Evaluation of Six-Minute Walk Test (6MWT) Performance with and without a Facemask

Introduction: 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. When comparing performance measures with and without wearing a surgical mask (SM) or an N95 mask when completing the Six-Minute Walk Test (6MWT) among older community-dwelling adults, limited research is available. This was a prospective, randomized, and counterbalanced repeated measures design with three testing conditions (no mask (NM), SM, and N95 mask). The purpose of this study was to compare Six-Minute Walk Distance (6MWD), heart rate (HR), respiratory rate (RR), oxygen saturation (S_pO₂), rating of perceived exertion (RPE), and rating of perceived dyspnea (RPD) when performing the 6MWT with and without the use of a SM and an N95 mask. Methods: Thirty-six community-dwelling adults (17 males, 19 females), 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. Before 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). They 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, S_pO₂, RPE, and RPD. 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: No significant difference was found in 6MWD between walking conditions. HR, RR, and RPE significantly increased across time regardless of walking condition, but there was no significant difference between conditions. Overall, S_pO₂ significantly decreased from resting (97.0% ± .2) to immediate post-exercise (95.7% ± .3), and then returned to baseline (97.3% ± .2) 1-minute into recovery. No significant difference was found between conditions. The 6MWT performed with the N95 mask elicited significantly higher RPD scores when compared to both the NM and the SM conditions. Conclusions: Wearing a SM or an N95 mask had no significant effect on 6MWD, HR, RR, RPE, and S_pO₂ 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.