Dangers of Wearing a Face Mask while Exercising

Thank you Mr. Yoga Thevan for this piece of news!

Jogger's lung collapses after he ran for 2.5 miles while wearing a face mask | Daily Mail Online:

https://www.dailymail.co.uk/news/article-8311179/Joggers-lung-collapses-ran-2-5-miles-wearing-face-mask.html

JB Lim

Following the above  news sent by Mr. Yoga to a WhatsApp chat group, this author who was formerly a Trainer and Regional Staff Officer in Emergency Medicine and Basic Trauma Care, and in Advanced First-Aid for St. John Ambulance Malaysia wrote this comment

Other Clinical Scenarios:

Collapse of the lungs is just one possible event wearing a face mask while exercising when there is a very high demand for oxygen, especially to the brain

Allow me to take this opportunity from this news to highlight other possible outcome if we derive the body from adequate ventilation and oxygen during exercise by wearing a face mask

Never obstruct ventilation by wearing a mask in situations where there is a high demand for oxygen such during vigorous exercise, especially when the exercise is vigorous and prolonged such fast running or fast prolonged jogging

Anoxia and the Brain:

The first and the most vital organ affected by oxygen inadequacy is the brain, causing what we call cerebral anoxia (complete depletion of oxygen)  or by partial hypoxia (extremely low oxygen to the tissues).    



No doubt the brain will respond by increasing the heart rate (tachycardia if over a 100 beats / min) but not above that rate as the cardiopulmonary systems will fail to compensate to meet the oxygen demand by the brain.

In the event the cerebral anoxia is slight (hypoxia), one of the first presenting symptoms will be the loss of concentration and co-ordination with short-term memory loss.

Others are headache, light-headedness, dizziness, an increase in breathing rate (tachypnea) and sweating. There may be impaired field of vision, a sensation of numbness or tingling (“pins & needles” and paraesthesia), and even a sense of euphoria.

As the demand of oxygen increases due to an obstruction in adequate ventilation from face mask, anoxia, or extreme hypoxia becomes more unmistakable, causing confusion, agitation or drowsiness along with cyanosis (bluish tinge to the skin and lips, mouth and fingertips).

Neurologically, brief jerks of the limbs (myoclonus) and seizures may be presented from the damaging effects of lack of oxygen on the brain. If the anoxia is severe, it will result in loss of consciousness and possibly into coma.

Because of their high demand for oxygen and energy during exercise, the neurons (nerve cells) of the brain are chiefly affected as they are very sensitive to lack of oxygen, causing damage to all the cells throughout the brain, more in certain areas than in other regions.

Areas most sensitive to anoxic events are the cerebral cortex, expressly the parietal lobes and occipital lobes, the memory-storage hippocampus, the basal ganglia and the motor regions of cerebellum. At organ tissue and brain tissue levels we call it hypoxia 

Oxygen Debt:

However, there are situations such as a short sprint of say 50 - 100 metres where a runner does not even breathe at all to complete a race.

The sprinter uses energy-rich phosphate bond stored in the adenosine triphosphate (ATP) in the muscles and convert them into adenosine triphosphate (ADP) with the release of energy through hydrolysis.

Such short term exercises that does not require immediate oxygen is called anaerobic exercise and is any activity that breaks down ATP to APD for energy without using oxygen. Generally, these activities are of short length with high intensity.

The idea is to get a lot of energy released within a small period of time and where oxygen demand surpasses the oxygen supply.  During this short spurt of physical activity the person does not even breathe at all, and it is at this moment a face mask may be worn if he or she wishes.

Adenosine triphosphate, or ATP, is a small, relatively simple molecule considered as the main energy units of cells.

However in such a very short bust of energy where oxygen and breathing is temporally halted, a face mask may be worn if there is a need, but  this must be released immediately soon  after  for high volume ventilation (breathing) to replace the oxygen needed to metabolize the lactic acid accumulated.

The body underwent what we call an “Oxygen Debt” that must be replaced by deep breathing

This is the amount of extra oxygen needed by muscle tissue to oxidize lactic acid and to replenish the depleted ATP and phosphocreatine following vigorous exercise.

Hydrolysis of ATP:

The phosphoanhydride bonds (ATP) is considered high-energy.   This implies that an appreciable amount of energy is released when one of these bonds is broken in a water-mediated breakdown reaction (hydrolysis) whereby the ATP is hydrolyzed to ADP.

But the reaction is reversed from ADP to ATP when the oxygen debt is repaid and the un-oxidized glucose is oxidized from lactic acid.

I short, all exercises, short or long term, vigorous or mild and pleasant all requires oxygen, and adequate ventilation is an absolute necessity.

Thus  my recommendation as a medical  physiologist, face mask should  never be worn to obstruct the airways and ventilation  during  any form of exercises

Brain Swelling: 

A total or even a partial deficiency of oxygen is very crucial to the brain. 



This resulting cerebral anoxia may also produce brain swelling and this can add to brain damage by squeezing off smaller blood vessels and interrupting the local blood supply. 




This is similar to an increase in the intracranial pressure (ICP) such as during a head injury when intracranial fluid accumulates within an un-yielding and fixed volume of the skull  

This compromises the flow of blood supply to the brain even further.

There is a pressure and volume relationship between ICP, volume of CSF, blood, and brain tissue, and cerebral perfusion pressure (CPP) is known as the Monro–Kellie doctrine or hypothesis (1) (2) (3).

Monro - Kellie Hypothesis:

This hypothesis states that the cranial compartment is inelastic and that the volume inside the cranium is fixed. The cranium and its constituents (blood, CSF, and brain tissue) create a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another.  

Similar representation is shown if the brain swells due to a deficiency of oxygen to the brain or inadequate perfusion

Prolonged Outcome:

If the anoxic environment persists in prolonged exercise by blocking out adequate high volume  ventilation through respiration,  I am afraid severe anoxic damage to the brain is inevitable which may result in collapse of the person in the middle of the exercise.

If the mask is not removed immediately, and supplemental oxygen applied if necessary, these effects may cause other organs to fail.

If prolonged it may result in coma, and from there, the possibility of an event into a persistent vegetative state (PVS).

In PVS the basic brain functions such as breathing spontaneously, maintenance of heartbeat and blood pressure, digestion of food and urine output will be maintained, but the patient is in a vegetable state due to severe anoxia by blocking out ventilation and oxygen  wearing a face mask during  severe exercise such as fast and long distance running, or running up a hill.

  

References:

1.            Monro A (1783). Observations on the structure and function of the nervous system. Edinburgh: Creech & Johnson.

2.            Kellie G (1824). "Appearances observed in the dissection of two individuals; death from cold and congestion of the brain". Trans Med Chir Sci Edinb. 1: 84–169.

3.            Mokri B (June 2001). "The Monro-Kellie hypothesis: applications in CSF volume depletion". Neurology. 56 (12): 1746–8. doi:10.1212/WNL.56.12