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

Abstract

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). Supplementary Information The online version contains supplementary material available at 10.1007/s40279-022-01746-4.

WITHDRAWN: Physio-metabolic and clinical consequences of wearing face masks -Systematic review with meta-analysis and comprehensive evaluation

“…In contrast to our study, most of the recent systematic reviews [21][22][23][24][25] have only analysed a few outcome threshold values without considering comprehensive effects, exposure time and the susceptibility of the exposed organisms and tissues. Therefore, their recommendations e.g.…”

“…Furthermore, this recent scoping review on mask driven adverse effects and health risks has summoned for a systematic review. Though some important systematic reviews regarding masks and their effects already exist [21][22][23][24] , they are predominantly restricted to healthy and sportive individuals 21,23 . Due to the exclusion of children, pregnant women and diseased patients from these evaluations and conclusions 22,25 , the reviews do not provide sufficient evidence that masks can be employed in the general population as safe protective measures.…”

“…Physiological systematic reviews based purely on physiological effects of masks limit data interpretations to normal physiometabolic fluctuations i.e. beyond the domain of pathophysiological compensatory mechanisms (especially in the elderly and those with diminished compensatory reserves) and/or acute/chronic subliminal changes in the human microbiome 22,24 . Similarly, other manuscripts do not address subjective parameters, prevalence of symptoms and discomfort during mask use and concomitant physical changes such as heat and temperature in detail 21,23 .…”

The Spread of Exhaled Air and Aerosols during Physical Exercise

“…This must also be considered in whether to rely on an FFP2 mask or a surgical mask. In comparison to Zheng et al [ 23 ], RPE and thermal sensation did not differ due to face mask use in our study. Our observation of increased RPD with face mask usage is in line with their findings.…”

“…Parallel to the assessment of aerosol spreading and protective masks during physical stress, user satisfaction should also be investigated, as the use of face masks can affect user comfort and exertion. In their review, Zheng et al [ 23 ] found significantly increased Borg ratings of perceived exertion (RPE) for surgical masks, but not for filtering facepiece class 2 (FFP2) or cloth masks. In addition, reported perception of dyspnea (RPD), fatigue level, and thermal sensation increased with face mask usage.…”