Return to training in the COVID-19 era: Physiological effects of exercise in a veil, recommendations for fitness centers and an appeal to the government
With this article, we want to at least appeal to the government in this way. However, not by swearing, not by conspiracies, but by facts and the effort to compromise. We are aware that the situation is critical, which is reflected in the drastic measures taken. The moving median at level 500, which the Prime Minister spoke of as the main condition for relaxing the current measures, is in sight. Infinity, this is simply not possible, otherwise there is a risk that many operations in Slovakia will actually go bankrupt. The total closure of services in the spring of 2020 has already hit us hard, and it is possible that after this second wave we will have nowhere to train, and many will not even have anything to live on. If we do not find a compromise, the fitness industry will be on its knees. A compromise between a reasonable number of newcomers and an economic burden on the state, companies or people. The coronavirus just doesn't go away, so let's talk about the compromise we're proposing.
Before you start reading the following lines, we would like to inform you that this article will be continuously supplemented with the arrival of current studies. And although we are not doctors or virologists, our aim is to bring the most objective information possible on this topic. It is thus possible that the current wording will undergo a significant addition / change, which we will inform you about.
Introduction to the discussed issues
The outbreak of the COVID-19 pandemic has had, and still has, a significant impact on almost every aspect of our lives. In addition to other measures that accompany this unfortunate situation, whether we like it or not, wearing veils and respirators has become an essential part. Unfortunately, various operations or even entire sectors, including fitness centers, have been closed down. Regular exercise in a safe environment is an important strategy for a healthy lifestyle (Note 1). Although direct data on the number of those infected in fitness centers are absent, there is no denying that there is an increased risk of virus transmission. In addition, in the gym you will not only meet young and healthy people, but on the contrary, it is also visited by older and more obese people who fall into risk groups. In the future, this probably requires the wearing of veils during the entire exercise of physical activity, as an inseparable duty for everyone.
Why is it necessary to wear drapes during training in the gym?
COVID-19 is a respiratory infection caused by the SARS-CoV-2 virus, a new form of coronavirus. The primary way in which COVID-19 can be transmitted is probably through small droplets when talking, breathing, coughing or sneezing. Therefore, gyms, where there are a lot of people in an enclosed space who sweat, exhale many drops into the environment and at the same time catch common equipment (which they do not usually disinfect after themselves), are really a risky environment. If we add to this the fact that a significant part of the carriers of the disease, especially young people, is without obvious symptoms, the problem is exacerbated. It is young people who can later be an important source of virus transmission at home, to the aforementioned vulnerable groups.
In addition, some preliminary studies have shown that small droplets can spread up to 5 meters when walking (at a speed of 4 km / h) and even up to 10 meters when running (at a speed of 14.4 km / h). For example, running on a belt? YES, it's about modeling, not reality, in any case it's worth considering the possible minimization of risks in the gym. It should also be added that, according to another study, SARS-Cov-2 remains in the air for up to 3 hours. For solid surfaces, evidence suggests that SARS-Cov-2 may remain on the surface of metal, cardboard, glass, or plastic for more than a week. So one-handed arms and grips on machines?
Airway cover helps fight Covid
Masks have already been effective in reducing the spread of influenza and severe acute respiratory syndrome (SARS). Surgical drapes / masks or N95 respirators have also been effective in preventing influenza in healthcare professionals. Recent preliminary reports indicate the effectiveness of face masks in combating the COVID-19 pandemic. Two other well-conducted model studies based on real-world data have also shown a statistically highly significant benefit of wearing masks / drapes. Simply, yes, they help!
Specific case:
The findings published in the US Centers for Disease Control and Prevention (CDC) Weekly Report on Morbidity and Mortality provide a concrete example. According to this report, two hairdressers continued to work with symptoms until they tested positive (day 8), exposing 139 clients to COVID-19. However, hairdressers and their clients wore veils, as required by regulations. After tracing the contacts, none of the exposed clients showed symptoms. In addition, of the 67 tested, all were negative. Although such evidence has some limitations, the non-proliferation of SARS-CoV-2 can be attributed in part to the wearing of drapes (they wore a two-layer cotton or surgical drape).
Of course, it is necessary to distinguish between the protection of a person as an individual who wears a certain mask / veil and the protection of his surroundings. Civilians wear a veil to protect their surroundings. That's why it's important that everyone wears the drapes properly. Healthcare professionals, on the other hand, wear a respirator and other protective equipment to primarily protect themselves in a hazardous environment.
In addition, the coverage of the face is not fully sufficient, and if the drape is handled incorrectly, one can become infected anyway. Therefore, it is necessary to regularly disinfect your hands, do not touch your face or drape, always replace it and clean it. It is also questionable how effective are over-the-counter or following a home made drape. Although a higher specific case suggests an effect, this meta-analysis states that cloth drapes show minimal efficacy compared to medical drapes / respirators. However, the authors state that "something is better than nothing". Logically, a drape that does not fit flawlessly to the face cannot completely prevent the inhalation of particles from the air. In addition, the composition of the substance determines its filtering effects. However, they can at least partially reduce their direct discharge into common areas. This also applies to fitness center areas or their equipment (single arms, machines, belts, etc.) that are affected by fewer virus particles. That is why it is necessary for everyone to have them and to keep their distance from each other. I know that everyone wants to be as close as possible to the mirror and see themselves in it, but only then will it have the desired effect.
Study:
In this study, they observed the external emissions of aerosol particles in healthy people using a micron scale. Participants (there were 9 of them) performed 4 types of facial activity (breathing, talking, coughing and chewing), wearing different types of medical or homemade masks / drapes. KN95 surgical drapes and respirators have been found to reduce particle discharges by an average of 90% and 74% during conversation and coughing, confirming their effectiveness in reducing external aerosol emissions and thus the potential for SARS-CoV-2 to spread. It should be added that they could not determine the effectiveness of home-made cotton masks, whether single or double ply. They only determined that they needed to be cleaned regularly. In addition, it was mainly a matter of capturing larger particles (> 0.5 μm), so that the small ones are still able to penetrate. I would add that they dealt only with direct exhalation, not to the sides, and even the inhalation itself = the possibility of infection exists when the mask / drape does not fit. The point is, what we have already mentioned is that such a surgical drape does not protect you, but reduces the risk to other people around you.
In this case, they tested 14 commonly available masks or mask alternatives and the N95 respirator using the method of optical measurement of droplet transfer during ordinary speech. The droplets emitted during the narration were shown to be best filtered in the N95 respirator and the surgical drape, but the other drapes did not turn out completely poorly compared to the narration without it. The limitation is, they did not measure virus transmission, only the transmission of particles larger than> 0.5 μm.
Veil training
If fitness centers reopen (hopefully later this year!), It is more than likely that exercise drapes will be a must. We will not now argue about the question of whether it is necessary to have a veil in the gym, but whether they are safe during exercise. Alternatively, what impact will they have on our performance?
The use of any type of drape / mask reduces airflow to the lungs, compared to training without a drape. This causes a lower supply of oxygen to the lungs and consequently a lower supply to the muscles = so it makes our training more difficult. In this case, an increase in respiratory rate can be expected, so some negative side effects may occur, such as dizziness, shortness of breath and decreased performance. However, it has also been shown that after a period of adaptation, these symptoms and discomfort can be reduced or even eliminated. All previously published studies on face masks that have yielded positive results have been tested under low to medium stress conditions. Therefore, caution is warranted for athletes who exercise intensively for extended periods of time, especially if they wear too tight airway coverage (but this is important for their personal protection). They may thus also be at risk for physiologically significant hypercapnia and hypoxia. This hypothesis urgently needs to be tested.
Study:
This prospective crossover study compared the effects of wearing a surgical drape, FFP2 / N95 respirator in 12 healthy men (age 38r, BMI 24.5). They underwent a load test on a bicycle, which started at 50W, with the load being increased by another 50W every 3 minutes until they were depleted. Subsequently, they cycled for another 10 minutes at a load of 25 W (recovery). They monitored their performance, several health parameters and discomfort during exercise. The mean duration of the stress test decreased slightly with the drape (−29 ± 40 s) and decreased significantly with the respirator (o52 ± 45 s). At maximum load, there was a significant decrease in performance parameters. Wearing FFP2 / N95 resulted in a 13% reduction in VO2max and 23% ventilation.
The conclusion they presented states that masks / respirators (in addition to causing considerable discomfort) have a significant negative effect on cardiopulmonary capacity, which significantly impairs strenuous physical activity. In other words, there is a decrease in performance. Here's the answer to why you shouldn't train like crazy as intensely as without a veil.
Kampert and his group responded to this study in a letter to the author, where they pointed out several poorly formulated conclusions.
Thus, studies have shown higher values of oxygen consumption and pulmonary ventilation, together with increased volume and duration of training, shorter pauses, higher speed of movement and higher number of repetitions (assuming that the effort was the same). Therefore, in order to reduce cardiorespiratory stress when wearing a veil and the consequent "risk of contamination" due to changes in pulmonary ventilation and dyspnea, it is appropriate to:
reduce the volume / total length of training
train with a lower number of repetitions,
have longer pauses resp. longer breaks between exercises and series
avoid highly dynamic repeated movements (jumps on the crate, English, etc.)
CO2 issues - are we really poisoned?
This study aimed to assess the physiological effects of wearing surgical drapes or N95 respirators during short-term strenuous cycling training. So it's about cardio training. Healthy participants in this study underwent so-called maximum stress test without airway cover, with surgical drape and with N95 respirator. What is the stress test? In short, you cycle and gradually (every 30 seconds) the resistance increases and you go until complete failure. A total of sixteen volunteers (mean age 34, BMI 28.72 / m2) completed this protocol. Several parameters were compared → heart rate, respiratory rate, blood pressure, blood oxygen saturation and time to exhaustion. Levels of (terminal) carbon dioxide (EtCO2), which is highly controversial on the Internet, were also monitored.
The results:
When looking at the time to exhaustion, we do not find statistically significant differences - 18.9 ± 3.7 minutes without mask, 18.3 ± 3.7 minutes with surgical drape and 18.5 ± 3.6 minutes with N95 respirator. It should be noted that the other monitored parameters (systolic blood pressure, heart rate, oxygen saturation, respiratory rate, etc.) did not reach statistical significance at any stage of the protocol.
Wearing an N95 respirator was associated with higher EtCO2 values in most phases of the protocol (see graph). The differences were more pronounced when the load increased and at exhaustion (ie at the end, when they were already at 100%) reached a level of 8 mm Hg more. In other words, 15% higher values with a respirator than without it. For the surgical drape, it was 5 mm Hg more.
Unfortunately, this research is still lacking. In addition, we do not have a study that specifically examines strength training and its impact. From the data available so far, it can be concluded that in healthy individuals, short-term moderate aerobic physical activity with a surgical drape or respirator is possible, safe and is associated with only small changes in physiological parameters, especially a slight increase in EtCO2. However, it is not necessary to ignore the fact that the protocol lasted on average 18-19 minutes, it was not an uninterrupted two hours on a bicycle or an hour's run on a belt. Again, an argument on the other hand - the exercise is an intermittent physical activity, not a continuous physical activity without a break. Of course, vigilance is necessary in patients suffering from lung diseases, heavy smokers, people with cardiovascular diseases and the like. They cannot be advised to do this form of exercise with airway obstruction.
Recommendations for reopening fitness centers
Limiting the capacity of visitors when converting to a training (not total) area. The specific number is for professional discussion.
Mandatory hand disinfection, temperature measurement and registration before entering the fitness center. By registering, it is easy to search for contacts in case of infection.
Exercise in a surgical drape, or in a specially adapted exercise drape (Under Armor, etc.) with the obligation to have the mouth and nose covered during the entire time of visiting the fitness center.
Daily obligation to disinfect equipment (machines, dumbbells, treadmills, etc.), while providing equipment for hand disinfection in exercise areas.
Ensure adequate ventilation / air circulation to the outside. Where appropriate, provide direct air disinfection (ultraviolet disinfection equipment, which could be a promising solution).
Fitness center without the possibility of showering (unpleasant, but survivable).
Consider a temporary entry ban for at-risk populations. However, the problem is also that a significant proportion of at-risk people are overweight people who need fitness to improve their overall quality of life and health. Therefore, alternatively consider dedicated classes for seniors as the most vulnerable group. This could also avoid the issue of discrimination.
Proposed sanctions
Both the operator and the visitor are responsible for violating the wearing of the veil in the fitness center. This will prevent ignorance and disrespect for the set rules. Just a few exemplary sanctions in larger fitness centers and the problem is solved.
The possibility of canceling the season ticket without the possibility of a refund if the person concerned refuses to respect the measures taken.
The possibility of ordering the closure of the fitness center if it does not meet the measures taken or. he ignores them.
Recommendations for people
Be careful and watch for symptoms - Unfortunately, empathy is a trait that many lack. Keep your distance, and if you have symptoms, you better stay home and don't risk endangering the people around you. When training in a veil gym, also look for side effects including dizziness, dizziness and shortness of breath. If this happens to you, take a break and stop exercising. If the symptoms are not resolved by resting, go out of the fitness center (or into a well-ventilated area) and put the drape down for a while. If you have an asthmatic who cannot tolerate exercise in a veil (or other health problems), it is necessary to choose another form of physical activity outside the commercial gym (training at home / outdoors).
Approach the intensity of the exercise sensibly - As we mentioned in the article, if you want to avoid the risk then - lower volume / length of training, longer pauses and breaks between sets and exercises, minimize highly dynamic exercises. Unfortunately, performance athletes are likely to experience a decline in performance. But lower performance is better than none, right?
Choose the right drape - Giving the best recommendation is not easy. While one drape is more comfortable, the other protects the surroundings more. A surgical drape or a multi-layer cotton drape will definitely be a good choice. Of course, a textile drape with at least a double layer will be better than nothing. Avoid respirators during exercise, which protects the most, but also has the greatest impact on sports performance and potential health risks.
Handle the drape responsibly - Do not use the same drape more than once. If it is a sports towel for multiple uses, pay attention to its sufficient cleanliness and disinfection, or they have ironed it. Do not grab the veil from the front during the exercise, take it off your face by attaching it from the back. If you get too sweaty, have another veil in reserve so you don't have to exercise all the time in a sweaty and wet veil. Finally, we add, not a drape as a drape in terms of certification. See the report for more details.
Conclusion
I know that many people reject the veil in principle and you want it to end. We are also tired of it, but we perceive reality (the number of infected over 40 million and 1.1 million deaths as of October 18, 20), and therefore we must find a compromise. Once the situation is at least slightly stabilized (we will overcome the peak / the moving median will not increase for two weeks in a row), it is time to look for a compromise for the reopening of fitness centers. Although also in the form of exercise in drapes and in compliance with strict hygiene measures. Otherwise, in this situation, our sector will not survive until the end of the year!
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