Cardiopulmonary Exercise and the Risk of Aerosol Generation While Wearing a Surgical Mask

Abstract

Cardiopulmonary exercise training is associated with improvements in health-related quality-of-life, physical function, and overall mortality rates in patients with cardiovascular or pulmonary disease. 1,2 Currently, many structured cardiopulmonary exercise training programs are running at limited operational capacity or are closed due to an increased concern of possible spread of severe acute respiratory syndrome coronavirus 2 through droplet and aerosol generation that could occur with exercise. 2,3 In the community, many gyms are reopening, given the lack of evidence of potential aerosol generation during exercise. 4 This lack of evidence is a concern because of potential coronavirus disease 2 transmission from asymptomatic or presymptomatic individuals in these settings. 4 Presently, we sought to quantify and characterize particle generation associated with healthy adults performing exercise of different intensities. MethodsThis was a single-center study conducted at Mayo Clinic Florida and was approved by the institutional review board. Four adult volunteers free of cardiorespiratory, musculoskeletal, and metabolic disease consented and performed staged exercise.

How to Safely Reopen Cardiopulmonary Rehabilitation Facilities

“…This finding seems contradictory to their findings among healthy volunteers. 4 Aside from the lack of pulmonary disease as a pathophysiologic explanation, the small sample size (n ¼ 4) of the healthy volunteer study may explain those results. In fact, Blocken et al 6 implemented a study with 35 healthy volunteers who exercised without wearing a mask in a 866 m 3 gym.…”

“…12 However, the aerosol particle concentrations that are generated by the healthy population during exercise with face masks in the gym and the safe number of individuals to be allowed inside the room remains to be investigated, especially as a larger amount of bacteria were observed in the room air of gym facilities that had a smaller space between individuals. 13 Undoubtly, the two studies conducted by Helgeson et al 4,5 in healthy volunteers and patients reinforce this need.…”

“…Shortly after the American Thoracic Society guidance was published, Helgeson et al 4 published a study of aerosol particle concentrations generated by healthy volunteers during exercises while wearing a procedure mask in their rehabilitation center, which has a volume of 473.2 m 3 and an air exchange frequency of 6.3 times per hour. They observed that the aerosol particle concentrations during "light" and "hard" exercises were similar to the ambient level, a significant difference occurring only in case of "very hard" exercise.…”

“…10 Currently, if none of the aforementioned measures (limiting the number of patients in each class, using physical barriers, increasing air exchange frequency, or adding mobile air cleaning units) can be taken in the cardiopulmonary rehabilitation centers, rehabilitation staff should wear more effective personal protection equipment, such as N95 masks rather than procedure masks, especially for those who need to approach the patients during exercises. 7 Another critical finding in the two studies by Helgeson et al 4,5 was the aerosol clearance time, which is vital to guide the washout period between classes to protect patients. The clearance time depends on the room volume and air exchange frequency.…”

Mitigation of Aerosols Generated During Exercise Testing With a Portable High-Efficiency Particulate Air Filter With Fume Hood

“…It has been suggested that vigorous exercise such as performed during clinical exercise testing, generates aerosols with potential for carrying COVID-19. 1 The Centers for Disease Control and Prevention recommends that aerosol-generating procedures be performed with appropriate personal protection equipment and, when possible, in negative pressure rooms to allow clearance of aerosols through room air exchanges by increasing room ventilation with or without the use of high-efficiency particulate air (HEPA) filters. 2…”