Effects of surgical face masks on cardiopulmonary parameters during steady state exercise

Abstract

Wearing face masks reduce the maximum physical performance. Sports and occupational activities are often associated with submaximal constant intensities. This prospective crossover study examined the effects of medical face masks during constant-load exercise. Fourteen healthy men (age 25.7 ± 3.5 years; height 183.8 ± 8.4 cm; weight 83.6 ± 8.4 kg) performed a lactate minimum test and a body plethysmography with and without masks. They were randomly assigned to two constant load tests at maximal lactate steady state with and without masks. The cardiopulmonary and metabolic responses were monitored using impedance cardiography and ergo-spirometry. The airway resistance was two-fold higher with the surgical mask (SM) than without the mask (SM 0.58 ± 0.16 kPa l−1 vs. control [Co] 0.32 ± 0.08 kPa l−1; p < 0.01). The constant load tests with masks compared with those without masks resulted in a significantly different ventilation (77.1 ± 9.3 l min−1 vs. 82.4 ± 10.7 l min−1; p < 0.01), oxygen uptake (33.1 ± 5 ml min−1 kg−1 vs. 34.5 ± 6 ml min−1 kg−1; p = 0.04), and heart rate (160.1 ± 11.2 bpm vs. 154.5 ± 11.4 bpm; p < 0.01). The mean cardiac output tended to be higher with a mask (28.6 ± 3.9 l min−1 vs. 25.9 ± 4.0 l min−1; p = 0.06). Similar blood pressure (177.2 ± 17.6 mmHg vs. 172.3 ± 15.8 mmHg; p = 0.33), delta lactate (4.7 ± 1.5 mmol l−1 vs. 4.3 ± 1.5 mmol l−1; p = 0.15), and rating of perceived exertion (6.9 ± 1.1 vs. 6.6 ± 1.1; p = 0.16) were observed with and without masks. Surgical face masks increase airway resistance and heart rate during steady state exercise in healthy volunteers. The perceived exertion and endurance performance were unchanged. These results may improve the assessment of wearing face masks during work and physical training.

The impact of face masks on performance and physiological outcomes during exercise: a systematic review and meta-analysis

“…For example, measuring arterial oxygen saturation with pulse oximetry is quite variable, end-tidal CO 2 is a crude estimate of alveolar CO 2 , and most studies estimated arterial CO 2 levels with transcutaneous measurements, and would not be as accurate as direct measures of blood gases. Ventilation, tidal volume, and respiratory rate may be difficult to measure while wearing a face mask because it necessitates either wearing a mask for breath collection over the face mask (Fikenzer et al, 2020;Lässing et al, 2020;Li et al, 2021;Mapelli et al, 2021) or insertion of a cannula into the nose underneath the face mask (Epstein et al, 2020). This may affect the normal functioning of a face mask during exercise (e.g., wearing a breath-collection mask over a face mask might effectively seal the face mask to the face and not allow air to escape the sides of the mask).…”

The Impact of Face Masks on Performance and Physiological Outcomes during Exercise: A Systematic Review and Meta-analysis

“…For example, measuring arterial oxygen saturation with pulse oximetry is quite variable, end-tidal CO2 is a crude estimate of alveolar CO2, and most studies estimated arterial CO2 levels with transcutaneous measurements, and would not be as accurate as direct measures of blood gases. Ventilation, tidal volume, and respiratory rate may be difficult to measure while wearing a face mask because it necessitates either wearing a mask for breath collection over the face mask (Fikenzer et al, 2020;Lässing et al, 2020;Li et al, 2021;Mapelli et al, 2021) or insertion of a cannula into the nose underneath the face mask (Epstein et al, 2020). This may affect the normal functioning of a face mask during exercise (e.g., wearing a breath-collection mask over a face mask might effectively seal the face mask to the face and not allow air to escape the sides of the mask).…”

“…When studies with high risk of bias were excluded from the analyses, there was a small significant reduction in oxygen saturation with N95 (MD = -0.3%; 95% CI -0.6, -0.0%; p=0.03), but not surgical masks (p=0.21). For the studies employing surgical masks, three used submaximal exercise tests (Lässing et al, 2020;Person et al, 2018;Shein et al, 2021) and three used maximal exercise tests (Epstein et al, 2020;Mapelli et al, 2021;Shaw et al, 2020). There was no effect of wearing a surgical mask when only submaximal (p=0.52) tests were included, but a small significant reduction when only maximal tests were included (MD = -0.6%; 95% CI -1.1, -0.0%; p=0.04).…”

“…muscle oxygen uptake) during exercise while wearing a surgical mask (Supplementary Figure S2). Two evaluated arterial-venous oxygen content difference (Fikenzer et al, 2020;Lässing et al, 2020) and one evaluated tissue oxygenation index (oxygenated hemoglobin relative to total hemoglobin) (Shaw et al, 2020). These studies showed surgical masks had no impact on muscle oxygenation during exercise (p=0.08).…”

Effects of face masks on performance and cardiorespiratory response in well-trained athletes

“…Data on the effects of face masks during strenuous exercise are scarce, with a single study focusing on steady-state exercise [ 10 ]. To the best of our knowledge, no study has yet examined the effects of face masks on the individual anaerobic threshold in athletes, an intensity marker commonly used for training prescriptions in endurance sports [ 11 , 12 ].…”