ‘novel coronavirus’, and it’s proving that every day. With all the weight of scientists and doctors (and quacks and charlatans) of the world behind us, we still seem to be struggling to understand how it affects the body, and what’s the best way to contain and treat it.

However, what we do know for sure, is that the best ways to keep it at bay, are:

1.       Physical distancing (I prefer this term to ‘social distancing’)

2.       Masks (any type, ranging from the N95 respirator to a simple home-made face covering)

3.       Hand hygiene

 

Exercise and Immunity:

Regular exercise has been shown to boost immunity. Having a stronger immunity is clearly an asset at a time like this. However, this is not a case of ‘more is always better.’ Research has shown that exercise and immunity have a ‘J-shaped relationship’, which means that the best immunity is attained with moderate levels of exercise. Not exercising at all, and excessive exercise lead to lowered immunity as compared to moderate exercise. Do keep in mind, that the terms moderate and excessive are relative. If you have been exercising, prior to the start of the lockdown, please continue to do so at your usual levels, but do not increase it dramatically. If you haven’t been exercising it might be a good time to start a moderate program, such as brisk walking or cycling.

 

 Exercise and Masks:

When exercising indoors, in your own home, you certainly do not need to wear a mask. The recommendations will be focussed on outdoor exercise. In general, the risk of viral transmission is significantly lower outdoors, than indoors, which is a great advantage to start with. But do keep in mind when exercising outdoors, especially at higher intensities, the risk of aerosols and droplets (which contain the virus) travelling further due to heavy breathing, or the wind is theoretically much higher, than when a person is standing still.

 

Intensity matters:

For most people, wearing a mask is uncomfortable at first, especially during exercise. But like with most things, with a bit of practice one gets used to it. While doing low or moderate intensity exercise, such as brisk walking, wearing a mask should not be uncomfortable, but when you start increasing the intensity, the degree of discomfort might increase. When exercising with a mask, your perception of effort tends to increase, which means you might need to reduce your intensity to feel the same level of effort you feel, without a mask.

 

Distance matters, even more:

If you are lucky enough to stay in an area where you can exercise outdoors, with no one around you, then it would be fine to exercise without a mask. Most guidelines recommend you stay 6 feet away from those around you (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html). However, during exercise, I would suggest increasing that distance, since, as explained above, the droplets may travel further. There is no specific cut-off that has been scientifically proven, but out of abundant caution, I would recommend trying to maintain a distance of 20 feet. Now, I know that’s not possible for most people living in crowded cities, so here is my practical suggestion. Try and exercise using routes, and timings, such that you come across the least number of people. Have your mask around your neck, or ears, and lower it when no one is around you. When passing through an area, where you cannot maintain the required distance, raise the mask and cover your nose and mouth. You can lower it again, when clear of people.

 

What about carbon dioxide poisoning?

There have been reports in the social media, from various parts of the world regarding people collapsing due to exercising with face masks, and blaming it on carbon dioxide poisoning due to ‘rebreathing’ the air. There is no scientific evidence to support this. Masks are designed to allow the flow of air in both directions. Surgeons and other healthcare workers, have been wearing masks since decades, without any ill effects. Yes, sometimes one does feel a sense of suffocation if not used to it- in that case, it’s fine to simply uncover your face and mouth for a few breaths, till you feel better. Here are links to two good articles on the subject.(https://www.forbes.com/sites/marshallshepherd/2020/07/01/debunking-2-myths-toxic-coronavirus-masks-and-breathing-warms-the-climate/#3b2d907a30f4; 

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/debunked-myths-about-face-masks)

One word of caution here – those with pre-existing respiratory and cardiac conditions may feel a greater subjective sense of discomfort, with a mask and need to adjust their activity accordingly. Actually, this can apply to others, too. If you are feeling uncomfortable exercising with a mask, reduce your exercise intensity and see how it feels. If you feel better, that’s great, if not, stop exercising and have a word with your doctor.

 

Take-home messages:

1.       Masks, physical distancing and hand hygiene are proven strategies to prevent the spread of coronavirus.

2.       Exercise improves your immunity, for which moderate-intensity exercise is best.

3.       When exercising outdoors, if you are able to maintain a 20 foot distance from others, it would be fine to let your mask (guard) down. When unable to maintain the distance, put it back on.

4.       Exercising with a mask, may lead to a greater subjective perception of effort, so you may need to reduce your exercise intensity.

5.       There are no ill effects of wearing a mask. If you feel uncomfortable while exercising with it, or have any serious health conditions, please speak to your doctor.