"Exercise with facemask; Are we handling a devil's sword?" - A physiological hypothesis

The effects of wearing face masks on the perception and mood of male healthy male adults during treadmill running: A pilot study

In the past few years, the face mask has been recommended for the prevention of exposing others to COVID-19. Wearing a face mask may have the potential to increase dyspnea and discomfort during exercise; however, controversy exists on whether wearing face masks during exercise affects exercise performance, perception, and mood in runners. We investigated the physiological and perceptual responses of healthy male adults who had experienced long-distance running while exercising at different intensities. Nine healthy young adults who were long-distance runners wearing surgical face mask conducted an incremental treadmill protocol. The protocol was three 6-min stages (20%, 40%, and 60% of maximal heart rate, respectively). The rating of perceived exertion (RPE) and the feeling scale (FS) were measured. RPE was higher in mask condition than in unmask condition (No mask vs. Face mask, light; 8.22 vs. 8.78, p = 0.615, middle; 10.00 vs. 10.78, p = 0.345, high; 12.33 vs. 13.67, p = 0.044.), while FS was not different between conditions. The present study shows that wearing a mask may increase rating of perceived exertion and discomfort when the exercise intensity exceeds a certain threshold in healthy male adults who have experienced long-distance running.

Impact of Concurrent Use of N95 and Surgical Masks on Peripheral Oxygen Saturation and Heart Rate Frequency-A Prospective Study during the COVID-19 Outbreak

Background and Objectives: The COVID-19 outbreak has necessitated the prolonged use of N95 facemasks in addition to traditional surgical facemasks by healthcare workers. The aim of this study was to investigate the effect of wearing N95 facemasks in addition to surgical facemasks on peripheral oxygen saturation (SpO2) and heart rate (HR) among dental professionals during routine care. Materials and Methods: This prospective study compared SpO2 and HR between dental providers wearing N95 + surgical facemasks vs. wearing a surgical facemask only. SpO2 and HR were recorded using a portable pulse oximeter before wearing the facemask (T0); at 30 min (T1); at 1 h (T2); and at the end of clinical activity (T3). Inter-group and intra-group differences were assessed with independent t tests and repeated measures ANOVA, respectively. Results: A total of 88 participants (57 wearing N95 + surgical facemasks, and 31 wearing a surgical facemask only) completed the study. The two groups did not statistically differ in SpO2 at different timepoints nor showed any intra-group differences. The participants wearing N95 + surgical facemasks exhibited a statistically higher HR at T0 (p = 0.007), T2 (p = 0.010), and T3 (p = 0.014) compared to those wearing a surgical facemask only. A statistically significant decrease was observed in HR between T0 and T3 in those wearing N95 + surgical facemasks (p = 0.012). No intra-group differences were seen in HR over time in those wearing a surgical facemask only. Conclusions: The continuous use of an N95 in addition to a surgical facemask did not show any significant effects in SpO2 during routine care; however, the concurrent use of an N95 and a surgical facemask seemed to be accompanied by a decrease in HR, although the values remained within the normal range.

Sports despite masks: no negative effects of FFP2 face masks on cardiopulmonary exercise capacity in children

Face masks were recognized as one of the most effective ways to prevent the spread of the COVID-19 virus in adults. These benefits were extended to children and adolescents. However, the fear of negative consequences from wearing a face mask during physical exercise led to cancellations of physical education lessons. This further decreased the amount of physical activity available to children and adolescents during the pandemic. However, there is little published data on the potential adverse effects of wearing the most effective and partially mandatory FFP2/N95 face masks during PE or physical activity (PA) in this age. Even though the pandemic has been declared as passed by the WHO, the rise of a new pandemic and thus the use of face masks for limiting its spread is inevitable, so we need to be better prepared for alternative options to lockdown and limitation of PA in such a scenario. Twenty healthy children aged 8-10 years performed two identical cardiopulmonary exercise tests as an incremental step test on a treadmill within an interval of 2 weeks, one time without wearing a protective mask and one time wearing an FFP2 mask. The cardiopulmonary exercise parameter and especially the end-expiratory gas exchange for oxygen and carbon dioxide (petO2 and petCO2) were documented for each step, at rest and 1 min after reaching physical exhaustion. Twelve boys (mean age 8.5 ± 1.4 years) and 8 girls (mean age 8.8 ± 1.4 years) showed no adverse events until maximal exertion. The mean parameters measured at peak exercise did not differ significantly between both examinations (mean peak VO2 = 42.7 ± 9.5 vs 47.8 ± 12.9 ml/min/kg, p = 0.097, mean O2pulse 7.84 ± 1.9 ml/min vs. 6.89 ± 1.8, p = 0.064, mean VE/VCO2slope 33.4 ± 5.9 vs. 34.0 ± 5.3, p = 0.689). The only significant difference was the respiratory exchange rate (RER, 1.01 ± 0.08 vs 0.95 ± 0.08, p = 0.004). The measured respiratory gases (end-tidal O2 and CO2) decreased and respectively increased significantly in almost every step when wearing an FFP2 mask. However, these levels were well below hypercapnia and above hypoxia.

CONCLUSION

 In this study, no significant differences in the cardiorespiratory function at peak exercise could be discerned when wearing an FFP2/N95 face mask. While the end-tidal values for CO2 increased significantly and the end-tidal values for O2 decreased significantly, these values did never reach levels of hypercapnia or hypoxia. Furthermore, the children terminated the exercise at a lower RER and heart rate (HR) suggesting a subconscious awareness of the higher strain. Since the detrimental effects of limiting sports during the pandemic are well documented, stopping PE lessons altogether because of the minor physiological effects of wearing these masks instead of simply stopping pushing children to perform at their best seems premature and should be reconsidered in the future.

WHAT IS KNOWN

• Wearing a face mask has an influence on psychological, social, and physiological functions in adults. • Because of the observed effects of wearing face masks in adults, physical activity in children was limited during the pandemic.

WHAT IS NEW

• Wearing an FFP2/N95 mask during physical activity did not lead to hypercapnia or hypoxia in children in this study. • Even though end-tidal CO2 values were significantly higher and end-tidal O2 values significantly lower when wearing an FFP2/N95 face mask, no pathological values were reached.

Effect of wearing surgical mask during controlled aerobic training on functional capacity and perceived stress in inactive men: a randomized trial

The study aims to assess the impact of wearing a surgical mask during training on inactive men's functional capacity and perceived stress. Seventy non-smoker males with body mass index of 25-30 kg/m2 and moderate-intensity activity of fewer than 150 min/week were allocated randomly into two equal groups. The surgical mask group performed a controlled endurance exercise while wearing a surgical mask of three protection layers. The mask-less group performed a controlled endurance exercise without wearing any mask. Functional capacity and Perceived Stress were evaluated before and after the intervention. A significant improvement was observed within groups post-intervention in favor of the mask group regarding the Time Up and Go test (P < 0.05), with a 15.1% percentage improvement. Post-intervention, there was a significant change in the perceived stress score for the mask and mask-less groups (P < 0.05). The improvement in PSS was in favor of mask-less group participants as they changed from being categorized as moderate to mild stress on the PSS, with a 27.1% percentage improvement. Exercising while wearing a surgical mask Positive impacts functional capacity and negatively impacts Perceived Stress in inactive adults. An additional study evaluating the physiological effects of masks on continuous exercise is necessary.

The Impact of Wearing Different Face Masks on Vigorous Physical Exercise Performance and Perceived Exertion among COVID-19 Infected vs. Uninfected Female Students

Under certain circumstances, masks are an effective and immediate solution to reduce the spread of viral infection. However, the impact of masks on the ability to perform vigorous exercise remains an area of concern. Primarily, this impact has been explored in healthy subjects, yielding contradictory findings, and little is known of it among COVID-19-infected individuals. This study examined the effects of surgical masks, N-95 masks, and unmasked conditions on the performance and perceived exertion (RPE) of infected vs. non-infected young women during high-intensity, repeated sprint exercise (5mSRT). Following a familiarization session, eighty-three (42 COVID-19-previously infected (PIG) and 43 non-infected (NIG)), female participants (age 20.02 ± 1.05 years, BMI 21.07 ± 2.1 kg/m2) were randomly assigned to one of three mask conditions: unmasked, surgical mask, or N95 mask. All participants attended three test sessions (i.e., one session for each mask condition) at least one week apart. At the beginning of each test session, data related to participants' physical activity (PA) and sleep behaviours during the previous week were collected. In each test session, participants performed the 5mSRT, during which performance indicators (best distance (BD), total distance (TD), fatigue index (FI) and percentage decrement (PD)) were collected, along with RPE. ANOVA indicated no significant main effects of Groups and Masks, and no significant interaction for Groups × Masks for BD, FI, PD, RPE and most sleep and PA behaviours (p > 0.05). For TD, the Groups × Mask interaction was significant (p = 0.031 and ƞp2 = 0.042). Posthoc analysis revealed, in the unmasked condition, there was no difference in TD between PIG and NIG (p > 0.05). However, when wearing a surgical mask, PIG covered lower TD compared to NIG (p < 0.05). Additionally, different types of masks did not affect TD in NIG, while PIG performed the worst using the surgical mask (p < 0.05). These results suggest post-COVID-19 individuals can maintain physical fitness through regular exercise (i.e., sport science curricula) in unmasked conditions, but not when wearing a surgical mask. Furthermore, the impact of different types of face masks on physical performance seems to be minimal, particularly in uninfected populations; future research is warranted to further explore this impact in post-COVID conditions.

Changes in Reaction Time, Balance and Neuroplasticity after Exercise with a Face Mask in Male Adults with Mild COVID-19 Symptoms

This study compared physiological, perceptual and neuroprotective hormone and metabolite responses and changes in coordination as an effect of aerobic exercise with and without a face mask in people with mild symptoms of COVID-19. Forty men took part in this study. Half declared mild symptoms of SARS-CoV-2 infection in the 6 months before the study (Declared) and the other half did not (Non-declared). In a random order, with a 7-day interval, they performed a 30-min walk on a treadmill at a speed of 6 km/h wearing a surgical face mask (Masked) and without it (Unmasked). The heart rate, heart rate variability, oxygen saturation, lactate concentration and rate of perceived exertion were recorded. The reaction time and balance were measured before and after the exercise. The concentrations of brain-derived neurotrophic factor, testosterone, cortisol, epinephrine and antibodies in the blood serum were determined. Physiological and perceptual responses, reaction times, and balance did not differ between the tested conditions. Three-way RM-ANOVA with post hoc Bonferroni analysis revealed lower post-exercise cortisol concentrations in the Masked and Unmasked conditions in both groups (p ≤ 0.001). Asymptomatic infection with this virus is prevalent, and mild COVID-19 causes similar responses to aerobic exercise with a surgical face mask and does not lead to impaired coordination.

The plausible effects of wearing face masks on sports performance - A scoping review

Objectives

The objectives of this scoping review are to discuss, firstly, the positive aspects of wearing face masks during training (such as a barrier to COVID-19 transmission, air pollutant exposure, and adding load on respiratory resistance flow); secondly, the negative aspects (adverse effects on body temperature and hypoxia risks); and thirdly, the training responses of wearing face masks on aerobic and anaerobic performance.

News

Besides social distancing and hand hygiene, wearing a face mask is proposed to be the prime advocacy for virus containment. During the period of high risk of contamination, the return to sport guidelines proposed by international and national sport federations included wearing face masks during training sessions. However, it is necessary to discuss the pros and cons of wearing face masks during exercise.

Prospects

Although it was essential to wear a face mask during exercise or sport-specific training, there is conflicting evidence on the implications of the use of face masks on physical, physiological as well as psychological well-being or performance. Based on the conflicting empirical findings and anecdotal evidence, certain recommendations have been made for adequate use of face masks during exercise; both to break the chain of transmission and prevent the physiological compromise expected from wearing face masks during exercise. The present review can help stakeholders balance sport guidelines in the event of a respiratory virus pandemic with athlete safety.

Conclusion

Conflicting evidence of mechanistic links between the dose of exercise and the possible adverse effects associated with exercising with face masks is available. Adequately powered studies with strong methodological quality on appropriate selection of masks and usage based on the intensity, duration, and type of sport, age, and gender is needed now for the stakeholders to make informed decisions with respect to exercising with face masks.

Effect of High Intensity Interval Training Under Mask on Forced Vital Capacity in Football Players

The purpose of the study was to investigate the effect of high interval training (HIIT) under mask on forced vital capacity in football players. Fourteen male football players (age 20 ± 2 years) were randomized into the without mask group (CON) or with the 2 difference mask groups [Surgical mask (SM), FFP2 mask (FM)]. HIIT program were implemented six movements in each session three times per week. Body composition, forced vital capacity and percutaneous oxygen saturation test were taken before and after 4 weeks intervention. The results show that forced vital capacity was statistically significant increased with both types of masks (SM: 5.68 ± 1.07 L; FM: 5.26 ± 0.86 L; CON: 4.66 ± 0.48 L, p < 0.01). Additionally, not significant difference in percutaneous oxygen saturation (SpO2) was found, and fat free mass (SM: 54.45 ± 4.01 kg; FM: 57.08 ± 4.38kg; CON: 58.34 ± 1.81 kg, p<0.01) were statistically significant changed with SM and CON but not FM. In conclusion, wearing surgical masks and FFP2 face mask during high-intensity interval exercise showed certain positive impacts on cardiopulmonary function. This short-term high-intensity interval training can be used to improve forced vital capacity performance among football players. This finding can be applied to develop the strength of breathing muscles in the future.

The physiological, perceptual, and thermoregulatory responses to facemask use during exercise

The use of masks in public settings and when around people has been recommended to limit the spread of Coronavirus disease 2019 (COVID-19) by major public health agencies. Several different types of masks classified as either medical- or non-medical grade are commonly used among the public. However, concerns with difficulty breathing, re-breathing exhaled carbon dioxide, a decrease in arterial oxygen saturation, and a decrease in exercise performance have been raised regarding the use of mask during exercise. We review the current knowledge related to the effect of different masks during exercise on cardiorespiratory, metabolic, thermoregulatory, and perceptual responses. As such, the current literature seems to suggest that there are minimal changes to cardiovascular, metabolic, and no changes to thermoregulatory parameters with facemask use. However, differences in ventilatory parameters have been reported with submaximal and maximal intensity exercise to volitional fatigue. Literature on perceptual responses to exercise indicate an impact on ratings of perceived exertion, dyspnea, and overall discomfort dependent on mask use as well as exercise intensity. In conclusion, data from the current literature suggests a minimal impact on physiological, perceptual, and thermoregulatory responses dependent on the type of mask used during exercise.

Exercise-induced expression of SARS-CoV-2 entry receptors: impact of mask modality, sex, and exercise intensity

BACKGROUND

Wearing a facemask affects physiological responses to exercise. We explored how exercising with a facemask affects the expression of SARS-CoV-2 entry receptor (angiotensin-converting enzyme 2 [ACE2]) and some associated genes (angiotensin type-1 receptors [AT<inf>1</inf>R]; Mas receptor [MasR]; hypoxia-inducible factor 1α [HIF-1α]; endothelial nitric oxide synthase [eNOS]) among healthy males and females.

METHODS

One hundred forty-four apparently healthy individuals (72 females; age: 30±6) were allocated to three mask groups of 48 (N95, Surgical, No Mask) with two exercise subgroups for each mask for both sexes. Participants in each experimental group performed either a submaximal (walking with no grade) or maximal (a modified Bruce Protocol) treadmill exercise test. Blood samples were collected before and after each exercise test and used to analyze the mRNA expression of the genes studied.

RESULTS

The post-exercise expression of genes examined were comparable between Surgical, N95, and No Mask (P>0.05). ACE2 was significantly greater in Surgical and N95 against No Mask at baseline and following moderate-intensity exercise (P<0.05). Whilst similar expressions were noted for MasR and eNOS (P>0.05), AT<inf>1</inf>R was greater in N95 than Surgical following high-intensity exercise (P<0.05). HIF-1α following either exercise intensity was significantly lower in N95 than Surgical (P<0.05). AT<inf>1</inf>R and HIF-1α were similar between Surgical and N95 against No Mask (P>0.05). ACE2 and AT<inf>1</inf>R were significantly higher in either mask modality than No Mask in males at baseline and postexercise (P<0.05). HIF-1α, MasR, and eNOS expressions were comparable between all mask groups in either sex (P<0.05).

CONCLUSIONS

Our findings suggest that wearing a facemask does not differentiate the gene expression of SARS-CoV-2 entry receptor following exercise among both sexes.

Effects of High-Intensity Exercise on Physiological Indicators of Recovery Period by Wearing Face Masks of Elite Athletes

Athletes need to maintain the necessary physical conditioning for sports performance while wearing face masks to reduce the risk of virus transmission during training and competition during the COVID-19 situation. The quantitative and physiological effects of face masks on exercise capacity needs to be reported. The purpose of this study was to evaluate elite athletes to quantify, in detail, the effect of a KF94 face mask on changes in lactic acid during recovery after high-intensity aerobic exercise. Thirteen elite soft tennis athletes were recruited. A crossover design was used to examine the effects of using a disposable KF94 face mask compared with not masking during exercise. The participants completed a shuttle run test experiment two times during a 3-day period, including 5−10 min of warmup according to their personal preferences. The lactic acid concentration at 20 min of recovery after maximum exercise was 5.98 ± 1.53 mM/L without a mask and 7.61 ± 1.85 mM/L with a KF94 mask (p < 0.001). The maximum laps of shuttle run tests were 101.5 ± 22.5 laps without a mask and 94.2 ± 20.2 laps with a KF94 mask (p < 0.001). Intense exercise after wearing quarantine masks reduces the maximum aerobic exercise ability and decreases the ability to recover lactic acid.

Effects of Wearing a Mask During Exercise on Physiological and Psychological Outcomes in Healthy Individuals: A Systematic Review and Meta-Analysis

BACKGROUND

Wearing face masks in public is an effective strategy for preventing the spread of viruses; however, it may negatively affect exercise responses. Therefore, this review aimed to explore the effects of wearing different types of face masks during exercise on various physiological and psychological outcomes in healthy individuals.

METHODS

A literature search was conducted using relevant electronic databases, including Medline, PubMed, Embase, SPORTDiscus, Web of Science, and Cochrane Central Register of Controlled Trials on April 05, 2022. Studies examining the effect of mask wearing (surgical mask, cloth mask, and FFP2/N95 respirator) during exercise on various physiological and psychological parameters in apparently healthy individuals were included. For meta-analysis, a random effects model was used. Mean difference (MD) or standardized MD (SMD) with 95% confidence intervals (CI) were calculated to analyze the total effect and the effect in subgroups classified based on face mask and exercise types. The quality of included studies was examined using the revised Cochrane risk-of-bias tool.

RESULTS

Forty-five studies with 1264 participants (708 men) were included in the systematic review. Face masks had significant effects on gas exchange when worn during exercise; this included differences in oxygen uptake (SMD - 0.66, 95% CI - 0.87 to - 0.45), end-tidal partial pressure of oxygen (MD - 3.79 mmHg, 95% CI - 5.46 to - 2.12), carbon dioxide production (SMD - 0.77, 95% CI - 1.15 to - 0.39), and end-tidal partial pressure of carbon dioxide (MD 2.93 mmHg, 95% CI 2.01-3.86). While oxygen saturation (MD - 0.48%, 95% CI - 0.71 to - 0.26) decreased slightly, heart rate was not affected. Mask wearing led to higher degrees of rating of perceived exertion, dyspnea, fatigue, and thermal sensation. Moreover, a small effect on exercise performance was observed in individuals wearing FFP2/N95 respirators (SMD - 0.42, 95% CI - 0.76 to - 0.08) and total effect (SMD - 0.23, 95% CI - 0.41 to - 0.04).

CONCLUSION

Wearing face masks during exercise modestly affected both physiological and psychological parameters, including gas exchange, pulmonary function, and subjective discomfort in healthy individuals, although the overall effect on exercise performance appeared to be small. This review provides updated information on optimizing exercise recommendations for the public during the COVID-19 pandemic.

SYSTEMATIC REVIEW REGISTRATION NUMBER

This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42021287278).

A Cloth Facemask Causes No Major Respiratory or Cardiovascular Perturbations During Moderate to Heavy Exercise

PURPOSE

Investigate whether a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in untrained individuals.

METHODS

Healthy participants (n = 35; 17 men, age 30 [4] y, and 18 women, age 28 [5] y) underwent a progressive square wave test at 4 intensities: (1) 80% of ventilatory anaerobic threshold; (2) ventilatory anaerobic threshold; (3) respiratory compensation point; and (4) exercise peak (Peak) to exhaustion, 5-minute stages, with or without a triple-layered cloth facemask (Mask or No-Mask). Several physiological and perceptual measures were analyzed.

RESULTS

Mask reduced inspiratory capacity at all exercise intensities (P < .0001). Mask reduced respiratory frequency (P = .001) at Peak (-8.3 breaths·min-1; 95% confidence interval [CI], -5.8 to -10.8), respiratory compensation point (-6.9 breaths·min-1; 95% CI, -4.6 to -9.2), and ventilatory anaerobic threshold (-6.5 breaths·min-1; 95% CI, -4.1 to -8.8), but not at Baseline or 80% of ventilatory anaerobic threshold. Mask reduced tidal volume (P < .0001) only at respiratory compensation point (-0.5 L; 95% CI, -0.3 to -0.6) and Peak (-0.8 L; 95% CI, -0.6 to -0.9). Shallow breathing index was increased with Mask only at Peak (11.3; 95% CI, 7.5 to 15.1). Mask did not change HR, lactate, ratings of perceived exertion, blood pressure, or oxygen saturation.

CONCLUSIONS

A cloth facemask reduced time to exhaustion but had no major impact on cardiorespiratory parameters and had a slight but clinically meaningless impact on respiratory variables at higher intensities. Moderate to heavy activity is safe and tolerable for healthy individuals while wearing a cloth facemask.

CLINICALTRIALS

gov: NCT04887714.

The influence of N95 and FFP2 masks on cardiorespiratory variables in healthy individuals during aerobic exercise: a systematic review and meta-analysis

OBJECTIVE

In view of the current COVID-19 pandemic, the objective of this study was to determine, through a systematic review and meta-analysis, whether the use of N95/FFP2 masks during aerobic exercise has a significant impact on HR, RR, SpO2, and blood pressure (BP) in healthy individuals.

METHODS

We searched the MEDLINE database for studies published in English between 2005 and 2021. To reduce bias and increase reliability, only randomized controlled trials and randomized crossover clinical trials were considered for inclusion. The selected outcomes included HR, RR, SpO2, and BP, with perceived exertion being evaluated by means of the Borg scale.

RESULTS

Eight controlled trials were included in the meta-analysis. Seven evaluated HR (p > 0.05), five evaluated RR (p > 0.05), five evaluated SpO2 and BP (p > 0.05 for both), and six evaluated perceived exertion, presenting controversial results such as risk ratios that were grouped for each variable.

CONCLUSIONS

This study suggests that N95 and FFP2 masks do not have significant effects on HR, RR, SpO2, and BP during aerobic exercise in healthy individuals.

Performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask

OBJECTIVE

To investigate if a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in healthy young individuals.

METHODS

Nine participants (sex, female/male: 6/3; age: 13±1 years; VO2peak: 44.5±5.5 mL/kg/min) underwent a progressive square-wave test at four intensities: (1) 80% of ventilatory anaerobic threshold (VAT), (2) VAT, and (3) 40% between VAT and [Formula: see text] wearing a triple-layered cloth facemask or not. Participants then completed a final stage to exhaustion at a running speed equivalent to the maximum achieved during the cardio-respiratory exercise test (Peak). Physiological, metabolic, and perceptual measures were measured.

RESULTS

Mask did not affect spirometry (forced vital capacity, peak expiratory flow, forced expiratory volume; all p≥0.27), respiratory (inspiratory capacity, end-expiratory volume [EELV] to functional vital capacity ratio, EELV, respiratory frequency [Rf], tidal volume [VT], Rf/VT, end-tidal carbo dioxide pressure, ventilatory equivalent to carbon dioxide ratio; all p≥0.196), hemodynamic (heart rate, systolic and diastolic blood pressure; all p>0.41), ratings of perceived exertion (p = 0.04) or metabolic measures (lactate; p = 0.78) at rest or at any exercise intensity.

CONCLUSIONS

This study shows that performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04887714.

The effect of surgical masks on vital signs and EtCO2 in patients on oxygen therapy

BACKGROUND

There are conflicting data on the effects of masks on vital signs and end-tidal CO₂ (EtCO₂) values in the literature.

AIMS

This study aims to evaluate the changes in the vital parameters and EtCO₂ values of the patients who were administered oxygen through nasal cannula (NC) and simple oxygen mask (SOM) and wore surgical masks (SM) on top during their treatment.

METHODS

The prospective, observational study was conducted from January 2021, over consecutive 30 days, in the emergency department of a tertiary-care university hospital. The vital signs and EtCO₂ values of the subjects administered O₂ were noted at the time of arrival and at the 30th and 120th minutes of treatment. Changes in vital signs and EtCO₂ values were compared with regard to NC-SM and SOM-SM applications over a 120-min study period.

RESULTS

Sixty-eight subjects were included in two groups (NC-SM [n = 49] and SOM-SM [n = 19]). At the 120th minute, a decrease in systolic and diastolic blood pressure, heart rate, and respiratory rate and an increase in oxygen saturation were observed in the group including all subjects. After decreasing slightly in the first 30 min, the EtCO₂ value remained stable.

CONCLUSIONS

NC-SM and SOM-SM applications do not affect adversely, and even seem to lead to recovery of, the vital signs and EtCO₂ values during 120 min in subjects with acute complaints.

Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations

In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO₂, SpO₂^, PaO₂ increased ETCO₂, PaCO₂), psychiatric symptoms (panic attacks, anxiety) and skin reactions. These complications are related to the duration of use and/or disease severity. Difficulties in communication is another issue to be considered especially with young children, older person and people with hearing impairments. Even if benefits of wearing face masks exceed the discomfort, it is recommended to take an "air break" after 1-2 h consecutively of mask-wearing. However, well-designed prospective studies are needed. The COVID-19 pandemic could represent a unique opportunity for collecting large amount of real-world data.

The effects of cloth face masks on cardiorespiratory responses and VO2 during maximal incremental running protocol among apparently healthy men

We aimed to determine the effects of wearing a cloth face mask on cardiorespiratory response, peak oxygen uptake (Vo₂), respiratory muscle effort, and exercise tolerance during incremental exercise. The study had a randomized crossover design: 11 apparently healthy young men performed the Bruce protocol treadmill test in two conditions, wearing a cloth face mask (CFM) and without CFM (CON), in random order. Minute ventilation and oxygen uptake were measured using a mass spectrometry metabolic analyzer; cardiac output (CO) was measured using an impedance CO monitor; and mouth pressure (P_m) was measured and calculated as an integral P_m to assess respiratory muscle effort. Maximal minute ventilation was 13.4 ± 10.7% lower in the CFM condition than in the CON condition (P < 0.001). The peak Vo₂ (52.4 ± 5.6 and 55.0 ± 5.1 mL/kg/min in CFM and CON, respectively) and CO were not significantly different between the two conditions. However, the integral value of P_m was significantly higher (P = 0.02), and the running time to exhaustion was 2.6 ± 3.2% lower (P = 0.02) in the CFM condition than in the CON condition. Our results suggest that wearing a cloth face mask increased respiratory muscle effort and decreased ventilatory volume in healthy young men; however, Vo₂ remained unchanged. Exercise tolerance also decreased slightly.

Face Mask in COVID-19 and Its Association With Dry Eye Disease: A Cross-Sectional Study

AIM

To determine whether wearing a face mask for more than three to six hours/day leads to the new onset of symptoms or worsening of pre-existing dry eye disease (DED) in healthcare workers (HCWs) of our institute.

METHODOLOGY

An observational cross-sectional study, where 114 HCWs using face masks regularly participated voluntarily in the study. A survey with a modified Ocular Surface Disease Index (OSDI) questionnaire was completed by participants. They were divided into groups based on their sex, age, how long they had been wearing face masks, and whether they had a history of DED.

RESULTS

We found that for HCWs who had previously experienced DED and who were under the age of 40, wearing a face mask for more than three to six hours/day could contribute to or worsen symptoms of DED. Also, we observed that the N-95 mask has a higher chance of causing DED than surgical masks.

CONCLUSION

Medical professionals need to be aware of any potential dry eye symptoms related to the prolonged use of a face mask. Additional consideration should be given to patients who already have DED. The possible concerns that incorrectly fitted facemasks may cause to the health of their ocular surface should be discussed with patients by ophthalmologists. Future research involving larger populations will shed light on the prevalence and scope of the mask-associated dry eye problem.

Impacts of surgical mask wearing on cardiopulmonary fitness using a six-minute walk test among older adults with hypertension

Background

This study aims to investigate the impacts of surgical mask wearing on cardiopulmonary fitness using a six-minute walk test (6MWT) among older adults with hypertension.

Methods

The 45 older adults with hypertension volunteers were recruited and randomized into a no mask wearing condition and a surgical mask wearing condition. All volunteers were investigated through submaximal exercise testing using a 6MWT. Cardiopulmonary parameters were measured before and after performing a 6MWT.

Results

The results indicate post performance on the 6MWT for both the with and without surgical mask conditions significantly increased systolic blood pressure, heart rate, respiratory rate, and oxygen saturation (SpO₂) when compared to before performing a 6MWT. However, surgical masks resulted in no differences to systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, SpO₂, and 6MWT distance when compared to no masks. In contrast, the surgical mask condition significantly increased perceived exertion when compared with the no mask condition (p < 0.05).

Conclusion

This study indicates that surgical masks did not have an impact on cardiopulmonary fitness in older adults with hypertension.

Effect of Face Masks on Physiological and Perceptual Responses during 30 Minutes of Self-Paced Exercise in Older Community Dwelling Adults

This study examined the effects of different types of masks (no mask, surgical mask (SM), and N95-mask) on physiological and perceptual responses during 30-min of self-paced cycle ergometer exercise. This study was a prospective randomly assigned experimental design. Outcomes included workload (Watts), oxygen saturation (SpO₂), end-tidal carbon dioxide (PetCO₂), heart rate (HR), respiratory rate (RR), rating of perceived exertion (RPE), and rating of perceived dyspnea (RPD). Volunteers (54-83 years (n = 19)) completed two familiarization sessions and three testing sessions on an air braked cycle ergometer. No significant difference was found for condition x time for any of the dependent variables. RPE, RPD, and PetCO₂ were significantly higher with an N95-mask vs. no mask (NM) ((p = 0.012), (p = 0.002), (p < 0.001)). HR was significantly higher with the SM compared to the NM condition (p = 0.027) (NM 107.18 ± 9.96) (SM 112.34 ± 10.28), but no significant difference was found when comparing the SM to the N95 condition or when comparing the N95condition to the NM condition. Watts increased across time in each condition (p = 0.003). Initially RR increased during the first 3 min of exercise (p < 0.001) with an overall gradual increase noted across time regardless of mask condition (p < 0.001). SpO₂ significantly decreased across time but remained within normal limits (>95%). No significant difference was found in Watts, RR, or SpO₂ regardless of mask condition. Overall, the N95mask was associated with increased RPE, RPD, and PetCO₂ levels. This suggests trapping of CO₂ inside the mask leading to increased RPE and RPD.

Acute Effects of Facial Coverings on Anaerobic Exercise Performance in College-Aged Adults

The use of facial coverings has been amplified during the COVID-19 pandemic as a means to minimize the spread of disease. However, facial coverings may impede ventilation during high-intensity activity, leading to a reduction in cardiopulmonary exercise capacity. Thus, the purpose of this study was to determine the acute impact of different facial coverings on exercise performance in college-aged individuals during a 300-yard shuttle. It was hypothesized that the lowest heart rate (HR), completion time (CT), and rate of perceived exertion (RPE) would occur with no mask. Furthermore, it was hypothesized the SHEMA97 mask would have lower HR, CT, and RPE compared to surgical and fabric masks. Results showed the use of the fabric mask resulted in significantly higher HR compared to no mask (p = 0.006). The SHEMA97 mask resulted in faster CT and lower RPE compared to both the fabric and surgical masks (p < 0.001). All mask conditions yielded significantly higher levels of perceived discomfort than wearing no mask (p < 0.05). While the use of facial coverings can help prevent the spread of disease, their use during exercise may pose limitations to performance; however, the ability of the SHEMA97 to provide minimal changes to CT and RPE provides a promising option.

Aerobic Performance Detriments while Wearing a Face Mask Diverge Among Males and Females

The current study examined the impact of wearing a face mask (FM) at rest and while exercising on cardiorespiratory variables and aerobic performance between males and females. Nine males (21.4 ± 0.5 yr) and 9 females (21.8 ± 3.6 yr) performed a pulmonary function test and a graded maximal exercise test (GXT) on a treadmill with an FM and without an FM in random order. During the GXT, cardiorespiratory variables were measured at different exercise intensities (rest, 40%, 55%, 70%, 80%, 100% of VO₂max) and during recovery. Regardless of sex, both males and females significantly (p = .01) reduced their resting pulmonary functions, including forced vital capacity (18.7% and 19.6%, respectively), forced expiratory volume in one second (43.9% and 45.7%, respectively), and peak expiratory flow (85.2% and 87.5%, respectively) with an FM. During the GXT, both VO₂ and ventilation (VE) in males were significantly (p < .01) lower with an FM only at 100% of VO₂max, while females showed a significantly (p < .01) lower VO₂, VE, and tidal volume (V_t) with an FM throughout the entire GXT. The partial pressure of exhaled CO₂ was significantly (p = .02) higher at 100% of VO₂max with an FM only in males. Although wearing an FM reduced resting pulmonary functions and the maximal aerobic performance for both males and females, there was a clear sex-specific response during the GXT, indicating that females were less capable to adapt to the pulmonary obstruction induced by wearing an FM.

Acute Effects of Wearing Different Surgical Face Masks during High-Intensity, Short-Rest Resistance Exercise on Cardiorespiratory and Pulmonary Function and Perceptual Responses in Weightlifters

This study investigated the effect of wearing a typical surgical mask (SM) or a three-dimensional (3D) SM (3DSM) during whole-body, high-intensity, short-rest resistance exercise on cardiorespiratory, respiratory, and perceptual comfort responses in weightlifters. Twenty elite weightlifters (6 women and 14 men; age = 24.1 ± 4.9 years; height: 167.45 ± 7.60 cm; body mass = 76.48 ± 19.86 kg) who participated in this study performed 3 resistance exercise sessions in a randomized order: (1) without a mask (NM), (2) while wearing a typical SM, and (3) while wearing a 3DSM. Resistance exercise consisted of a descending pyramid scheme starting at 10 repetitions, with a decrease of one repetition per set for the back squat, bench press, and deadlift, as fast as possible at 75% of the one-repetition maximum. Cardiorespiratory and pulmonary function and comfort were measured. Across all conditions, effective postexercise hypotension (PEH) was noted in terms of decreased systolic blood pressure (−4.64%), diastolic BP (−5.36%), mean arterial pressure (−5.02%), and ankle–brachial index (−6.84%). However, the heart rate (40.34%) and rate of pressure product (33.60%) increased, and no effects on pulmonary function were observed in the three conditions. The participants reported higher breathing resistance and tightness when wearing a typical SM than when wearing a 3DSM or no mask. Therefore, both wearing and not wearing a face mask during whole-body, high-intensity, short-rest resistance exercise promoted PEH and exerted no detrimental effect on pulmonary function. Coaches, trainers, and athletes should consider wearing a 3DSM during resistance exercise.

Blood gas levels, cardiovascular strain and cognitive performance during surgical mask and filtering face piece application

Mask induced airway resistance and carbon dioxide rebreathing is discussed to impact gas exchange and to induce discomfort and impairments in cognitive performance. N = 23 healthy humans (13 females, 10 males; 23.5 ± 2.1 years) participated in this randomized crossover trial (3 arms, 48-h washout periods). During interventions participants wore either a surgical face mask (SM), a filtering face piece (FFP2) or no mask (NM). Interventions included a 20-min siting period and 20 min steady state cycling on an ergometer at 77% of the maximal heart rate (HR). Hemodynamic data (HR, blood pressure), metabolic outcomes (pulse derived oxygen saturation, capillary carbon dioxide (pCO₂), and oxygen partial pressure (pO₂), lactate, pH, base excess), subjective response (ability to concentrate, arousal, perceived exertion) and cognitive performance (Stroop Test) were assessed. Compared to NM, both masks increased pCO₂ (NM 31.9 ± 3.3 mmHg, SM = 35.2 ± 4.0 mmHg, FFP2 = 34.5 ± 3.8 mmHg, F = 12.670, p < 0.001) and decreased pH (NM = 7.42 ± 0.03, SM = 7.39 ± 0.03, FFP2 = 7.39 ± 0.04, F = 11.4, p < 0.001) during exercise. The FFP2 increased blood pressure during exercise (NM = 158 ± 15 mmHg, SM = 159 ± 16 mmHg, FFP2 = 162 ± 17 mmHg, F = 3.21, p = 0.050), the SM increased HR during sitting (NM = 70 ± 8 bpm, SM = 74 ± 8 bpm, FFP2 = 73 ± 8 bpm, F = 4.70, p = 0.014). No mask showed any comparative effect on other hemodynamic, metabolic, subjective, or cognitive outcomes. Mask wearing leads to slightly increased cardiovascular stress and elevated carbon dioxide levels during exercise but did not affect cognitive performance or wellbeing.

Effects of Wearing Face Masks on Cardiorespiratory Parameters at Rest and after Performing the Six-Minute Walk Test in Older Adults

The effects of wearing cloth masks and surgical masks were investigated on respiratory rate, heart rate, blood pressure, oxygen saturation and perceived exertion at rest and after performing a six-minute walk test (6MWT) in older adults. Forty older adults were recruited and randomized into six groups including wearing no mask, cloth masks and surgical masks, at rest and during the 6MWT. At rest, all subjects sat quietly wearing no mask, a cloth mask or a surgical mask. All subjects performed a 6MWT by walking as fast as possible without running while wearing no mask, a cloth mask or a surgical mask. Respiratory rate, heart rate, blood pressure, oxygen saturation and perceived exertion were assessed before and after the rest and the 6MWT. Results showed that cloth masks and surgical masks did not impact cardiorespiratory parameters at rest or after performing a 6MWT, while an increase in perceived exertion was apparent in the groups wearing surgical masks and cloth masks after performing the 6MWT (p < 0.01). Cloth masks and surgical masks did not have an impact on cardiorespiratory fitness at rest and after performing the 6MWT in older adults.

Does wearing a mask while exercising amid COVID-19 pandemic affect hemodynamic and hematologic function among healthy individuals? Implications of mask modality, sex, and exercise intensity

OBJECTIVES

We investigated how wearing a mask - and its modality (surgical vs. N95) - affect hemodynamic and hematologic function in males and females across two exercise intensities (submaximal (SUB) and maximal (MAX)).

METHODS

144 individuals participated in the present study and were randomly allocated to three mask groups of 48 (N95, SURGICAL, and NO MASK) with two exercise subgroups for each mask group (MAX, n = 24; SUB, n = 24) for both sexes. Participants in each experimental group (N95SUB, N95MAX; SURSUB, SURMAX; SUB, MAX) were assessed for their hemodynamic and hematologic function at baseline and during recovery after exercise.

RESULTS

No significant differences were noted for either hemodynamic or hematologic function at post-exercise as compared to baseline with regard to mask modality (P > 0.05). Heart rate (HR) for maximal intensity were significantly greater at 1 min post-exercise in N95 as compared to SURGICAL (P < 0.05). No differences were noted for hemodynamic and hematologic function with N95 and SURGICAL compared to NOMASK for either intensity (P > 0.05). Females showed significantly greater HR values at 1 min post-exercise in N95 as compared to NO MASK, but no significant differences were noted for hematological function between sexes (P > 0.05).

CONCLUSION

Our findings show that wearing a face mask (N95/surgical) while exercising has no detrimental effects on hemodynamic/hematologic function in both males and females, and suggest that wearing a mask, particularly a surgical mask, while exercising during the ongoing pandemic is safe and poses no risk to individual's health. Future studies examining physiological responses to chronic exercise with masks are warranted.

Facemask wearing does not impact neuro-electrical brain activity

Given the massive use of facemasks (FMs) during the covid-19 pandemic, concerns have been raised regarding the effect of FMs wearing on overall health. This study aimed at evaluating the effect of surgical FM on brain neuro-electrical activity. Electroencephalography (EEG) background frequency (BGF) and background amplitude (BGA) was performed on 30 volunteers before (baseline), during and after wearing a FM for 60 min. Measurements were done during normal ventilation, hyperventilation and post-hyperventilation (PHVR). Blood gas levels were assessed at baseline and after FM use. EEG analysis concerning baseline (without FM) (BGA), was 47.69 ± 18.60 µV, wearing FM, BGA was 48.45 ± 17.79 µV, post FM use BGA was 48.08 ± 18.30 µV. There were no statistically significant differences between baseline BGA and BGA under FM and post FM. BGF, Baseline data were 10.27 ± 0.79, FM use 10.30 ± 0.76 and post FM use was 10.33 ± 0.76. There were no statistically significant differences between baseline BGF and BGF under FM and post FM. Venous blood gases, and peripheral oxygen saturation were not significantly affected by FM use. Short-term use of FM in young healthy individuals has no significant alteration impact on brain's neuro-electrical activity

The Cardiopulmonary Effects of Medical Masks and Filtering Facepiece Respirators on Healthy Health Care Workers in the Emergency Department: A Prospective Cohort Study

Background

International COVID-19 guidelines recommend that health care workers (HCWs) wear filtering facepiece (FFP) respirators to reduce exposure risk. However, there are concerns about FFP respirators causing hypercapnia via rebreathing carbon dioxide (CO₂). Most previous studies measured the physiological effects of FFP respirators on treadmills or while resting, and such measurements may not reflect the physiological changes of HCWs working in the emergency department (ED).

Objective

Our aim was to evaluate the physiological and clinical impacts of FFP type II (FFP2) respirators on HCWs during 2 h of their day shift in the ED.

Methods

We included emergency HCWs in this prospective cohort study. We measured end-tidal CO₂ (ETCO₂), mean arterial pressure (MAP), respiratory rate (RR), and heart rate values and dyspnea scores of subjects at two time points. The first measurements were carried out with medical masks while resting. Subjects then began their day shift in the ED with medical mask plus FFP2 respirator. We called subjects after 2 h for the second measurement.

Results

The median age of 153 healthy volunteers was 24.0 years (interquartile range 24.0–25.0 years). Subjects’ MAP, RR, and ETCO₂ values and dyspnea scores were significantly higher after 2 h. Median ETCO₂ values increased from 36.4 to 38.8 mm Hg. None of the subjects had hypercapnia symptoms, hypoxia, or other adverse effects.

Conclusion

We did not observe any clinical reflection of these changes in physiological values. Thus, we evaluated these changes to be clinically insignificant. We found that it is safe for healthy HCWs to wear medical masks plus FFP2 respirators during a 2-h working shift in the ED.

Impact of surgical mask on performance and cardiorespiratory responses to submaximal exercise in COVID-19 patients near hospital discharge: A randomized crossover trial

Background

Wearing a surgical mask in hospitalized patients has become recommended during care, including rehabilitation, to mitigate coronavirus disease 2019 (COVID-19) transmission. However, the mask may increase dyspnoea and raise concerns in promoting rehabilitation activities in post-acute COVID-19 patients.

Objective

To evaluate the impact of the surgical mask on dyspnoea, exercise performance and cardiorespiratory response during a 1-min sit-to-stand test in hospitalized COVID-19 patients close to discharge.

Methods

COVID-19 patients whose hospital discharge has been planned the following day performed in randomized order two sit-to-stand tests with or without a surgical mask. Outcome measures were recorded before, at the end, and after two minutes of recovery of each test. Dyspnoea (modified Borg scale), cardiorespiratory parameters and sit-to-stand repetitions were measured.

Results

Twenty-eight patients aged 52 ± 10 years were recruited. Compared to unmasked condition, dyspnoea was significantly higher with the mask before and at the end of the sit-to-stand test (mean difference[95%CI]: 1.0 [0.6, 1.4] and 1.7 [0.8, 2.6], respectively). The difference was not significant after the recovery period. The mask had no impact on cardiorespiratory parameters nor the number of sit-to-stand repetitions.

Conclusion

In post-acute COVID-19 patients near hospital discharge, the surgical mask increased dyspnoea at rest and during a submaximal exercise test but had no impact on cardiorespiratory response or exercise performance. Patients recovering from COVID-19 should be reassured that wearing a surgical facemask during physical or rehabilitation activities is safe. These data may also mitigate fears to refer these patients in rehabilitation centres where mask-wearing has become mandatory.

Wearing a surgical mask: effects on gas exchange and hemodynamic responses during maximal exercise

The importance of using masks during exercise has increased since the coronavirus disease‐2019 (COVID‐19). This study aimed to investigate the effects of using surgical masks on gas exchange and exercise responses in maximal exercise. Twenty‐six participants were included. Participants performed the maximal exercise tests twice, masked, and unmasked. Gas exchange parameters (at maximal exercise and anaerobic threshold [AT]) and hemodynamic responses were measured. In the hemodynamic responses measured at rest, only the saturation of peripheral oxygen (SpO₂) was lower in the masked (mean: 97.23 ± 1.33%) measurement than in the unmasked (mean: 97.96 ± 1.07%) measurement (p = 0.006). Test duration was lower in the masked test (unmasked: 10.32 ± 1.36 min vs. masked: 10.03 ± 1.42 min, p = 0.030). Peak oxygen consumption (VO_2peak) (unmasked: 31.23 ± 5.37 vs. masked: 27.03 ± 6.46 ml/kg/min), minute ventilation (V_E) l/min, and energy expenditure (EE) kcal/hour were higher in unmasked tests (p < 0.001). There was no difference in the gas exchange parameters measured at the AT in the masked and unmasked tests (p > 0.05). Respiratory gas exchange parameters were affected in peak exercise due to increased respiratory workload, but not at the AT. There was no change in hemodynamic responses because vascular control may not be affected by mask usage.

Physiological Effects of Exercising at Different Intensities Wearing Surgical or Double-layer Cotton Facemasks Compared to Not Wearing a Mask

Since the beginning of the SARS-CoV-2 pandemic, the community use of facemasks has been widely recommended. However, their use during exercise has raised safety concerns. Thus, we compared the physiological differences between exercising wearing a surgical (SM) or a double-layer-cotton (DLC) facemask and not wearing a mask (NM). Sixteen volunteers underwent 4 bouts of cycling-based exercise, which consisted of two different intensities: light-to-moderate and moderate-to-high. Facemasks were used as follows: bout-1 and 4: NM; bout-2: SM or DLC and bout-3: DLC or SM. Ventilatory, metabolic, pulmonary gas exchange (PGE) and perceptual variables were collected. At both exercise intensities compared to NM, both facemasks induced similar ventilatory adaptations, increasing inspiratory time and tidal volume and decreasing breathing frequency. Effect sizes (ES) were larger for DLC than for SM. At moderate-to-high, both facemasks reduced the minute ventilation, whereas at light-to-moderate, it was only seen with DLC. End tidal and mixed CO₂ pressures, as well as the difference between them, increased with both facemasks. Again, ES was larger for DLC than SM. No relevant oxygen saturation drop was observed with both facemaks and exercise intensities. A small ES increament in VO₂ and VCO₂ were seen with both facemasks. Effort perception increased at moderate-to-high for both exercise intensities, buth larger EF were with DLC than SM . DLC increased facial temperature during both exercise intensities. In conclusion, ventilatory adjustments imposed during facemask exercise influenced PGE and metabolic and perceptual changes. Larger ES were mostly seen for DLC than SM.Novelty Bullets Facemasks affect the breathing pattern by changing the frequency and amplitude of pulmonary ventilation.The augmented ventilatory work increases VO2, VCO2, and RPE and promotes nonconcerning drops in SpO2 and CO2 retention.Increased inspiratory and expiratory pressure can account for the reduction in pulmonary physiological dead space.

Bayesian network meta-analysis of face masks' impact on human physiology

Several concerns regarding the safety of face masks use have been propounded in public opinion. The objective of this review is to examine if these concerns find support in the literature by providing a comprehensive overview of physiological responses to the use of face masks. We have performed a systematic review, pairwise and network meta-analyses to investigate physiological responses to the use of face masks. The study has been registered with PROSPERO (C RD42020224791). Obtained results were screened using our exclusion and inclusion criteria. Meta-analyses were performed using the GeMTC and meta R packages. We have identified 26 studies meeting our inclusion and exclusion criteria, encompassing 751 participants. The use of face masks was not associated with significant changes in pulsoxymetrically measured oxygen saturation, even during maximal-effort exercises. The only significant physiological responses to the use of face masks during low-intensity activities were a slight increase in heart rate, mildly elevated partial pressure of carbon dioxide (not meeting criteria for hypercarbia), increased temperature of facial skin covered by the mask, and subsequent increase of the score in the rating of heat perception, with N95 filtering facepiece respirators having a greater effect than surgical masks. In high-intensity conditions, the use of face masks was associated with decreased oxygen uptake, ventilation, and RR. Face masks are safe to use and do not cause significant alterations in human physiology. The increase in heart rate stems most likely from increased respiratory work required to overcome breathing resistance. The increase in carbon dioxide is too small to be clinically relevant. An increased rating of heat perception when using face masks results from higher temperature of facial skin covered by the mask.

Breathability performance of antiviral cloth masks treated with silver nanoparticles for protection against COVID-19

The global widespread of coronavirus disease 2019 (COVID-19) has caused shortage of medical face masks and led to developing of various types of cloth masks with different levels of protection and comfort to meet the market demands. Breathing comfort is a significant aspect that should be considered during the design of cloth masks along with the filtration efficiency; otherwise, the wearer will feel suffocated. In this work, different types of cotton and polyester knitted fabrics blended with spandex yarns were produced and treated with silver nanoparticles to be used as antiviral cloth masks. Scanning electron microscope, transmission electron microscope, and EDX were used to characterize the silver nanoparticles (AgNPs). Antiviral activity was assessed against SARS-CoV-2 coronavirus as well. The influence of using different fabric materials, number of layers, and hybrid layers on their air permeability and breathability were investigated to evaluate the comfortability of the cloth masks. Physiological impacts of wearing the cloth masks were evaluated by measuring oxygen saturation of hemoglobin and heart rate of the wearers while doing various activities. The results indicated that AgNPs have low cytotoxicity and considerable efficiency in inhibition of SARS-CoV-2. Adding spandex yarns with different count and ratios reduced the porosity and air permeability of the fabrics. Moreover, the combination of three hybrid layers' mask made of polyester fabric in the outer layer with 100% cotton fabric in the inner layer showed high comfortability associated with high air permeability and breathability. Also, wearing these masks while doing activities showed no significant effect on blood oxygen saturation and heart rate of the wearers.

Effect of wearing different types of face masks during dynamic and isometric resistance training on intraocular pressure

CLINICAL RELEVANCE

The use of face masks has demonstrated to be an effective strategy to prevent transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Wearing face masks, mainly Filtering Face Piece 2 (FFP2) masks, during exercise practice has demonstrated to affect several physiological measures.

BACKGROUND

This study was aimed at assessing the intraocular pressure (IOP) behaviour during the execution of the dynamic and isometric biceps-curl exercise with a surgical and FFP2 face mask.

METHODS

Twenty two physically active young adults performed sets of 10 repetitions against the 10-RM (repetition maximum) load and 1-minute isometric effort against a load 15% lower than the 10-RM load with the FFP2 and surgical mask and without any mask. A total of six exercise sets (3 experimental conditions [FFP2, surgical and control] × 2 exercise modalities) were performed. A rebound tonometer was used to measure IOP before, during (10 measurements), and after (30-seconds of passive recovery) each training set.

RESULTS

At rest, there were not statistically significant IOP differences (p = 0.222). During dynamic exercise, there was a progressive IOP rise (p < 0.001), and a higher IOP response with the FFP2 than without the mask (corrected p-value = 0.003). For the isometric exercise, there was a greater IOP response as a function of accumulated effort (p < 0.001), which was dependent of the face mask used (FFP2> surgical>control; corrected p-values< 0.01).

CONCLUSIONS

The FFP2 masks cause a heightened IOP response during the execution of dynamic and isometric biceps-curl exercise, suggesting that, when possible, glaucoma patients should limit the use of FFP2 masks during resistance training.

Physiological Effects of Surgical and N95 Masks During Exercise in the Covid-19 Era

Background

During the COVID-19 pandemic, studies of the physiological effects of masking during exercise have been rare.

Methods

Twelve healthcare workers performed a cardiopulmonary exercise test while wearing a surgical mask, an N95 mask, or no mask. Variables were collected at rest, warm-up, anaerobic threshold, and maximal exercise.

Results

From rest to maximal exercise, both the surgical and N95 masks decreased inspiratory flow, minute ventilation, and prolonged inspiratory time compared to the no mask condition. Oxygen uptake (VO₂) and oxygen pulse (VO₂/HR) decreased at rest, warm-up, and maximal exercise in both the surgical and N95 mask conditions (vs. no mask). At the anaerobic threshold, the surgical mask also led to a reduction of oxygen uptake and oxygen pulse compared to no mask. The maximal oxygen uptake (VO₂% predicted) also decreased in both the surgical and N95 mask conditions. In addition, the severity of dyspnea increased, and exercise time decreased for both surgical and N95 masks. Compared to no mask, wearing an N95 mask led to lower breathing frequency and lower ventilation efficacy (assessed by VE/VCO₂ and VE/VO₂) from rest to maximal exercise (all p < 0.05 for trend). Wearing an N95 also led to retention of carbon dioxide (p < 0.05 for trend).

Conclusions

Wearing a surgical mask leads to a somewhat negative impact on cardiopulmonary function, and this effect is more serious with an N95 mask. Attention should be paid to exercise while wearing surgical or N95 masks.

Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO₂ and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO₂, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO₂ level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO₂ of -1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0-4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

The impact of FFP3 respirators on the blood saturation

This study aims to investigate whether wearing a filtering facepiece class 3 respirators with personal protective equipment (FPP3/PPE) during work in the intensive care unit (ICU) affects the blood saturation (SpO2), the heart rate (HR), and the well-being of health care workers (HCWs). This preliminary study included a group of 21 volunteers (including 16 females (76%), with a median age of 23 years). Each worker served as his own control and performed the test two times: they wore the FFP3/PPE and did not wear it for a three-hour shift in the ICU. The working with an FFP3/PPE compared to not working with an FFP3/PPE caused a significant, but within normal ranges, influence on the level of SpO2 with a mean decrease of - 1.43%. The highest reduction in the SpO2 was - 2.29% and occurred after 150 min of work. All of the score scales of the well-being markers increased consecutively but moderately during the shift while wearing the FFP3/PPE. We assume that a 3-h shift rhythm is a safe and reliable solution, i.e., three hours of working in the FFP3/PPE in the ICU, followed by rest or working without an FFP3/PPE.

Effects of wearing different facial masks on respiratory symptoms, oxygen saturation, and functional capacity during six-minute walk test in healthy subjects

BACKGROUND

During the current COVID-19 pandemic and increased air pollution levels, wearing a facial mask has been recommended. This study aimed to compare the impact of wearing different masks when performing a submaximal functional activity (six-minute walk test; 6MWT) on respiratory symptoms, oxygen saturation, and functional capacity.

METHODS

Twenty-nine subjects (10 men, 19 women; age 22 ± 1 yr.; FEV₁/FVC 0.90 ± 0.01) performed four rounds of 6MWT wearing different masks (surgical (Medima SK, Thailand), handmade cloth, and N95 (3M AuraTM 1870⁺, USA)) and while not wearing a mask. Respiratory symptoms (dyspnea and breathing effort), oxygen saturation, and other physiological parameters were assessed before and after each walking trial.

RESULTS

Six-minute walking distances were comparable between walking trials (P = 0.59). At the end of minute 6, a significant difference between groups was found on dyspnea (P = 0.02) and breathing effort (P < 0.001). Post hoc tests showed that wearing a cloth mask significantly increased dyspnea (P = 0.004) compared to wearing a surgical mask. Wearing a cloth mask also significantly increased breathing effort compared to wearing a surgical mask (P < 0.001) and not wearing a mask (P < 0.001). Likewise, while wearing an N95 mask, breathing effort significantly increased compared to wearing a surgical mask (P = 0.007) and not wearing a mask (P = 0.002).

CONCLUSIONS

Wearing different masks while performing submaximal functional activity results in no differences in functional performance, oxygen saturation, heart rate, or blood pressure. However, wearing cloth masks and N95 masks results in higher respiratory symptoms.

Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic

Introduction and objectives

During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training.

Methods

Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage.

Results

Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions.

Conclusions

Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.

Effect of Wearing Surgical Face Masks During Exercise: Does Intensity Matter?

Face masks are widely recommended as means of controlling the coronavirus disease outbreak. This study aimed to examine the physiological and perceptual responses of wearing surgical face masks while exercising at different intensities. Thirteen healthy young adults (mean age, 21.9 ± 1.4 years) conducted randomized crossover trials with or without a surgical face mask. In each trial, participants completed an incremental treadmill protocol, with three 6-min stages (light, moderate, and vigorous at 25, 50, and 75% maximal oxygen uptake, respectively). Physiological outcomes (heart rate, blood lactate, and oxygen saturation level), perceived exertion and discomfort feeling were assessed. No significant differences were observed in physiological outcomes with or without masks at different exercise intensities (p > 0.05). However, the rating of perceived exertion (RPE) was significantly higher when exercising vigorously (mask: 15.5 ± 1.5 vs. no-mask: 14.2 ± 2.1, p < 0.05). Participants wearing masks reported marked discomfort, such as feeling hot, humid, and breathing resistance. Although face mask-wearing during exercise may not have detrimental effects on major physiological parameters, it can increase perceived exertion level and discomfort when the exercise intensity exceeds a certain threshold. Therefore, healthcare professionals should cautiously evaluate each person’s ability to exercise while wearing a mask and tailor their prescription accordingly.

What do masks mask? A study on transdermal CO2 monitoring

Medical professionals have complained of extreme discomfort and fatigue from continuous wearing of N95 respirators (N95) overlaid with surgical masks (SM) and face shields (FS) during COVID-19 pandemic. However, there are no reports on the effect of face coverings on transdermal CO₂ (TrCO₂) levels (a measure of blood CO₂) during moderate activity. In this study, real-time monitoring of TrCO₂, heart rate and skin surface temperature was conducted for six subjects aged 20-59 years with and without wearing personal protective equipment (PPE). We initially studied the effect of wearing PPE (N95+SM+FS) at rest. Then, the effect of moderate stepping/walking activity (120 steps per minute for 60 min) while wearing PPE was evaluated. In addition, we investigated the effect of exercising intensity with different masks. We observed a significant difference (p < 0.0001) in TrCO₂ levels between without and with PPE during moderate exercise, but not while resting. TrCO₂ levels were correlated to exercise intensity independently with masking condition and breathability of masks. For the first time, we present data showing that a properly fitting N95 worn along with SM and FS consistently leads to elevated TrCO₂ under moderate exertion, which could contribute to fatigue over long-term use.

Effects of surgical masks on the responses to constant work-rate cycling performed at different intensity domains

We aimed at examining the impact of wearing surgical face masks on exercise performance. Thirty-two healthy adults (16 males and 16 females) completed a graded exercise test to measure peak oxygen uptake (VO_2peak ) and the ventilatory threshold (VT). Then, on separate days, all participants performed resting and standardized protocols (moderate intensity: 25% infra-VT; severe intensity: 25% supra-VT) on two different conditions (with and without a surgical mask). The use of masks reduced both VO₂ and minute ventilation during moderate and severe exercise (p < 0.0001), and this effect was particularly pronounced during severe exercise. Time to exhaustion was also shortened by ~10% on the face mask condition (p = 0.014). In contrast, neither heart rate nor the respiratory exchange ratio was affected by masking. The submaximal VO₂ was similar between the two epochs of analysis obtained during moderate cycling (i.e. 3-6 min vs. 7-10 min) and this occurred similarly between conditions. In conclusion, the impact of the surgical masks on exercise capacity is particularly pronounced during severe exercise performed at constant work rate. Ultimately, this may implicate a considerable impairment of structured or even unstructured strenuous physical activity. Clinical Trials registration number: NCT04963049.

Physical Activity in Polluted Air-Net Benefit or Harm to Cardiovascular Health? A Comprehensive Review

Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. In this context, the World Health Organization estimated 4.2 and 3.2 million global deaths per year in response to ambient air pollution and insufficient physical activity, respectively. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease. Thus, determining the tradeoff between the health benefits of physical activity and the potential harmful effects of increased exposure to air pollution during physical activity has important public health consequences. In the present comprehensive review, we analyzed evidence from human and animal studies on the combined effects of physical activity and air pollution on cardiovascular and other health outcomes. We further report on pathophysiological mechanisms underlying air pollution exposure, as well as the protective effects of physical activity with a focus on oxidative stress and inflammation. Lastly, we provide mitigation strategies and practical recommendations for physical activity in areas with polluted air.

Tent versus Mask-On Acute Effects during Repeated-Sprint Training in Normobaric Hypoxia and Normoxia

Repeated sprint in hypoxia (RSH) is used to improve supramaximal cycling capacity, but little is known about the potential differences between different systems for creating normobaric hypoxia, such as a chamber, tent, or mask. This study aimed to compare the environmental (carbon dioxide (CO₂) and wet-globe bulb temperature (WGBT)), perceptual (pain, respiratory difficulty, and rate of perceived exertion (RPE)), and external (peak and mean power output) and internal (peak heart rate (HRpeak), muscle oxygen saturation (SmO₂), arterial oxygen saturation (SpO₂), blood lactate and glucose) workload acute effects of an RSH session when performed inside a tent versus using a mask. Twelve well-trained cyclists (age = 29 ± 9.8 years, VO₂max = 70.3 ± 5.9 mL/kg/min) participated in this single-blind, randomized, crossover trial. Participants completed four sessions of three sets of five repetitions × 10 s:20 s (180 s rest between series) of all-out in different conditions: normoxia in a tent (RSNTent) and mask-on (RSNMask), and normobaric hypoxia in a tent (RSHTent) and mask-on (RSHMask). CO₂ and WGBT levels increased steadily in all conditions (p < 0.01) and were lower when using a mask (RSNMask and RSHMask) than when inside a tent (RSHTent and RSNTent) (p < 0.01). RSHTent presented lower SpO₂ than the other three conditions (p < 0.05), and hypoxic conditions presented lower SpO₂ than normoxic ones (p < 0.05). HRpeak, RPE, blood lactate, and blood glucose increased throughout the training, as expected. RSH could lead to acute conditions such as hypoxemia, which may be exacerbated when using a tent to simulate hypoxia compared to a mask-based system.

Wearing a Surgical Face Mask Has Minimal Effect on Performance and Physiological Measures during High-Intensity Exercise in Youth Ice-Hockey Players: A Randomized Cross-Over Trial

COVID-19 transmission is prevalent during ice-hockey; however, it is unknown whether wearing face masks as a mitigation strategy affects hockey players’ performance. We used a randomized cross-over study to compare wearing a surgical mask to a sham mask (control) in youth hockey players (21 males, 5 females, 11.7 ± 1.6 y) during a simulated hockey period (cycle ergometry; six shifts of 20 s of “easy” pedaling (40% peak power), 10 s of “hard” pedaling (95% peak power), 20 s of “easy” pedaling, with shifts separated by 5 min rests). A seventh shift involved two 20 s Wingate tests separated by 40 s rest. Heart rate, arterial oxygen saturation and vastus lateralis tissue oxygenation index (hemoglobin saturation/desaturation) was assessed each shift. On-ice testing was conducted with the maximal Yo-Yo intermittent recovery test. No differences between mask and control conditions for performance were found (Wingate average power: 245 ± 93 vs. 237 ± 93 W, Peak power: 314 ± 116 vs. 304 ± 115 W, on-ice distance: 274 ± 116 vs. 274 ± 110 m) and for heart rate or arterial oxygen saturation during simulated hockey shifts. Tissue oxygenation index was lower from shifts one to six for males (p < 0.05) and shift seven for females (p < 0.01) while wearing a mask. Wearing a face mask had no effect on performance in hockey players with only minor effects on muscle oxygenation. ClinicalTrials.gov (NCT04874766) (accessed on 6 May 2021).

Effect of Surgical Masks on Cardiopulmonary Function in Healthy Young Subjects: A Crossover Study

Objective: Mask plays an important role in preventing infectious respiratory diseases. The influence of wearing masks in physical exercise on the human body needs to be studied. The purpose of this study is to explore the influence of wearing surgical masks on the cardiopulmonary function of healthy people during exercise. Methods: The physiological responses of 71 healthy subjects (35 men and 36 women, age 27.77 ± 7.76 years) to exercises with and without surgical masks (mask-on and mask-off) were analyzed. Cardiopulmonary function and metabolic reaction were measured by the cardiopulmonary exercise test (CPET). All tests were carried out in random sequence and should be completed in 1 week. Results: The CPETs with the mask-on condition were performed undesirably (p < 0.05), and the Borg scale was higher than the mask-off (p < 0.001). Rest oxygen uptake ( V . O 2 ) and carbon dioxide production ( V . CO₂) with the mask-on condition were lower than mask-off (p < 0.01), which were more obvious at peak exercise ( V . O_{2 peak} : 1454.8 ± 418.9 vs. 1628.6 ± 447.2 ml/min, p < 0.001; V . CO_{2 peak} : 1873.0 ± 578.7 vs. 2169.9 ± 627.8 ml/min, p = 0.005), and the anaerobic threshold (AT) brought forward (p < 0.001). At different stages of CPET with the mask-on condition, inspiratory and expiratory time (Te) was longer (p < 0.05), and respiratory frequency (Rf) and minute ventilation ( V . _E ) were shorter than mask-off, especially at peak exercise (Rf _peak : 33.8 ± 7.98 vs. 37.91 ± 6.72 b/min, p < 0.001; V . _Epeak : 55.07 ± 17.28 vs. 66.46 ± 17.93 l/min, p < 0.001). V _T was significantly lower than mask-off just at peak exercise (1.66 ± 0.45 vs. 1.79 ± 0.5 l, p < 0.001). End-tidal oxygen partial pressure (PetO₂), end-tidal carbon dioxide partial pressure (PetCO₂), oxygen ventilation equivalent ( V . _E / V . O₂), and carbon dioxide ventilation equivalent ( V . _E / V . CO₂) with mask-on, which reflected pulmonary ventilation efficiency, were significantly different from mask-off at different stages of CPET (p < 0.05), but no significant difference in percutaneous oxygen saturation (SpO₂) was found. Differences in oxygen pulse ( V . O₂/HR), oxygen uptake efficiency slope (OUES), work efficiency (△ V . O₂/△W), peak heart rate (HR), and peak systolic blood pressure (BP) existed between two conditions (p < 0.05). Conclusion: Wearing surgical masks during aerobic exercise showed certain negative impacts on cardiopulmonary function, especially during high-intensity exercise in healthy young subjects. These results provide an important recommendation for wearing a mask at a pandemic during exercises of varying intensity. Future research should focus on the response of wearing masks in patients with related cardiopulmonary diseases.

Effect of Different Types of Face Masks on the Ventilatory and Cardiovascular Response to Maximal-Intensity Exercise

The development of new models of face masks makes it necessary to compare their impact on exercise. Therefore, the aim of this work was to compare the cardiopulmonary response to a maximal incremental test, perceived ventilation, exertion, and comfort using FFP2 or Emotion masks in young female athletes. Thirteen healthy sportswomen (22.08 ± 1.75 years) performed a spirometry, and a graded exercise test on a treadmill, with a JAEGER^® Vyntus CPX gas analyzer using an ergospirometry mask (ErgoMask) or wearing the FFP2 or the Emotion mask below the ErgoMask, randomized on 3 consecutive days. Also, menstrual cycle status was monitored to avoid possible intrasubject alterations. The results showed lower values for the ErgoMask+FFP2, compared to ErgoMask or ErgoMask+Emotion, in forced vital capacity (3.8 ± 0.2, 4.5 ± 0.2 and 4.1 ± 0.1 l, respectively); forced expiratory volume in 1 s (3.3 ± 0.2, 3.7 ± 0.2 and 3.5 ± 0.1 l); ventilation (40.9 ± 1.5, 50.6 ± 1.5 and 46.9 ± 1.2 l/min); breathing frequency (32.7 ± 1.1, 37.4 ± 1.1 and 35.3 ± 1.4 bpm); VE/VO₂ (30.5 ± 0.7, 34.6 ± 0.9 and 33.6 ± 0.7); VE/VCO₂ (32.2 ± 0.6, 36.2 ± 0.9 and 34.4 ± 0.7) and time to exhaustion (492.4 ± 9.7, 521.7 ± 8.6 and 520.1 ± 9.5 s) and higher values in inspiratory time (0.99 ± 0.04, 0.82 ± 0.03 and 0.88 ± 0.03 s). In conclusion, in young healthy female athletes, the Emotion showed better preservation of cardiopulmonary responses than the FFP2.