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Effects of wearing a cloth face mask on performance, physiological and perceptual responses during a graded treadmill running exercise test
  1. Simon Driver1,
  2. Megan Reynolds1,
  3. Katelyn Brown2,
  4. Jakob L Vingren3,
  5. David W Hill3,
  6. Monica Bennett4,
  7. Taylor Gilliland1,
  8. Evan McShan1,
  9. Librada Callender1,
  10. Erin Reynolds1,
  11. Nate Borunda5,
  12. John Mosolf5,
  13. Casey Cates6,
  14. Alan Jones6
  1. 1Sports Therapy and Research, Baylor Scott and White Health, Frisco, Texas, USA
  2. 2Department of Cardiovascular Rehabilitation, Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, USA
  3. 3Kinesiology, Health Promotion and Recreation, University of North Texas, Denton, Texas, USA
  4. 4Biostatistics Core, Baylor Scott and White Research Institute, Dallas, Texas, USA
  5. 5Sports Performance, Sports Academy, Frisco, Texas, USA
  6. 6Department of Orthopedics, Baylor University Medical Center at Dallas, Dallas, Texas, USA
  1. Correspondence to Dr Simon Driver; Simon.Driver{at}


Objectives To (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.

Methods Randomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.

Results The final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p<0.001), maximal oxygen consumption (VO2max) (−818±552 mL/min, p<0.001), minute ventilation (−45.2±20.3 L/min), maximal heart rate (−8.4±17.0 beats per minute, p<0.01) and increased dyspnoea (1.7±2.9, p<0.001). Our data also suggest that differences in SpO2 and rating of perceived exertion existed between the different stages of the CPET as participant’s exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.

Conclusion Cloth face masks led to a 14% reduction in exercise time and 29% decrease in VO2max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.

  • physical activity
  • respiratory
  • fatigue

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  • Contributors Study concept—SD, MR, KB, JLV and DWH. Study design—SD, MR, LC, MB, KB, JLV and DWH. Literature search—SD, MR, EM, KB, TG, JLV and DWH. Data acquisition—SD, MR, KB, TG, EM and LC. Data analysis—MB and LC. Manuscript preparation—SD, MR, KB, JLV, DWH, LC and MB. Manuscript editing—SD, MR, KB, MB, LC, TG, EM, ER, JLV, DWH, NB, JJM, CC and AJ. All authors read and approved the final manuscript.

  • Funding This research study was funded through the Baylor Scott and White Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol for the study was approved by the Institutional Review Board (IRB) committee of Baylor Scott and White Research Institute, Dallas, Texas, USA (IRB#: 020-353).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request per institutional policy.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.