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

Abstract

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.O2) 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.O2peak: 1454.8 ± 418.9 vs. 1628.6 ± 447.2 ml/min, p < 0.001; V.CO2peak: 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 (Rfpeak: 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). VT 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.

Possible toxicity of chronic carbon dioxide exposure associated with mask use, particularly in pregnant women, children and adolescents -a scoping review

“…However, elevated blood carbon dioxide levels are an important cornerstone of the so called Mask-Induced Exhaustion Syndrome (MIES) (Table 2) [11]. A significant rise in carbon dioxide occurring while wearing a mask is scientifically proven in many studies [11,[18][19][20][21][22][23][24][25]27,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], especially for N95-masks (Table 2) [20,[23][24][25]27,[30][31][32][33]35,[37][38][39]41,43,44], due to their higher deadspace and breathing resistance [11].…”

“…In a recent scoping review numerous important studies which provide statistically significant evidence for such CO 2 retention under the mouth-nose protection have been presented [11] and we have found additional studies that reveal scientific evidence of a carbon dioxide increase in the blood when masks are used. In total, significant changes (p<0.05) could be found in most of the evaluated studies that measured body CO 2 content during mask use [18,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] (Table 2). Experiments with relatively short evaluation times [45] or questionable study design [46,47] showed no effects caused by masks.…”

“…As a rise in carbon dioxide when wearing a mask is scientifically proven (Tables 1 and 2) [18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], further information about the phenomenon of the toxicological influence of elevated carbon dioxide of inhaled air on male fertility needs to be discussed. The toxic effects of low level carbon dioxide exposure on male fertility have been studied extensively in animal experiments.…”

The impacts of surgical mask in young healthy subjects on cardiopulmonary function and muscle performance: a randomized crossover trial

“…The mode of cycle ergometer exercise and progressive incremental exercise (ramp protocol) were used in the CPET protocol, which consists of 2 min of the resting stage, followed by 2 min of the unloaded pedaling stage (Unloaded stage: 0 watt/min), followed by 8–12 min of incremental/ramp exercise stage [Loaded stage: increased by ramp (watt/min), and the ramp was based on the formula as follow] until the subjects reach volitional exhaustion or the test is terminated by the medical monitor (see criteria for terminating the exercise test). This CPET study protocol was referred with our previous study [ 12 ]. Then, the participant ended with 3 min of recovery stage (0 watt/min) and 3 min of observation stage (static sitting).…”

To Mask or Not to Mask—Evaluation of Cognitive Performance in Children Wearing Face Masks during School Lessons (MasKids)

“…The same was demonstrated in three other studies showing that during physical exertion, all masks are safe and have only minimal impact on performance and physiological variables [ 4 , 5 , 6 ]. However, during high-intensity exercise, wearing a face mask can have a relevant influence [ 7 ]. Children wearing FFP2/K95 masks were more stressed, which was shown, for example, by a higher breathing rate or higher end-tidal CO 2 .…”