Background: During viral outbreaks, including the most recent coronavirus (COVID-19) pandemic, the use of personal protective equipment is recommended to prevent the spread of any highly contagious pathogen. Limited research has been performed when comparing performance measures and pacing patterns with and without wearing a surgical mask (SM) or an N95 mask when completing the Six-Minuate Walk Test (6MWT) among older community-dwelling adults. Study Design: This was a prospective, randomized, and counterbalanced repeated measures design with three testing conditions. Purpose: The purpose of this study was to compare Six-Minute Walk Distance (6MWD), heart rate (HR), respiratory rate (RR), oxygen saturation (SO), rating of perceived exertion (RPE), rating of perceived dyspnea (RPD), and walking pace when performing the 6MWT with and without the use of a SM and an N95 mask. Methods: Thirty-six community-dwelling adult ranging from 50 to 83 years of age, completed a familiarization 6MWT and three separate 6MWTs. All testing was performed outside on a 30-meter long, flat corridor. Prior to being tested, subjects completed the PAR-Q+, ACSM Exercise Pre-participation Health Screening Questionnaire, COVID-19 Screening Questionnaire, the Duke Activity Status Index Questionnaire (DASI) and had their temperature, height, weight and blood pressure measured. A two-way analysis of variance (ANOVA) with repeated measures was used to assess differences between walking conditions across time for 6MWD, HR, RR, SO, RPE, RPD, and walking pace. If there was a significant F ratio, Bonferroni posthoc tests were used to assess pairwise comparisons. Alpha was set at p <.05 to achieve statistical significance. Results: There was no difference in 6MWD between conditions. HR, RR, and RPE significantly increased across time regardless of walking condition, with no significant difference between conditions. Overall, SO significantly decreased from resting to immediate post-exercise, and then returned to baseline. No significant difference was found between conditions. The 6MWT performed with the N95 mask elecited significantly higher RPD scores when compared to both the NM and the SM conditions. No significant difference was found between groups for walking pace, but there was a significant difference noted across time when performing the 6MWT. Compared to minute 1, pace significantly decreased during minutes 2-5 followed by a significance increase in pace during the last minute of the walking test. Conclusions: Wearing a SM or an N95 mask had no significant effect of 6MWD, HR, RR, RPE, SO and walking pace in older community-dwelling adults when performing the 6MWT. Wearing the N95 mask was associated with significantly higher RPD scores when completing the 6MWT. The increased perception of breathlessness may be attributed to a tighter face seal of the N95 mask, increased breathing resistance, higher temperature/humidity levels, and carbon dioxide trapping inside the N95 mask. A variable pacing strategy was observed during the 6MWT. The N95 condition was associated with a trend toward a decrease in walking pace during minutes 3 and 4, however the difference were not significant. This data supports the concept that the subjects used an anticipatory-feedback model to downregulate their workload when wearing the N95 mask, to prevent large physiological changes, minimize premature fatigue, and manage dyspnea.
