The pandemic legacy face mask: hidden barrier or insignificant factor in exercise performance? A randomized crossover trial

Abstract

Background: Medical masks serve as a barrier that prevents droplet transmission - the primary route of infection for many respiratory diseases. The effects of protective medical mask use on exercise performance and the factors influencing mask compliance are equivocal. This study aimed to examine the impact of Type I medical mask use on lower extremity endurance, exercise capacity, exercise-related parameters, and comfort levels in healthy young adults. Methods: In this randomized crossover study, participants completed the 30-second sit-to-stand test, the incremental shuttle walk test (ISWT), and the 6-minute walk test (6MWT) in random order, both with and without a mask. Blood pressure, heart rate, percutaneous oxygen saturation (SpO(2)), dyspnea, and fatigue were assessed before and after each ISWT and 6MWT. Results: A total of 79 healthy participants (mean age = 21.11 +/- 1.47 years; 54 females [68.4%] and 25 males [31.6%]) were enrolled, and 74 completed the study. No significant differences were observed between conditions (with vs without a mask) for the 30-second sit-to-stand test, ISWT, or 6MWT distances (P > .05). Results revealed a significant main effect of time for all physiological variables (P < .001), while no significant condition or interaction effects were found for heart rate or blood pressure during both walking tests (P > .05). For the ISWT, a significant Time & times; Condition interaction was observed for SpO(2) (P = .013) and perceived dyspnea/fatigue (P < .05), indicating a greater postexercise decline in SpO(2) and higher symptomatic perception in the masked condition. Similarly, in the 6MWT, mask use significantly increased perceived dyspnea (P < .001), without altering the physiological trajectory. Conclusion: In healthy young adults, Type I medical mask use does not impair exercise capacity or endurance, despite increasing subjective dyspnea and fatigue. While causing a minor reduction in SpO(2) during the ISWT, it remains a physiologically safe intervention that should not be considered a barrier to performance in exercise field tests.