The Physiological Impact of Masking Is Insignificant and Should Not Preclude Routine Use During Daily Activities, Exercise, and Rehabilitation

Journal article

Haraf, R.H., Faghy, M., Carlin, B. and Josephson, R.A. 2021. The Physiological Impact of Masking Is Insignificant and Should Not Preclude Routine Use During Daily Activities, Exercise, and Rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention. 41 (1), pp. 1-5. https://doi.org/10.1097/hcr.0000000000000577
AuthorsHaraf, R.H., Faghy, M., Carlin, B. and Josephson, R.A.
Abstract

Masking has been employed as a strategy for reducing transmission of a variety of communicable diseases. With the outbreak of SARS-CoV-2, many countries have implemented mandatory public masking. However, the perceived impact of mask use on pulmonary function has been a deterrent to public compliance with recommendations. COVID-19 has shed light on the impact that comorbid cardiac and pulmonary conditions may have on disease severity. This knowledge has led to increased primary and secondary prevention efforts for which exercise and rehabilitation are central. The importance of safe methods of exercise while mitigating risk of viral transmission is paramount to global recovery from the pandemic and prevention of future outbreaks.
We constructed a focused literature review of the impact of various masks on pulmonary function at rest and with exercise. This was then incorporated into recommendations for the integration of masks with exercise and rehabilitation in the COVID-19 era.
While there is a paucity of evidence, we identified the physiological effects of masking at rest and during exercise to be negligible. The perceived impact appears to be far greater than the measured impact, and increased frequency of mask use leads to a physiological and psychological adaptive response.
Masking during daily activities, exercise, and rehabilitation is safe in both healthy individuals and those with underlying cardiopulmonary disease. Rehabilitation participants should be reassured that the benefits of masking during COVID-19 far outweigh the risks, and increased frequency of mask use invokes adaptive responses that make long-term masking tolerable.

KeywordsRehabilitation; Pulmonary and Respiratory Medicine; Cardiology and Cardiovascular Medicine
Year2021
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Journal citation41 (1), pp. 1-5
PublisherOvid Technologies (Wolters Kluwer Health)
ISSN1932-7501
Digital Object Identifier (DOI)https://doi.org/10.1097/hcr.0000000000000577
Web address (URL)https://journals.lww.com/jcrjournal/Fulltext/2021/01000/The_Physiological_Impact_of_Masking_Is.1.aspx
http://europepmc.org/abstract/med/33351538
Output statusPublished
Publication datesJan 2021
Publication process dates
Accepted01 Dec 2020
Deposited05 Jan 2021
Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

ContributorsUniversity Hospitals Cleveland Medical Center, and Case Western Reserve University, School of Medicine, Cleveland, Ohio, Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois, University of Derby and Sleep Medicine and Lung Health Consultants, Pittsburgh Critical Care Associates, Pittsburgh, Pennsylvania
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Arena, Ross, Bond, Samantha, Calvo, Isabel Romero, Lebowicz, Leah, Ozemek, Cemal, Severin, Richard, Laddu, Deepika, Faghy, Mark, Lavie, Carl J. and Carbone, Salvatore 2021. Shelter from the cytokine storm: Healthy living is a vital preventative strategy in the COVID-19 era. Progress in Cardiovascular Diseases. 73 (56), p. 60. https://doi.org/10.1016/j.pcad.2021.06.008
Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study (Preprint)
Yessica Abigail Tronco Hernández, Fabio Parente, Mark A Faghy, Clare M P Roscoe, Frances A Maratos and Faghy, M. 2021. Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study (Preprint). JMIR. https://doi.org/10.2196/preprints.30708
The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network
Arena, Ross, Stoner, Lee, Haraf, Rebecca H., Josephson, Richard, Hills, Andrew P., Dixit, Snehil, Popovic, Dejana, Smith, Andy, Myers, Jonathan, Bacon, Simon L., Niebauer, Josef, Dourado, Victor Z., Babu, Abraham S., Maden-Wilkinson, Thomas M., Copeland, Robert J., Gough, Lewis A., Bond, Sam, Stuart, Kaz, Bewick, Thomas, Ashton, Ruth E.M. and Faghy, Mark 2021. The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network. Progress in Cardiovascular Diseases. 67, pp. 2-10. https://doi.org/10.1016/j.pcad.2021.01.004
The Effects of a Nutrition Education Intervention on Sports Nutrition Knowledge during a Competitive Season in Highly Trained Adolescent Swimmers.
Foo, Wee Lun, Faghy, Mark A, Sparks, Andy, Newbury, Josh W and Gough, Lewis A 2021. The Effects of a Nutrition Education Intervention on Sports Nutrition Knowledge during a Competitive Season in Highly Trained Adolescent Swimmers. Nutrients. 13 (8). https://doi.org/10.3390/nu13082713
Cardiorespiratory and skeletal muscle damage due to COVID-19: making the urgent case for rehabilitation
Silva, Rebeca Nunes, Goulart, Cássia da Luz, Oliveira, Murilo Rezende, Tacao, Guilherme Yassuyuki, Back, Guilherme Dionir, Severin, Richard, Faghy, Mark, Arena, Ross and Borghi-Silva, Audrey 2021. Cardiorespiratory and skeletal muscle damage due to COVID-19: making the urgent case for rehabilitation. Expert Review of Respiratory Medicine. 15 (9), pp. 1107-1120. https://doi.org/10.1080/17476348.2021.1893169
Educators Perspectives on the Value of Physical Education, Physical Activity and Fundamental Movement Skills for Early Years Foundation Stage Children in England.
Dobell, Alexandra, Pringle, Andy, Faghy, Mark and Roscoe, Clare M P 2021. Educators Perspectives on the Value of Physical Education, Physical Activity and Fundamental Movement Skills for Early Years Foundation Stage Children in England. Children. 8 (5), p. 338. https://doi.org/10.3390/children8050338
Cardiopulmonary exercise testing as a vital sign in patients recovering from COVID-19.
Arena, Ross and Faghy, Mark A 2021. Cardiopulmonary exercise testing as a vital sign in patients recovering from COVID-19. Expert review of cardiovascular therapy. 19 (10), pp. 877-880. https://doi.org/10.1080/14779072.2021.1985466
Current and Future Implications of COVID-19 among Youth Wheelchair Users: 24-Hour Activity Behavior.
Conners, Ryan T, Bates, Lauren C, Lassalle, Patricia Pagan, Zieff, Gabriel, Whitehead, Paul N, Stevens, Sandra, Killen, Lauren, Cochrum, Robert, Rodebaugh, Kathryn L, Stoner, Lee and Faghy, Mark A 2021. Current and Future Implications of COVID-19 among Youth Wheelchair Users: 24-Hour Activity Behavior. Children. 8 (8). https://doi.org/10.3390/children8080690
COVID-19 infection and cardiometabolic complications: short- and long-term treatment and management considerations
Stoner, Lee, Faghy, Mark and Conners, Ryan 2021. COVID-19 infection and cardiometabolic complications: short- and long-term treatment and management considerations. Reviews in cardiovascular medicine. 22 (2), pp. 263-265. https://doi.org/10.31083/j.rcm2202031
Physical activity and sedentary behavior in people with spinal cord injury: Mitigation strategies during COVID-19 on behalf of ACSM-EIM and HL-PIVOT
Bates, Lauren, Conners, Ryan, Zieff, Gabriel, Adams, Nathan, T., Edgar, Kyle, M., Stevens, Sandra, Faghy, Mark, Arena, Ross, Vermeesch, Amber, Rodney, Joseph, P., Keith, Nicole and Stoner, Lee 2021. Physical activity and sedentary behavior in people with spinal cord injury: Mitigation strategies during COVID-19 on behalf of ACSM-EIM and HL-PIVOT. Disability and Health Journal. 15 (1). https://doi.org/10.1016/j.dhjo.2021.101177
Current activities centered on healthy living and recommendations for the future: a position statement from the HL-PIVOT network
Arena, Ross, Kaminsky, Leonard A., Williams, Mark, Sabbahi, Ahmad, Popovic, Dejana, Axtell, Robert, Faghy, Mark, Hills, Andrew P., Olivares Olivares, Silvia Lizett, Lopez, Mildred, Pronk, Nicolaas P., Laddu, Deepika, Samuel Babu, Abraham, Josephson, Richard, Whitsel, Laurie P., Severin, Rich, Christle, Jeffrey W., Zuniga Dourado, Victor, Niebauer, Joseph, Savage, Patrick, Austford, Leslie D. and Lavie, Carl J 2021. Current activities centered on healthy living and recommendations for the future: a position statement from the HL-PIVOT network. Current Problems in Cardiology. 46 (6). https://doi.org/10.1016/j.cpcardiol.2021.100823
A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5 km running time-trial performance
Brown, Peter I., Faghy, Mark, Davis, Nichola, Mayes, JP and Maden-Wilkinson, Tom 2020. A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5 km running time-trial performance. European Journal of Applied Physiology. 121, p. 183–191. https://doi.org/10.1007/s00421-020-04505-3
Using system mapping to help plan and implement city-wide action to promote physical activity
Cavill, Nick, Richardson, Debra, Faghy, Mark, Bussell, Chris and Rutter, Harry 2020. Using system mapping to help plan and implement city-wide action to promote physical activity. Journal of Public Health Research. 9 (3). https://doi.org/10.4081/jphr.2020.1759
Cardiopulmonary exercise testing in the COVID-19 endemic phase
Faghy, Mark, Hull, James, Cooper, Brendan and Sylvester, Karl 2020. Cardiopulmonary exercise testing in the COVID-19 endemic phase. British Journal of Anaesthesia. 125 (4), pp. 447-449. https://doi.org/10.1016/j.bja.2020.06.006
Cross validation of actigraph derived accelerometer cut‐points for assessment of sedentary behaviour and physical activity in children aged 8‐11 years
Duncan, Michael J., Eyre, Emma L.J., Cox, Val, Roscoe, C., Faghy, Mark, Tallis, Jason and Dobell, Alexandra 2020. Cross validation of actigraph derived accelerometer cut‐points for assessment of sedentary behaviour and physical activity in children aged 8‐11 years. Acta Paediatrica. 109 (9), pp. 1825-1830. https://doi.org/10.1111/apa.15189
Fundamental movement skills and accelerometer-measured physical activity levels during early childhood: a systematic review
Dobell, Alexandra, Pringle, Andy, Faghy, Mark and Roscoe, Clare M. P. 2020. Fundamental movement skills and accelerometer-measured physical activity levels during early childhood: a systematic review. MDPI AG. https://doi.org/10.3390/children7110224
A biopsychosocial framework for recovery from COVID-19
Stuart, K., Faghy, M.A., Bidmead, E., Browning, R., Roberts, C., Grimwood, S. and Winn-Reed, T. 2020. A biopsychosocial framework for recovery from COVID-19. International Journal of Sociology and Social Policy. 40 (9/10), pp. 1021-1039. https://doi.org/10.1108/ijssp-07-2020-0301
Integrated sports and respiratory medicine in the aftermath of COVID-19
Faghy, M., Ashton, R., Maden-Wilkinson, T., Copeland, R. J., Bewick, T. and Smith, A. 2020. Integrated sports and respiratory medicine in the aftermath of COVID-19. The Lancet Respiratory Medicine. 8 (9), p. p852. https://doi.org/10.1016/s2213-2600(20)30307-6
Calibration and cross-validation of accelerometery for estimating movement skills in children aged 8–12 years
Duncan, M., Dobell, A., Noon, M., Clark, C.T., Roscoe, C., Stodden, D., Sacko, R., Eyre, E. and Faghy, M. 2020. Calibration and cross-validation of accelerometery for estimating movement skills in children aged 8–12 years. Sensors. 20 (10), p. 2776. https://doi.org/10.3390/s20102776
Sodium bicarbonate ingestion improves time-to-exhaustion cycling performance and alters estimated energy system contribution: a dose-response investigation
Gurton, William H., Gough, Lewis A., Sparks, S. Andy, Faghy, Mark and Reed, Katharine E. 2020. Sodium bicarbonate ingestion improves time-to-exhaustion cycling performance and alters estimated energy system contribution: a dose-response investigation. Frontiers in Nutrition. 7. https://doi.org/10.3389/fnut.2020.00154
Inspiratory muscle training (IMT) for adults discharged from hospital with community acquired pneumonia (CAP) – a feasibility study
Pick, HJ, Faghy, Mark, Cresswell, G, Lim, WS and Bewick, T 2018. Inspiratory muscle training (IMT) for adults discharged from hospital with community acquired pneumonia (CAP) – a feasibility study. Thorax.
A review of inspiratory muscle training. When and why does it work?
Faghy, M. 2019. A review of inspiratory muscle training. When and why does it work? Japanese Journal of Physical Fitness and Sports Medicine. 68 (1), pp. 3-5. https://doi.org/10.7600/jspfsm.68.3
Functional training of the inspiratory muscles improves load carriage performance
Faghy, Mark and Brown, Peter I 2019. Functional training of the inspiratory muscles improves load carriage performance. Ergonomics. 62 (11), pp. 1439-1449. https://doi.org/10.1080/00140139.2019.1652352
Estimating physical activity in children aged 8–11 Years using Accelerometry: Contributions from fundamental movement skills and different Accelerometer placements
Duncan, Mike, Roscoe, Clare M. P., Faghy, Mark, Tallis, Jason and Eyre, Emma 2019. Estimating physical activity in children aged 8–11 Years using Accelerometry: Contributions from fundamental movement skills and different Accelerometer placements. Frontiers in Physiology. https://doi.org/10.3389/fphys.2019.00242
P25 Inspiratory muscle training (IMT) for adults discharged from hospital with community acquired pneumonia (CAP) – a feasibility study
HJ Pick, MA Faghy, G Cresswell, WS Lim, T Bewick and Faghy, M. 2018. P25 Inspiratory muscle training (IMT) for adults discharged from hospital with community acquired pneumonia (CAP) – a feasibility study. BMJ Journals. https://doi.org/10.1136/thorax-2018-212555.183
Active recovery strategy and lactate clearance in elite swimmers
Mark A. Faghy, Mitch Lomax and Peter I. Brown 2018. Active recovery strategy and lactate clearance in elite swimmers. The Journal of Sports Medicine and Physical Fitness. 59 (9), pp. 1487-1491. https://doi.org/10.23736/s0022-4707.18.09228-9
From startline to frontline: the application of respiratory exercise physiology to occupational performance
Faghy, Mark, Blacker, Sam D. and Brown, Peter I. 2017. From startline to frontline: the application of respiratory exercise physiology to occupational performance. Sport and Exercise Scientist.
Whole body active warm up and inspiratory muscle warm up do not improve running performance when carrying thoracic loads
Faghy, Mark and Brown, Peter I. 2017. Whole body active warm up and inspiratory muscle warm up do not improve running performance when carrying thoracic loads. Applied physiology, nutrition, and metabolism. 42 (8). https://doi.org/10.1139/apnm-2016-0711
Impact of Weekly Swimming Training Distance on the Ergogenicity of Inspiratory Muscle Training in Well-Trained Youth Swimmers
Lomax M, Kapus J, Brown PI and Faghy M 2017. Impact of Weekly Swimming Training Distance on the Ergogenicity of Inspiratory Muscle Training in Well-Trained Youth Swimmers. Journal of Strength and Conditioning Research. 33 (8), pp. 2185-2193. https://doi.org/10.1519/jsc.0000000000002375
Functional inspiratory muscle training (IMT) improves load carriage performance greater than traditional IMT techniques: 1652 Board #305 June 2, 9: 00 AM - 10: 30 AM.
Faghy, Mark, Lindley, Martin R. and Brown, Peter I. 2016. Functional inspiratory muscle training (IMT) improves load carriage performance greater than traditional IMT techniques: 1652 Board #305 June 2, 9: 00 AM - 10: 30 AM. Wolters Kluwer. https://doi.org/10.1249/01.mss.0000486377.59880.50
Pilot study : can inspiratory muscle training relieve symptoms ff dyspnoea and improve quality of life for advanced cancer patients ?: 1872 Board #24 June 2, 3: 30 PM - 5: 00 PM.
Lindley, Martin R., Faghy, Mark, Sowter, Heidi M. and Mickleborough, Timothy D. 2016. Pilot study : can inspiratory muscle training relieve symptoms ff dyspnoea and improve quality of life for advanced cancer patients ?: 1872 Board #24 June 2, 3: 30 PM - 5: 00 PM. Wolters Kluwer. https://doi.org/10.1249/01.mss.0000486545.72377.ea
Effects of load mass carried in a backpack upon respiratory muscle fatigue
Faghy, Mark, Blacker, Sam D. and Brown, Peter I. 2016. Effects of load mass carried in a backpack upon respiratory muscle fatigue. European Journal of Sport Science. 16 (8), pp. 1032-1038. https://doi.org/10.1080/17461391.2016.1202326
Limitations and trainability of the respiratory system during exercise with thoracic loads
Faghy, Mark 2016. Limitations and trainability of the respiratory system during exercise with thoracic loads. PhD Thesis https://doi.org/10.48773/92y02
Training the inspiratory muscles improves running performance when carrying a 25 kg thoracic load in a backpack
Faghy, Mark and Brown, Peter I. 2015. Training the inspiratory muscles improves running performance when carrying a 25 kg thoracic load in a backpack. European Journal of Sport Science. 16 (5), pp. 585-594. https://doi.org/10.1080/17461391.2015.1071878
Preloaded Time Trial to Assess Load Carriage Performance
Mark A. Faghy and Peter I. Brown 2014. Preloaded Time Trial to Assess Load Carriage Performance. Journal of Strength and Conditioning Research. 28 (12), pp. 3354-3362. https://doi.org/10.1519/jsc.0000000000000555
Thoracic load carriage-induced respiratory muscle fatigue
Faghy, M. and Brown, P.I. 2014. Thoracic load carriage-induced respiratory muscle fatigue. European Journal of Applied Physiology. 114, p. 1085–1093. https://doi.org/10.1007/s00421-014-2839-4
Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters
Brown, Peter I., Venables, Heather, Liu, Hymsuen, de Witt, Julie T., Brown, Michelle R. and Faghy, Mark 2013. Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters. European Journal of Applied Physiology. 113, p. 2849–2855. https://doi.org/10.1007/s00421-013-2726-4