Effects of wearing facemasks on the sensation of exertional dyspnea and exercise capacity in healthy subjects

Abstract

Due to the currently ongoing pandemic of coronavirus disease 2019 (COVID-19), it is strongly recommended to wear facemasks to minimize transmission risk. Wearing a facemask may have the potential to increase dyspnea and worsen cardiopulmonary parameters during exercise; however, research-based evidence is lacking. We investigated the hypothesis that wearing facemasks affects the sensation of dyspnea, pulse rate, and percutaneous arterial oxygen saturation during exercise. Healthy adults (15 men, 9 women) underwent a progressive treadmill test under 3 conditions in randomized order: wearing a surgical facemask, cloth facemask, or no facemask. Experiment was carried out once daily under each condition, for a total of 3 days. Each subject first sat on a chair for 30 minutes, then walked on a treadmill according to a Bruce protocol that was modified by us. The experiment was discontinued when the subject’s pulse rate exceeded 174 beats/min. After discontinuation, the subject immediately sat on a chair and was allowed to rest for 10 minutes. Subjects were required to rate their levels of dyspnea perception on a numerical scale. Pulse rate and percutaneous arterial oxygen saturation were continuously monitored with a pulse oximeter. These parameters were recorded in each trial every 3 minutes after the start of the exercise; the point of discontinuation; and 5 and 10 minutes after discontinuation. The following findings were obtained. Wearing a facemask does not worsen dyspnea during light to moderate exercise but worsens dyspnea during vigorous exercise. Wearing a cloth facemask increases dyspnea more than wearing a surgical facemask during exercise and increases pulse rate during vigorous exercise, but it does not increase pulse rate during less vigorous exercise. Wearing a surgical facemask does not increase pulse rate at any load level. Lastly, wearing a facemask does not affect percutaneous arterial oxygen saturation during exercise at any load level regardless of facemask type.

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

“…Even during the highest exercise intensity domains, there were no changes in heart rate, or systolic and diastolic blood pressure when wearing a cloth facemask. Moreover, the slight overall reduction in blood oxygen saturation (not detected at individual exercise intensities) was not clinically meaningful, supporting previous studies showing no effect of wearing a facemask on oxygen saturation [24, 25]. These findings collectively can counteract misinformation during the COVID-19 pandemic, particularly relating to the use of masks during exercise and its supposed negative effects on cardiac overload, acid-base balance, and oxygen saturation [28].…”

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

“…For instance, recent evidence suggested that wearing a cloth face mask (i.e., also common for people to use for exercising) may increase dyspnea more than wearing a surgical face mask during vigorous exercise, potentially due to differences in breathing resistance and tightness exerted by these two types of masks. These factors should been addressed thoroughly in future studies (Fukushi et al, 2021). However, we do believe that our current findings provide valuable information that will assist in formulating evidence-based exercise recommendations related to mask-wearing in the current pandemic.…”

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

“…Overall, 22 studies used a progressive exercise test [ 3 , 12 , 14 , 18 , 24 , 26 , 30 , 35 , 36 , 39 , 41 , 43 – 45 , 48 , 50 , 51 , 53 – 55 , 59 , 60 ], while 19 employed the steady-state constant exercise test [ 13 , 15 , 25 , 29 , 31 , 34 , 37 , 38 , 40 , 42 , 46 , 47 , 49 , 52 , 56 – 58 , 61 , 62 ], and two used interval exercise tests [ 28 , 32 ]. Moreover, one study used a resistance exercise test [ 33 ], and one used a sit-to-stand test [ 27 ].…”

“…For the psychological outcomes, RPE was the most commonly used scale reported in 27 studies [ 12 , 14 , 18 , 27 , 28 , 30 – 34 , 36 , 38 , 41 , 42 , 44 – 48 , 51 , 52 , 54 , 56 – 60 ]. Two studies were excluded because of the unavailability of raw data [ 27 , 48 ].…”