Wearing face mask during physical exercise

Q4 Medicine Motricidade Pub Date : 2020-12-31 DOI:10.6063/MOTRICIDADE.21849
T. Barbosa
{"title":"Wearing face mask during physical exercise","authors":"T. Barbosa","doi":"10.6063/MOTRICIDADE.21849","DOIUrl":null,"url":null,"abstract":"It was in November 2019 that the first cases of humans infected by COVID-19 were identified in Wuhan, China. In November 2020, the Center for Systems Science Engineering at John Hopkins University reported 55 million global cases and 1.3 million deaths. World Health Organisation broke down the global cases by regions. Until November 2020, there were 23.1 million confirmed cases in the Americas, 15.2 million in Europe, 10 million in South-East Asia, 3.5 million in Eastern Mediterranean, 1.4 million in Africa and 0.8 million in Western Pacific. These numbers show that this is a public health crisis at global scale and is not contained to a single region as happened in the recent past. Since the 2000s, there were some smaller-scale outbreaks, such as SARS (2002-2003, 700 deaths), Swine Flu (2009-2010, 200 thousand deaths) and, Ebola (2014-2016, 11.3 thousand deaths). To find a pandemic leading to a larger death toll one must go back to the 1950s and 1960s. The Asian Flu (1957-1958) killed 1.1 million people and the Hong Kong Flu (1968-1970) with 1.0 million deaths. \nCOVID-19 pandemic is far more than a public health crisis. It has been disrupting the livelihood of everyone, affecting the economy, and having a negative social impact on a globalised world. The landscape across several industries changed suddenly. Industries had to adapt to the pandemic, including Education and Sports. For instance, United Nations Children’s Fund (UNICEF) reported in September 2020 that at least 463 million children whose schools closed due to COVID-19, had no access to home-based learning. At the peak of the first wave and lockdowns, around 1.5 billion schoolchildren were affected by school closures. One out of three children did not have any kind of formal education for more than 6 months. Now, most educational systems are providing at least remote (radio, TV, online, etc.) or blended learning. It is no different in the Sports industry. In 2019, the 6 most popular team sports in Portugal (Handball, Basketball, Football/Soccer, Futsal, Roller Hockey) had 220,000 age-group athletes. By November 2020, these 6 team sports had a total of 46,000 age-group athletes. In one year, about 174,000 young athletes dropped out of the sport or were no longer registered at the governing bodies (i.e., National Sports Federation). One may wonder the short- mid- and long-term impact of the lack of formal education and sports participation in this cohort of schoolchildren. \nCountries have been putting in place guidelines allowing athletes to resume training and competition. The guidelines, its stringency and enforcement vary from country to country and there is no stablished consensus on the best practices to tackle the transmission of the virus. There is an ongoing discussion if face mask can or should be worn doing physical exercise. A few of questions are raised quite often when one is engaged in dialogs on this matter: (1) does the mask affects the athletic performance? (2) how comfortable is to exercise wearing a face mask? (3) does the mask leads to hypercapnia (the increase of partial carbon dioxide in the body)? \nThe number of research papers in the literature on this topic is rather scarce (as of 14 November 2020). Running a search, it was possible to retrieve seven papers addressing the abovementioned questions (Roberge et al., 2010; Goh et al., 2019; Epstein et al., 2020; Fikenzer et al., 2020; Otsuka, Komagata, & Sakamoto, 2020; Shaw et al., 2020; Wong et al., 2020). Overall, 187 participants were recruited in these seven studies (between 6 and 106 participants). Most studies requested the participants to perform endurance exercises (cycling and walking/running) during 6 to 60 minutes at moderate-vigorous intensity (Figure 1). One study did not report the duration of the exertion, one reported 60 minutes and all others less than 20 minutes. Thus, studies addressed the effect of wearing a face mask (cloth mask, surgical mask or filtering facepiece/N95) during short bouts at moderate-maximal intensity. As such, it remains unclear the effect of wearing face mask in a wide range of sports and exercise programmes that do not require such level of physical exertion (duration and intensity). \nA random effects model (restricted maximum likelihood) was run on R to estimate the effect sizes of wearing face mask (experimental conditions) in comparison to not wear it (control condition) in the athletic performance, perceived effort and partial carbon dioxide (Figure 2). Wearing face masks had a trivial effect on the athletic performance (I2 = 0%; g = -0.05; 95CI: -0.34;0.25). Therefore, wearing the mask has no effect on the performance delivered during reasonably short bouts of moderate-maximal intensity. Face masks had a large effect on the perceived effort (I2 = 71%; g = 0.61; 95CI: 0.03; 1.19). Thus, the mask is deemed as a discomfort during exercise. The face mask had a large effect on carbon dioxide retention (I2 = 76%; g = 0.55, 95CI: -0.13; 1.23). Carbon dioxide increased wearing the face mask, but below 45 mm Hg, which was selected as a cut-off value for hypercapnia (Yang et al., 2015; Morales-Quinteros et al., 2019). Having said that, the upper bound of the 95% confidence interval of at least one study (Roberge et al., 2010) is close to 45 mm Hg (95CI: 37.99-46.00) wearing a filtering facepiece/N95 and walking 60 minutes at 4 km/h. Due to the small number of studies available, one should refrain from running further analyses such as subgroup comparisons (cloth masks vs surgical mask vs filtering facepiece/N95) to have insights on the statistical heterogeneity. \nIn summary, little is known about wearing face mask in exercise programmes and sports that do not require short bouts (6 to 20 minutes) of moderate-maximal exertion. Face mask does not change the athletic performance in 6-20 minutes bouts of moderate-maximal exertion. However, it increases the perceived effort and the partial carbon dioxide, even though below 45 mm Hg. Exercise and sport participation guidelines under COVID-19 pandemic should strike a balance between evidence furnished by public health, economy, and sport sciences. Policymakers are invited to take into consideration the sport science evidence abovementioned when drafting and updating guidelines on physical exercise in Sports and Education settings.","PeriodicalId":53589,"journal":{"name":"Motricidade","volume":"16 1","pages":"316-318"},"PeriodicalIF":0.0000,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Motricidade","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.6063/MOTRICIDADE.21849","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 1

Abstract

It was in November 2019 that the first cases of humans infected by COVID-19 were identified in Wuhan, China. In November 2020, the Center for Systems Science Engineering at John Hopkins University reported 55 million global cases and 1.3 million deaths. World Health Organisation broke down the global cases by regions. Until November 2020, there were 23.1 million confirmed cases in the Americas, 15.2 million in Europe, 10 million in South-East Asia, 3.5 million in Eastern Mediterranean, 1.4 million in Africa and 0.8 million in Western Pacific. These numbers show that this is a public health crisis at global scale and is not contained to a single region as happened in the recent past. Since the 2000s, there were some smaller-scale outbreaks, such as SARS (2002-2003, 700 deaths), Swine Flu (2009-2010, 200 thousand deaths) and, Ebola (2014-2016, 11.3 thousand deaths). To find a pandemic leading to a larger death toll one must go back to the 1950s and 1960s. The Asian Flu (1957-1958) killed 1.1 million people and the Hong Kong Flu (1968-1970) with 1.0 million deaths. COVID-19 pandemic is far more than a public health crisis. It has been disrupting the livelihood of everyone, affecting the economy, and having a negative social impact on a globalised world. The landscape across several industries changed suddenly. Industries had to adapt to the pandemic, including Education and Sports. For instance, United Nations Children’s Fund (UNICEF) reported in September 2020 that at least 463 million children whose schools closed due to COVID-19, had no access to home-based learning. At the peak of the first wave and lockdowns, around 1.5 billion schoolchildren were affected by school closures. One out of three children did not have any kind of formal education for more than 6 months. Now, most educational systems are providing at least remote (radio, TV, online, etc.) or blended learning. It is no different in the Sports industry. In 2019, the 6 most popular team sports in Portugal (Handball, Basketball, Football/Soccer, Futsal, Roller Hockey) had 220,000 age-group athletes. By November 2020, these 6 team sports had a total of 46,000 age-group athletes. In one year, about 174,000 young athletes dropped out of the sport or were no longer registered at the governing bodies (i.e., National Sports Federation). One may wonder the short- mid- and long-term impact of the lack of formal education and sports participation in this cohort of schoolchildren. Countries have been putting in place guidelines allowing athletes to resume training and competition. The guidelines, its stringency and enforcement vary from country to country and there is no stablished consensus on the best practices to tackle the transmission of the virus. There is an ongoing discussion if face mask can or should be worn doing physical exercise. A few of questions are raised quite often when one is engaged in dialogs on this matter: (1) does the mask affects the athletic performance? (2) how comfortable is to exercise wearing a face mask? (3) does the mask leads to hypercapnia (the increase of partial carbon dioxide in the body)? The number of research papers in the literature on this topic is rather scarce (as of 14 November 2020). Running a search, it was possible to retrieve seven papers addressing the abovementioned questions (Roberge et al., 2010; Goh et al., 2019; Epstein et al., 2020; Fikenzer et al., 2020; Otsuka, Komagata, & Sakamoto, 2020; Shaw et al., 2020; Wong et al., 2020). Overall, 187 participants were recruited in these seven studies (between 6 and 106 participants). Most studies requested the participants to perform endurance exercises (cycling and walking/running) during 6 to 60 minutes at moderate-vigorous intensity (Figure 1). One study did not report the duration of the exertion, one reported 60 minutes and all others less than 20 minutes. Thus, studies addressed the effect of wearing a face mask (cloth mask, surgical mask or filtering facepiece/N95) during short bouts at moderate-maximal intensity. As such, it remains unclear the effect of wearing face mask in a wide range of sports and exercise programmes that do not require such level of physical exertion (duration and intensity). A random effects model (restricted maximum likelihood) was run on R to estimate the effect sizes of wearing face mask (experimental conditions) in comparison to not wear it (control condition) in the athletic performance, perceived effort and partial carbon dioxide (Figure 2). Wearing face masks had a trivial effect on the athletic performance (I2 = 0%; g = -0.05; 95CI: -0.34;0.25). Therefore, wearing the mask has no effect on the performance delivered during reasonably short bouts of moderate-maximal intensity. Face masks had a large effect on the perceived effort (I2 = 71%; g = 0.61; 95CI: 0.03; 1.19). Thus, the mask is deemed as a discomfort during exercise. The face mask had a large effect on carbon dioxide retention (I2 = 76%; g = 0.55, 95CI: -0.13; 1.23). Carbon dioxide increased wearing the face mask, but below 45 mm Hg, which was selected as a cut-off value for hypercapnia (Yang et al., 2015; Morales-Quinteros et al., 2019). Having said that, the upper bound of the 95% confidence interval of at least one study (Roberge et al., 2010) is close to 45 mm Hg (95CI: 37.99-46.00) wearing a filtering facepiece/N95 and walking 60 minutes at 4 km/h. Due to the small number of studies available, one should refrain from running further analyses such as subgroup comparisons (cloth masks vs surgical mask vs filtering facepiece/N95) to have insights on the statistical heterogeneity. In summary, little is known about wearing face mask in exercise programmes and sports that do not require short bouts (6 to 20 minutes) of moderate-maximal exertion. Face mask does not change the athletic performance in 6-20 minutes bouts of moderate-maximal exertion. However, it increases the perceived effort and the partial carbon dioxide, even though below 45 mm Hg. Exercise and sport participation guidelines under COVID-19 pandemic should strike a balance between evidence furnished by public health, economy, and sport sciences. Policymakers are invited to take into consideration the sport science evidence abovementioned when drafting and updating guidelines on physical exercise in Sports and Education settings.
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进行体育锻炼时佩戴口罩
2019年11月,中国武汉发现了第一例人类感染COVID-19的病例。2020年11月,约翰霍普金斯大学系统科学工程中心报告了全球5500万例病例和130万例死亡。世界卫生组织将全球病例按地区分列。截至2020年11月,美洲有2310万确诊病例,欧洲有1520万例,东南亚有1000万例,东地中海有350万例,非洲有140万例,西太平洋有80万例。这些数字表明,这是一场全球范围的公共卫生危机,而不是像最近发生的那样局限于一个地区。自2000年代以来,出现了一些规模较小的疫情,如SARS(2002-2003年,700人死亡)、猪流感(2009-2010年,20万人死亡)和埃博拉(2014-2016年,11.3万人死亡)。要找到导致更大死亡人数的大流行,必须追溯到20世纪50年代和60年代。亚洲流感(1957-1958)造成110万人死亡,香港流感(1968-1970)造成100万人死亡。COVID-19大流行不仅仅是一场公共卫生危机。它扰乱了每个人的生计,影响了经济,并对全球化的世界产生了负面的社会影响。几个行业的格局突然发生了变化。包括教育和体育在内的行业必须适应疫情。例如,联合国儿童基金会(儿基会)在2020年9月报告说,至少有4.63亿因COVID-19而关闭学校的儿童无法获得家庭学习。在第一波疫情和封锁的高峰期,约有15亿学童受到学校关闭的影响。三分之一的儿童没有接受任何形式的正规教育超过6个月。现在,大多数教育系统至少提供远程(广播、电视、在线等)或混合学习。体育产业也是如此。2019年,葡萄牙最受欢迎的6项团队运动(手球、篮球、足球/足球、五人制足球、轮滑曲棍球)拥有22万名年龄组运动员。截至2020年11月,这6个团队项目共有46000名年龄组运动员。在一年内,约有174 000名年轻运动员退出这项运动或不再在管理机构(即全国体育联合会)登记。人们可能想知道,在这群学童中,缺乏正规教育和体育参与的短期、中期和长期影响。各国一直在制定指导方针,允许运动员恢复训练和比赛。这些指导方针及其严格程度和执行情况因国而异,在应对病毒传播的最佳做法方面没有达成既定共识。人们正在讨论是否可以或应该在进行体育锻炼时戴口罩。当人们就这个问题进行对话时,有几个问题经常被提出:(1)面具会影响运动员的表现吗?(2)戴口罩运动是否舒适?(3)口罩是否会导致高碳酸血症(体内部分二氧化碳增加)?关于这一主题的文献研究论文数量相当少(截至2020年11月14日)。通过搜索,可以检索到7篇针对上述问题的论文(Roberge et al., 2010;Goh et al., 2019;Epstein et al., 2020;Fikenzer et al., 2020;大冢,Komagata,坂本,2020;Shaw et al., 2020;Wong et al., 2020)。总的来说,在这7项研究中招募了187名参与者(6至106名参与者)。大多数研究要求参与者在6到60分钟内进行中等强度的耐力运动(骑自行车和步行/跑步)(图1)。一项研究没有报告运动的持续时间,一项研究报告了60分钟,所有其他研究都不到20分钟。因此,研究解决了在中等最大强度的短期比赛中佩戴口罩(布口罩、外科口罩或过滤面罩/N95)的影响。因此,在不需要这种体力消耗水平(持续时间和强度)的广泛运动和锻炼项目中,戴口罩的效果尚不清楚。在R上运行随机效应模型(限制最大似然)来估计戴口罩(实验条件)与不戴口罩(控制条件)在运动成绩、感知努力和部分二氧化碳方面的效应大小(图2)。戴口罩对运动成绩的影响微不足道(I2 = 0%;G = -0.05;95 ci: -0.34, 0.25)。因此,在适度的短时间内,在中等强度和最大强度的比赛中,戴口罩对表现没有影响。口罩对感知努力有很大影响(I2 = 71%;G = 0.61;95 ci: 0.03;1.19)。因此,口罩被认为是运动时的不适。面罩对二氧化碳滞留有很大的影响(I2 = 76%;g = 0.55, 95CI: -0.13;1. 23)。戴口罩后二氧化碳增加,但低于45毫米汞柱,这是高碳酸血症的临界值(Yang et al., 2015;Morales-Quinteros等人,2019)。话虽如此,至少有一项研究(Roberge et al., 2010)的95%置信区间上限接近45毫米汞柱(95CI: 37.99-46.00),佩戴过滤面罩/N95,以4公里/小时的速度步行60分钟。由于可用的研究数量较少,应避免进行进一步的分析,如亚组比较(布口罩vs外科口罩vs过滤面罩/N95),以深入了解统计异质性。总之,在不需要短时间(6至20分钟)中等强度运动的锻炼项目和运动中,人们对戴口罩知之甚少。在6-20分钟的中等强度运动中,口罩不会改变运动员的运动表现。然而,它增加了感知的努力和部分二氧化碳,即使低于45毫米汞柱。COVID-19大流行下的运动和体育参与指南应在公共卫生、经济和体育科学提供的证据之间取得平衡。请政策制定者在起草和更新体育和教育环境中的体育锻炼指南时考虑到上述运动科学证据。
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Motricidade
Motricidade Health Professions-Physical Therapy, Sports Therapy and Rehabilitation
CiteScore
0.70
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审稿时长
24 weeks
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