Is it safe to exercise with a face mask on during COVID-19?

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Two teen boys died within a week of each other during compulsory physical education examinations while wearing face masks in China.

One of the 14-year-old students was wearing a surgical mask, and the other had on an N95 respirator.

According to Australian news outlet 7News, both boys “suddenly” collapsed on their school running track and were later pronounced dead, just six days apart.

One of the students’ father said that CCTV images of the incident showed his son doing laps of the athletics track in gym class when he fell backward within two to three minutes on April 24.

The family opted not to do an autopsy and was told by the local hospital that the boy died of sudden cardiac arrest.

“I suspect it was because he was wearing a mask,” the father said. “It was sunny and their PE class was in the afternoon when it was at least 20 degrees Celsius.

“It couldn’t have been comfortable wearing a mask while running.”

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In Chinese schools, the use of face masks is mandatory. Over concerns about the possibility of restricted breathing – and overall decreased student fitness as a result of a three-month pause in physical education – schools in some cities, such as of Tianjin and Shanghai, have eliminated running from end-of-term PE exams.

There’s no evidence that either mask contributed to the tragic outcomes, but the story gives rise to the question as to whether there’s any risk in exercising while wearing a mask.

Cao Lanxiu, a professor at Shaanxi University of Chinese Medicine, told local media that it’s unlikely the mask caused the teenagers collapse and suffocate.

“I don’t think mask-wearing has caused this sudden death,” Lanxiu said. “If this student had trouble breathing, he would’ve been conscious of that and wouldn’t have continued to run with the mask on until his heart stopped.”

Research is lacking when it comes to the use and safety of masks—whether it be a surgical mask, N95 respirator, or home-made version of various types of fabric—during physical activity. Yahoo Canada asked Canadian experts to weigh in.

Loren Chiu, associate professor in the Faculty of Kinesiology, Sport and Recreation at the University of Alberta, says that disposable N95 respirators are not designed for large head or neck movements, especially when done rapidly. They may slip, in which case the seal to the face is lost.

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“In this regard, they are about as effective as surgical masks which do not form a seal to the face,” Chiu explained. “Possibly, the bigger risk for either respirators or surgical masks is that if they are moving, the wearer may use their hands to adjust them, which may lead to touching their face with contaminated hands, or if they are a virus carrier, contaminating their hands.”

Reusable N95/N99 respirators typically provide a better fit for large head or neck movements, Chiu noted.

“However, if the respirator is functioning appropriately, it will reduce air flow into the breathing chamber, which may be uncomfortable and make it difficult to breathe during intense exercise,” he says.

A better option would be a mask designed specifically for physical activity, such as those that are intended for winter sports, Chiu added. For instance, he has a half face shield and a balaclava that together cover the mouth and nose and are designed to move with the head and neck.

A potential problem with cloth masks of any type is that they will collect moisture from breathing on them.

“It will not take long, particularly if someone is exercising, for the cloth to be saturated with moisture,” Chiu cautioned. “If the wearer is not a virus carrier and the virus is airborne in aerosolized form, it could collect on the wet cloth. Whether this affects the risk of the wearer to breathe in the virus is unknown.”

Another consideration is that wearing a mask or respirator of any sort will result in collection of warm air around the face.

“With warmer temperatures outside, this could increase sweat rate during exercise, as expelling warm air is part of the body's cooling mechanism,” Chiu said. “With increased sweating, there may be an increased tendency to touch one's face.

“I would think that wearing a mask while exercising outdoors is a moot point,” he added. “The potential benefits are countered by the drawbacks.”

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Chiu reminds that exercise should not be done in confined spaces, unless you’re exercising alone or with your family unit.

Marketa Stastna, manager of communications and marketing at the Lung Association, says that the organization follows instructions provided by Health Canada and the Public Health Agency of Canada in terms of mask use.

“The recommendations on the use face masks continue to evolve,” Stastna said. “However, as long as the mask is well fitted and you follow proper hygiene, there is no harm in wearing one.”

She reminds that single-use masks are generally only effective for an hour, then they need replacing.

Dr. Michael Koehle, director in the Division of Sport & Exercise Medicine at the School of Kinesiology and the Department of Family Practice at the University of British Columbia, reminds that the purpose of wearing a mask during exercise would be to protect those around people doing the exercise, not the exercisers themselves.

“The mask needs to prevent droplets in the exhaled air from coming into contact with others,” Koehle said. “At the same time, it needs to have enough flow to allow the exerciser to breathe adequately.

“Physical distancing is the most important means of reducing transmission during outdoor exercise,” he added. “The further apart exercisers are from each other the better, so as much as possible this should be a focus.”

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