Face Masks and Exercise in 2020: How to Work Out Safely and Effectively

Face Masks and Exercise - How To Do It Safely
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How is it possible to wear face masks and exercise? State and local mandates about mask-wearing continue to evolve based on Centers for Disease Control and Prevention (CDC) recommendations to reduce the spread COVID-19 via respiratory droplets. The question comes up as to how to safely navigate your workout routine and make progress toward your healthy-living goals. There’s no doubt wearing a face mask during exercise can be uncomfortable and take some getting used to, but there are ways to adapt.

Face Masks and Exercise - How To Do It Safely
How to Exercise Safely and Effectively With Face Masks

How to Master Proper Breathing with Face Masks and Exercise  

Contrary to some reports we’ve heard, wearing a cloth face mask doesn’t significantly reduce the amount of oxygen you can breathe in, though it can slow the rate at which you inhale it. Face coverings may also trap more exhaled carbon dioxide (CO2), which could possibly increase the gas in the blood, an entity known as hypercapnia. In certain circumstances, higher CO2 or lower oxygen may induce adaptive changes in your fitness.

Some people with underlying respiratory and cardiovascular conditions should take caution when exercising with a face mask on. However, for most people, the increase in CO2 does not pose a significant health risk. 

The real challenge for many is simply adjusting to wearing the mask, especially if you struggle with poor breathing patterns.  During the adaptation period, your response can lead to shorter chest breaths and adrenaline production, making one feel anxious. But there are ways to help mitigate this response.

1. Develop proper breathing technique with face masks and exercise. 

Use your diaphragm to breathe instead of your chest: Think of breathing through your back while expanding your ribs. Prone breathing, box breathing, and nasal breathing techniques can all help:

Prone Breathing:

  • Step 1: Sit in a comfortable position or lie flat on the floor, your bed, or another comfortable, flat surface.
  • Step 2: Relax your shoulders.
  • Step 3: Put a hand on your chest and a hand on your stomach.
  • Step 4: Breathe in through your nose for about four seconds. You should experience the air moving through your nostrils into your abdomen, making your stomach expand. During inspiration, make sure your stomach is moving outward while your chest remains relatively still.
  • Step 5: Purse your lips (as if you’re about to drink through a straw), press gently on your stomach, and exhale actively and slowly for about four seconds. You should feel your stomach moving inward, i.e. your belly button towards your spine. 
  • Step 6: Repeat these steps for several rounds, actively exhaling and passively inhaling. 

Box breathing: Inhale for four seconds, pause and hold your breath for four seconds, then exhale for four seconds. Gradually work up to a box breath of 8 seconds/8 seconds/8 seconds.

  • Step 1: Sitting upright, slowly exhale through your mouth, letting all the oxygen out of your lungs. Focus on this intention and be conscious of what you’re doing.
  • Step 2: Inhale slowly and deeply through your nose to the count of four. In this step, count to four very slowly in your head. Feel the air fill your lungs, one section at a time, until your lungs are completely full and the air moves into your abdomen.
  • Step 3: Hold your breath for another slow count of four.
  • Step 4: Exhale through your mouth for the same slow count of four, expelling the air from your lungs and abdomen. Be conscious of the feeling of the air leaving your lungs.

Nasal breathing: With your mouth closed, spend five minutes breathing only through your nose. Try this while performing lower intensity cardio.

2. Improve your ability to exhale to build CO2 tolerance with face masks and exercise.  

When combining face masks and exercise, you may need to reduce the intensity of sessions, especially cardio. You should also increase rest periods while doing cardio and strength training.

Continue to focus on breathing through your nose and aim for your exhales to be as least as long as your inhales, as that is how CO2 is expelled. Inadequate exhalation of CO2 is the main reason why it may accumulate in the bloodstream when using face masks and exercise together.

Pay close attention to your midsection — that is what should expand and contract as you breathe. If your shoulders and chest raise during inhale, you’re probably doing too much chest breathing.

3. Use the power of positive self-talk with face masks and exercise. 

Our thoughts affect not only our minds, but our bodies, too. Consciously and regularly checking in on how you feel as well as using intentional language — “I can” vs. “I can’t” — can help you physically and mentally relax during activity.

The good news is that your heart and lungs are getting an extra work out given the increased breathing resistance. Keep telling yourself you’ll feel like a beast when you can work out with the mask off!

Practical Tips 

At the end of the day, the transition to face masks and exercise might take some time — this should help you adjust as efficiently as possible.

How to pick a mask: 

  • Choose a version that you’re comfortable wearing while exercising. Both single and multi-layer options are available, and offer varying levels of protection. Your choice is based upon the desire for more layers, which may offer greater protection from respiratory droplets, or a single layer, which may improve breathing during exertion. Of course, wearing any mask properly affixed over the nose and mouth in general will reduce the spread of respiratory particulates.
  • For homemade masks, recent evidence suggests that combining a layer of high thread count cotton with a layer of silk may offer protection that’s as good as medical-grade masks. Research also shows that vacuum cleaner bag material may offer good protection against the spread of droplets as well. 
  • Ensure a proper fit — over the nose, not too loose, not too tight. If there are gaps along the edges of the mask where air can escape, the effectiveness decreases substantially.
  • Make sure it’s washable. The CDC recommends washing your mask between each use and drying either flat in direct sunlight or on the highest temperature. Follow the care instructions on your mask to maintain its efficacy when you’re wearing it. 
  • Masks with vents are not recommended by the CDC as it will allow exhaled air to escape freely and will not prevent the person wearing the mask from spreading droplets. 
  • Here’s a link from the CDC on considerations for wearing masks. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html

How to get used to wearing a mask:  These three tips translate well into current mask-wearing guidelines.

  • Try wearing your face masks and exercise a bit at home for a period of time to get acclimated to the fit.
  • While combining face masks and exercise, focus on nasal breathing as instructed above.
  • Continue to mentally remind yourself that while the mask may initially feel strange, you are in fact breathing in oxygen and exhaling carbon dioxide.

Things to do before you head to the club:  

Make sure your mask is clean and dry. Bring extra, clean masks to change into in case your mask becomes wet from sweat or heavier breathing. Damp masks are not only less effective, but they may make it more difficult to breathe.

Reminders for working out: 

  • Initially, you may want to shorten your workouts as you get used to exercising in a mask.
  • Adjust the intensity of your workout or increase your rest periods between sets or intervals.
  • Change your environment. If there are portions of your workout you can do outside (many clubs are offering outdoor classes now – but not a great idea if it’s 100+ degrees outside) you may not need to wear your mask in those settings (depending on local mandates, room for distancing etc).

Lastly, it goes without saying that if you’re not feeling well, the best choice is to stay home and connect with your healthcare provider on next steps. As we all navigate our way forward and adjust our exercise routines during this time, remember that your health, safety and fitness are a top priority. While wearing a mask during exercise may not feel ideal, there is no question that getting in your regular exercise is paramount to your health. Exercising with a mask on is still hands-down better than not exercising at all. 

Eduardo R Elizondo, MD, CLCP Fellow, American College of Sports Medicine https://charmaustin.com/why-charm/the-team/eduardo-elizondo-md/

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