Article

“You can leave your mask on”: effects on cardiopulmonary parameters of different airway protection masks at rest and during maximal exercise

Authors:
To read the full-text of this research, you can request a copy directly from the authors.
ResearchGate Logo

This article is featured on the COVID-19 research community page

View COVID-19 community

Abstract

Background During the COVID-19 pandemic, the use of protection masks is essential to reduce contagions. However, public opinion reports an associated subjective shortness of breath. We evaluated cardiorespiratory parameters at rest and during maximal exertion to highlight any differences with the use of protection masks. Methods Twelve healthy subjects underwent three cardiopulmonary exercise tests: without wearing protection mask, with surgical and with FFP2 mask. Dyspnea was assessed by Borg Scale. Standard pulmonary function tests were also performed. Results All the subjects (40.8±12.4 years; 6 males) completed the protocol with no adverse event. At spirometry, from no mask to surgical to FFP2, a progressive reduction of FEV 1 and FVC was observed (3.94±0.91 l, 3.23±0.81 l, 2.94±0.98 l and 4.70±1.21 l, 3.77±1.02 l, 3.52±1.21 l, respectively, p<0.001). Rest ventilation, O 2 uptake (V̇O 2 ) and CO 2 production (VCO 2 ) were progressively lower with a reduction of respiratory rate. At peak exercise, subjects revealed a progressively higher Borg scale when wearing surgical and FFP2. Accordingly, at peak exercise, V̇O 2 (31.0±23.4, 27.5±6.9, 28.2±8.8 ml/kg/min, p=0.001), ventilation (92±26, 76±22, 72±21 l, p=0.003), respiratory rate (42±8, 38±5, 37±4, p=0.04) and tidal volume (2.28±0.72, 2.05±0.60, 1.96±0.65 l, p=0.001) were gradually lower. We did not observed a significant difference in oxygen saturation. Conclusions Protection masks are associated with significant but modest worsening of spirometry and cardiorespiratory parameters at rest and peak exercise. The effect is driven by a ventilation reduction due to an increased airflow resistance. However, since exercise ventilatory limitation is far from being reached, their use is safe even during maximal exercise, with a slight reduction in performance.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... While protecting us from the COVID-19 transmission, masks are inducing variable side effects on our cardiorespiratory physiology [5][6][7], broncho-pulmonary gas-exchange[8] and in vivo metabolic processes. Studies have shown variable effects of surgical masks on cardiopulmonary parameters, O 2 -CO 2 homeostasis, blood pH and thermoregulation etc [9]. ...
... Studies have also shown that conditions such as resistive breathing and/or hypoxia driven hyperventilation, respiratory alkalosis and increased oxidative stress can cause immediate immune suppression [10,11] as well as may lead to metabolic alkalosis [12]. A recent pilot observation of mask driven cardiopulmonary effects in 12 healthy subjects (age: 40.8 ± 12.4 years) at rest and during exercise, are interpreted as signi cant but modest [7]. However, it could not offer an insight into such effects in elderly subjects and also into metabolic changes at the downstream level. ...
... In conclusion, real-time breathomics has revealed a deeper insight into the physio-metabolic side effects of face-mask wearing. Based on recent pilot observations of cardiopulmonary parameters during exercise and rest in 12 healthy adults [7], researchers have generally recommended the continuous mask use. Within our setup, we have investigated the respiratory-, hemodynamic-and down-stream metabolic changes in adults and elderly subjects. ...
Preprint
Full-text available
While protecting against the coronavirus transmission, face-masks may have adverse effects on respiratory-haemodynamic parameters. We investigated immediate and progressive effects of FFP2 and surgical masks on exhaled breath constituents and physiological attributes in 30 healthy volunteers at rest. We continuously monitored exhaled breath profiles in the mask space in elderly (age: 60–80 years) and adults (age: 20–60 years) over a period of 30 min by high-resolution real-time mass-spectrometry (PTR-ToF-MS). Peripheral oxygen saturation, respiratory- and haemodynamic parameters were measured (non-invasively) continuously in parallel. Profound and consistent decrease in SpO2 and increase in pET-CO2 indicates ascending deoxygenation and inadequate ventilation in subjects. Cardiac output and MAP changed as secondary. Exhalation of blood-borne volatile metabolites mirrored behaviour of cardiac output, MAP, SpO2, respiratory rate and pET-CO2. FFP2 masks affected more pronouncedly than surgical masks. Elderly cohort was more vulnerable to those effects. Exhaled humidity increased and exhaled oxygen decreased significantly over time. Breath profiles of endogenous aldehydes, hemiterpene, organosulfur, short-chain fatty acids, alcohols and ketone indicated cross-talks between physio-metabolic effects such as hypoxia, oxidative stress, hypoventilation, compartmental vasoconstriction, altered systemic bacterial activity and energy homeostasis. Concentrations of exogenous VOCs such as aromatics, nitrile and monoterpene depicted compartmental storage and washout. Breathomics allows unique physio-metabolic insights into side effects of face-mask wearing. Mask induced deoxygenation, oxidative stress, CO2 rebreathing, vasoconstriction and blood pressure fluctuations in elderly were clinically concerning (as leading towards hypoxia and hypoventilation). Intelligible global-pandemic policies should reconsider the type and wearing durations of recommended face-masks, based upon age and/or cardio-pulmonary conditions.
... Regarding the experimental setup, four designs studied the impact of mask wearing during rest [11,12,19,20], whilst twelve studies applied physical activity at low (n = 3) [6,11,12], moderate (n = 4) [6,[21][22][23] or vigorous intensities (n = 6) [8,[24][25][26][27][28]. ...
... The most common outcomes were heart rate (n = 13 studies), assessed via ECG or transcutaneous monitoring [6,8,11,12,[20][21][22][23][24][25][26][27][28] and oxygen saturation (n = 11), measured via a pulse oximeter [6, 11, 12, 20-25, 27, 28]. Breathing frequency was assessed in seven trials [6,8,12,22,24,25,27] and ventilation in five [6,8,[24][25][26][27]. ...
... The most common outcomes were heart rate (n = 13 studies), assessed via ECG or transcutaneous monitoring [6,8,11,12,[20][21][22][23][24][25][26][27][28] and oxygen saturation (n = 11), measured via a pulse oximeter [6, 11, 12, 20-25, 27, 28]. Breathing frequency was assessed in seven trials [6,8,12,22,24,25,27] and ventilation in five [6,8,[24][25][26][27]. Breathing gas analysis of oxygen uptake was assessed in five studies [8,19,[25][26][27] and carbon dioxide exhalation was analysed by three studies (VCO 2 ) [19,25,27]. ...
Article
Full-text available
Background: Protection against airborne infection is currently, due to the COVID-19-associated restrictions, ubiquitously applied during public transport use, work and leisure time. Increased carbon dioxide re-inhalation and breathing resistance may result thereof and, in turn, may negatively impact metabolism and performance. Objectives: To deduce the impact of the surgical mask and filtering face piece type 2 (FFP2) or N95 respirator application on gas exchange (pulse derived oxygen saturation (SpO2), carbon dioxide partial pressure (PCO2), carbon dioxide exhalation (VCO2) and oxygen uptake (VO2)), pulmonary function (respiratory rate and ventilation) and physical performance (heart rate HR, peak power output Wpeak). Methods: Systematic review with meta-analysis. Literature available in Medline/Pubmed, the Cochrane Library and the Web of Knowledge with the last search on the 6th of May 2021. Eligibility criteria: Randomised controlled parallel group or crossover trials (RCT), full-text availability, comparison of the acute effects of ≥1 intervention (surgical mask or FFP2/N95 application) to a control/comparator condition (i.e. no mask wearing). Participants were required to be healthy humans and >16 years of age without conditions or illnesses influencing pulmonary function or metabolism. Risk of bias was rated using the crossover extension of the Cochrane risk of bias assessment tool II. Standardised mean differences (SMD, Hedge’s g) with 95% confidence intervals (CI) were calculated, overall and for subgroups based on mask and exercise type, as pooled effect size estimators in our random-effects meta-analysis. Results: Of the 1499 records retrieved, 14 RCTs (all crossover trials, high risk of bias) with 25 independent intervention arms (effect sizes per outcome) on 246 participants were included. Masks led to a decrease in SpO2 during vigorous intensity exercise (6 effect sizes; SMD = -0.40 [95%-CI: -0.70, -0.09], mostly attributed to FFP2/N95) and to a SpO2-increase during rest (5 effect sizes; SMD = 0.34 [95%-CI: 0.04, 0.64]); no general effect of mask wearing on SpO2 occurred (21 effect sizes, SMD = 0.34 [95%-CI: 0.04, 0.64]). Wearing a mask led to a general oxygen uptake decrease (5 effect sizes, SMD = -0.44 [95%-CI: -0.75, -0.14]), to slower respiratory rates (15 effect sizes, SMD = -0.25 [95%-CI: -0.44, -0.06]) and to a decreased ventilation (11 effect sizes, SMD = -0.43 [95%-CI: -0.74, -0.12]). Heart rate (25 effect sizes; SMD = 0.05 [95%-CI: -0.09, 0.19]), Wpeak (9 effect sizes; SMD = -0.12 [95%-CI: -0.39, 0.15]), PCO2 (11 effect sizes; SMD = 0.07 [95%-CI: -0.14, 0.29]) and VCO2 (4 effect sizes, SMD = -0.30 [95%-CI: -0.71, 0.10]) were not different to the control, either in total or dependent of mask type or physical activity status. Conclusion: The number of crossover-RCT studies was low and the designs displayed a high risk of bias. The within-mask- and -intensity-homogeneous effects on gas exchange kinetics indicated larger detrimental effects during exhausting physical activities. Pulse derived oxygen saturation was increased during rest when a mask was applied whereas wearing a mask during exhausting exercise led to decreased oxygen saturation. Breathing frequency and ventilation adaptations were not related to exercise intensity. FFP2/N95 and, to a lesser extent, surgical mask application negatively impacted the capacity for gas exchange and pulmonary function but not the peak physical performance. Registration: Prospero registration number: CRD42021244634
... 95% CI À0.6, À0.0%; p = 0.03), but not surgical masks (p = 0.21). For the studies employing surgical masks, 3 used submaximal exercise tests ( and 3 used maximal exercise tests (Epstein et al. 2021;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 = À0.6%; ...
... 95% CI À1.1, À0.0%; p = 0.04). For studies using N95 masks, 2 studies involved maximal exercise testing (Epstein et al. 2021;Mapelli et al. 2021). When only including these, there was a small significant reduction in oxygen saturation (MD = À0.4%; ...
... When removed from analysis, results were still significant (P < 0.001). Studies with N95 masks involved a variety of populations and exercise protocols; Epstein et al. (2021) and Mapelli et al. (2021) used a maximal exercise test in healthy adults, Goh et al. (2019) involved children, and Kyung et al. (2020) involved patients with COPD. The results of the metaanalysis were unchanged when each study was removed or if only maximal exercise tests were assessed (p < 0.001). ...
Article
Full-text available
Face masks are promoted for preventing spread of viruses; however, wearing a mask during exercise might increase CO 2 rebreathing, decrease arterial oxygenation, and decrease exercise performance. A systematic review and meta-analysis was conducted on the impact of wearing a mask during exercise. Data sources included SPORTDiscus, PubMed, and Medline. Eligibility criteria included all study designs comparing surgical, N95, or cloth masks to a no mask condition during any type of exercise where exercise performance and/or physiological parameters were evaluated. Healthy and clinical participants were included. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals were calculated and pooled effects assessed. Twenty-two studies involving 1573 participants (620 females, 953 males) were included. Surgical, or N95 masks did not impact exercise performance (SMD −0.05 [−0.16, 0.07] and −0.16 [−0.54, 0.22], respectively) but increased ratings of perceived exertion (SMD 0.33 [0.09, 0.58] and 0.61 [0.23, 0.99]) and dyspnea (SMD 0.6 [0.3, 0.9] for all masks). End-tidal CO 2 (MD 3.3 [1.0, 5.6] and 3.7 [3.0, 4.4] mm Hg), and heart rate (MD 2 [0,4] beats/min with N95 masks) slightly increased. Face masks can be worn during exercise with no influences on performance and minimal impacts on physiological variables. PROSPERO registration: CRD42020224988. Novelty: Face masks can be worn during exercise with no impacts on performance and minimal impacts on physiological variables.
... Studies have been carried out showing safety, limited effects on health, reduced or no impact on performance in moderate to light exercise, 15,34,47 and even intense activity. 35 Other studies have reported clear changes and deterioration in the cardiopulmonary, respiratory, physiological, and perceived variables, 16,22,29,55 and even suggest adapting the intensity of the physical exercise or task undertaken. 16,55 These adjustments are not considered sufficiently significant to present a health risk, according to other authors, even at maximum output, though they do produce a reduction in performance. ...
... 16,55 These adjustments are not considered sufficiently significant to present a health risk, according to other authors, even at maximum output, though they do produce a reduction in performance. 29 They even state that prolonged use of a facemask could improve the muscle function of the respiratory system. 18 We also examined studies carried out on children and youths 17,27 and on adults and the elderly with pathologies such as chronic obstructive pulmonary disease (COPD) 21,43 and sarcopenia. ...
... A total of 49 studies underwent a full text selection and, after applying the exclusion and inclusion criteria, 5 articles were finally chosen and included in the revision. 15,29,34,47,55 Furthermore, a total of 6 articles were identified using other methods from the citation search, out of which 3 were included in the review. 6,22,35 In total, 8 articles with 105 participants (79 men and 26 women) complied with our inclusion criteria. ...
Article
Context Use of facemasks in sport has been a particularly complex issue during the COVID-19 pandemic. Objectives A systematic review to examine the physiological effects the different types of masks have on healthy adults when doing physical exercise. Data sources PubMed, SPORTDiscus, Scopus, and Litcovid were searched up to March 20, 2021, following the PRISMA model. Articles published in the last 5 years with healthy adults. Study Selection A total of 633 studies related to the use of masks during physical exercise were found, of which 8 articles met the criteria to be included. Study Design Systematic review. Level of Evidence Level 2. Data Extraction The search process and the review of the articles were carried out by independent expert researchers. The risk of bias and the methodological quality of the different studies included in the systematic review were calculated following the Cochrane criteria using an adaptation for random cross-studies. Once the information was properly structured, the results were extracted, and the findings of the study analyzed. Results There were significant changes in the following physiological variables when engaging in physical exercise using masks: 25% in the heart rate and dyspnea, 37.5% in the rating of perceived exertion, 50% in the pulmonary variables, and 37.5% in discomfort. The oxygen saturation, blood pressure, systolic blood pressure, diastolic blood pressure, and the concentration of blood lactate did not present any significant effect in this study. Conclusions The usage of masks by a healthy adult population during the performance of physical exercise has shown minimal effects with regard to physiological, cardiorespiratory, and perceived responses. Some symptoms can be dyspnea, effort perceived, or discomfort, among others. These findings indicate that the use of masks is not harmful to individuals’ health. It does not present any significant detrimental effect on physical performance or risk to their well-being. However, further experiments are required to corroborate the findings of this review.
... However, the protection masks are associated with a significant worsening of spirometry measurements due to an increase in airflow resistance. 15 Therefore, it is important to ensure their safe use during Data are presented as mean ± SD. *Missing datapoint(s) due to pulse oximeter with heart rate monitoring malfunction. Abbreviations: bpm; breathes or beats per minute; HR, hearth rate; RR, respiratory rate; SpO 2 , pulse oxygen saturation; STST, 1-min sit-to-stand test; T 0 : before the STST; T 2 : 60-s post-STST; T 3 : 120-s post-STST rehabilitation in patients with respiratory diseases. ...
... 18 It is only at high intensity exercise that the masks reduce exercise performance. 15,19,20 A recent study found that the intensity of the 1-min sit-to-stand test was not sufficiently high to elicit an increase in dyspnoea sensation with the surgical mask in young healthy adults. 21 A clinically relevant increase in dyspnoea was only noted at the end of the sit-to-stand test with the cloth mask, probably because this mask opposed more resistance to airflow than the surgical mask. ...
... The dyspnoea sensation with the surgical mask was heightened during the effort, which is likely the reflect of a greater airflow resistance associated to higher ventilation demand while exercising. 15 Surprisingly, although dyspnoea at recovery was higher than dyspnoea before the test, the difference between the masked and unmasked conditions was no longer significant. Dyspnoea is a complex sensation involving sensory and affective dimensions which are closely intertwined. ...
Article
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.
... The results regarding differences in RR between no mask and N95 FFRs were conflicting-Epstein et al. 18 reported no significant difference and Fikenzer et al. 10 reported a significant reduction of RR associated with wearing N95 FFRs. Two of the studies included in the systematic review examined the effect of N95 FFRs on SpO 2 during high-intensity exercises 18,25 . Neither reported significant differences between the mask and no-mask conditions. ...
... Content courtesy of Springer Nature, terms of use apply. Rights reserved 25 and Fikenzer et al. 10 reported a significant reduction in tidal volume when wearing N95 FFRs (both studies) and a surgical mask (only Mapelli et al. 25 ). We have obtained only two studies examining cloth masks. ...
... Content courtesy of Springer Nature, terms of use apply. Rights reserved 25 and Fikenzer et al. 10 reported a significant reduction in tidal volume when wearing N95 FFRs (both studies) and a surgical mask (only Mapelli et al. 25 ). We have obtained only two studies examining cloth masks. ...
Article
Full-text available
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.
... 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) ...
... 95% CI -1.1, -0.0%; p=0.04). For studies using N95 masks, two studies involved maximal exercise testing (Epstein et al., 2020;Mapelli et al., 2021). When only including these, there was a small significant reduction in oxygen saturation (MD = -0.4%; ...
... When removed from analysis, results were still significant (P<0.001). Studies with N95 masks involved a variety of populations and exercise protocols; Epstein et al. (2020) and Mapelli et al. (2021) used a maximal exercise test in healthy adults, Goh et al. (2019) involved children, and Kyung et al. (2020) involved patients with COPD. The results of the meta-analysis were unchanged when each study was removed or if only maximal exercise tests were assessed (p<0.001). ...
Preprint
Full-text available
Face masks are promoted for preventing spread of viruses; however, wearing a mask during exercise might increase CO 2 rebreathing, decrease arterial oxygenation, and decrease exercise performance. A systematic review and meta-analysis was conducted on the impact of wearing a mask during exercise. Data sources included SPORTDiscus, PubMed, and Medline. Eligibility criteria included all study designs comparing surgical, N95, or cloth masks to a no mask condition during any type of exercise where exercise performance and/or physiological parameters were evaluated. Healthy and clinical participants were included. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals were calculated and pooled effects assessed. Twenty-two studies involving 1,573 participants (620 females, 953 males) were included. Surgical, or N95 masks did not impact exercise performance (SMD −0.05 [-0.16,0.07] and −0.16 [-0.54,0.22], respectively) but increased ratings of perceived exertion (RPE) (SMD 0.33 [0.09,0.58] and 0.61 [0.23,0.99]) and dyspnea (SMD 0.6 [0.3,0.9] for all masks). End-tidal CO 2 (MD 3.3 [1.0, 5.6] and 3.7 [3.0,4.4] mmHg), and heart rate (MD 2 [0,4] beats/min with N95 masks) slightly increased. Face masks can be worn during exercise with no influences on performance and minimal impacts on physiological variables. PROSPERO Registration CRD42020224988 Novelty Points Face masks can be worn during exercise with no impacts on performance and minimal impacts on physiological variables.
... It has been demonstrated that wearing PFM during aerobic exercise increases breathing resistance, decreases arterial oxygen saturation, and could lead to respiratory discomfort 5,10,[12][13][14] . ...
... Furthermore, recent studies showed differences in cardiovascular response wearing PFM during endurance exercise 5,13,16 . However, several investigations reported that the use of PFM caused no differences in hemodynamic parameters (i.e., heart rate, blood pressure), exercise tolerance, respiratory rate, and rating of perceived exertion (RPE) 14,[17][18][19] . ...
... Considering the relevance of the subject regarding the use of PFM after the advent of the COVID-19 pandemic, several studies have been recently conducted with the purpose of elucidating its physiological effects on the wearer 5,6,[35][36][37][38][39]13,14,[16][17][18][19]33,34 . Interestingly, when assessing the effects of surgical and FFP2/N95 masks in cardiorespiratory capacity, the FFP2/N95 ...
Article
Full-text available
Protective face mask (PFM) has been widely used for safety purposes and, after the advent of the COVID-19 pandemic, its use is growing steadily, not only among healthcare personnel but also the general population. While PFM is important to preserve the wearer from contaminating agents present in the airflow, they are well known to increase the subjective perception of breathing difficulty. Although some studies demonstrated that PFM use worsens exercise tolerance, there are several studies stating that there is no such limitation with the use of PFM. Moreover, no serious adverse effects during physical exercise have been found in the literature. Physical exercise represents a significant challenge to the human body through a series of integrated changes in function that involve most of its physiologic systems. In this respect, cardiovascular and respiratory systems provide the capacity to sustain physical tasks over extended periods. Within this scenario, both convective oxygen (O2 ) transport (product of arterial O2 content x blood flow) to the working locomotor muscles and O2 diffusive transport from muscle capillaries to mitochondria are of paramount importance to endurance performance. Interestingly, the effects of PFM on cardiorespiratory response during aerobic exercise depends on the type of mask and exercise (i.e., walking, running, or cycling), including decrease in ventilatory demands, arterial oxygen levels, maximal oxygen consumption, and endurance performance. The purpose of this review was to elucidate the effect of protective face mask-wearing on 1) cardiorespiratory responses during aerobic exercise and 2) endurance performance.
... Several studies have demonstrated that facemasks increase the cardio-respiratory stress and elevate perceived exertion during mild to moderate exercise in healthy subject or in patients with COPD [29][30][31][32]. Moreover, the protection masks are associated with a significant worsening of FEV 1 and FVC due to an increase in airflow resistance, which can impact the perceived exertion for a similar effort [33]. The most significant impacts have been associated with the use of N95 respirators [29,30,34]. ...
... The most significant impacts have been associated with the use of N95 respirators [29,30,34]. Yet, surgical facemasks have also shown to impact these parameters while exercising [14,31,33,34]. Similar to our study, Person et al. have shown that wearing a surgical facemask had no impact on heart rate, SpO 2 , or walking distance during a 6-min walk test (6MWT) in healthy adults [28]. ...
... The 1STST effort intensity may thus not have been sufficiently high to elicit an increase in dyspnoea sensation compared to NM in our cohort of young healthy adults. In line with this, Mapelli et al. have shown that the increased sensation of dyspnoea with protection masks became progressively apparent at higher exercise intensity [33]. This could explain the small impact on leg RPE we found using facemasks during an exercise of relatively mild intensity. ...
Article
Background Surgical (SM) or cloth facemasks (CM) has become mandatory in many public spaces during the COVID-19 pandemic. They may interfere with the participation in physical activities. Objective To evaluate how these masks influence dyspnoea (primary outcome), exercise performance and cardiorespiratory response during a 1-min sit-to-stand test (1STST), and to assess masks discomfort sensations. Methods A randomized crossover trial was conducted in healthy adults. They performed 3 1STST (with either no mask (NM), a SM, or a CM) separated from each other by 24-72 hours. The number of 1STST repetitions and leg rate of perceived exertion (RPE) were measured. Dyspnoea (Borg scale), hearth rate, respiratory rate and SpO2 were recorded before and at the end of 1STST, as well as after a short resting period. Several domains of subjective discomfort perceptions with masks were assessed. Results Twenty adults aged 22 ± 2y (11 males) were recruited. Wearing the CM generated significantly higher dyspnoea than NM at all time points, but it only became clinically relevant after the 1STST (median difference, 1 [95%CI 0 to 1]). The SM generated a small but significant higher leg RPE than NM (median difference, 1 [95%CI 0 to 1]). The masks had no impact on 1STST performance nor cardiorespiratory parameters. Both masks were rated similarly for discomfort perceptions except for breathing resistance where CM was rated higher. Conclusions In healthy adults, the CM and SM had minimal to no impact on dyspnoea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise test.
... A previous study discovered that, at constant load (steady state exercise), using SM was associated with a significant increase in airway resistance, reduced oxygen uptake, and increased heart rate [13]. Furthermore, some studies compared pulmonary and cardiovascular capacity, at maximal load, using SM and FFP2/N95 in healthy adults [14][15][16], showing that there is a significant reduction in performance (Pmax and VO2max) with FFP2/N95, whereas that reduction, although present, is not that consistent with SM. Therefore, according to these studies, medical masks have a marked negative impact on cardiopulmonary capacity that significantly impairs strenuous physical and work activities. ...
... Therefore, according to these studies, medical masks have a marked negative impact on cardiopulmonary capacity that significantly impairs strenuous physical and work activities. Additionally, subjects manifest a progressively higher Borg scale value from no mask < SM < to FFP2/N95, suggestive of a greater dyspnea when masks are worn, at maximal load [14,15]. Likewise, different studies show a perception of discomfort associated with the use of masks [4,15]. ...
... Participants were administered three different subjective scales during rest (rest), in the warm-up (warm-up), at the end of the test (max) and after five minutes of recovery (300 s rec). Perceived ventilation was measured with a visual analog scale (VAS VE) of 0-10 (from 0: I cannot breathe; to 10; I breathe perfectly), the rate of perceived exertion (RPE) with a visual scale of 0-10 (from 0: not at all intense; to 10; extremely intense) [14,15], and degree of mask comfort with a visual analog scale of 0-10 (from 0: very comfortable; to 10; extremely uncomfortable) [4,15,17,18]. Before the start of the tests, all scales were explained to the participants, so that they were familiar with them, and all possible doubts were answered to ensure the correct application of these scales during the project. ...
Article
Full-text available
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.
... Studies in adults have shown that it is safe to wear facemasks even during intense physical exercise [3][4][5][6], but data for children are lacking. The few paediatric studies included healthy children observed at rest or during mild physical exercise. ...
... [8] During the first 60 minutes of evaluation, there was no significant change in SpO2 and partial pressure of end tidal carbon dioxide (PETCO2). Studies conducted in adults found that wearing of masks could reduce performance, but did not affect gas exchange in healthy individuals undergoing moderate to vigorous exercise [3,4,6] or in patients with severe lung impairment after a 6-minute walk test. [5] Our data do not allow us to state whether the wearing of facemasks can lead to breathing difficulties or exacerbate breathing problems. ...
... It is thought that masks can increase airflow resistance with subsequent increased breathing effort, resulting in a feeling of discomfort frequently associated with their use. [4,6,7] Further limitations of our study include the small sample size, the short period of exercise, the assessment of surgical masks only and the absence of a control group without facemasks. However, it was not feasible to conduct a controlled study as it was recommended at that time to perform EIA tests with a mask to minimise the risk of SARS-CoV-2 transmission. ...
Article
Full-text available
No episodes of oxygen desaturation or carbon dioxide retention were observed in this cross-sectional study assessing children with exercise-induced symptoms wearing a surgical facemask during a submaximal treadmill exercise test https://bit.ly/3GuxhvO.
... This study utilized a randomized double-blind counterbalanced cross-over design in which 26 youth hockey players (21 males, 5 females; age 11.7 ± 1.6 y) were randomized to wear either a three-layer surgical face mask (AMD Medicom Inc, Quebec, QC, Canada) or a "sham" mask, which had a hole cut out of it to expose the mouth and nose (as described by Mapelli et al. [16] (Figure 1A,B)) while completing a simulated hockey period on a cycle ergometer, as well as during an on-ice skating performance assessment. Participants then crossed over to the other condition (i.e., face mask or sham mask) for identical testing on a different day. ...
... Females had greater ratings of perceived exertion for the second half of the simulated hockey period (i.e., shifts 5-7) when wearing the mask compared to the sham mask, while no difference was observed at any time point in males. While no other research has been conducted in children wearing face masks on ratings of perceived exertion to make a comparison, the results in adults are mixed, with some suggesting increased ratings of perceived exertion while exercising with a mask [16,29] and others reporting no difference [15,[30][31][32]. However, after reviewing the literature, Shaw et al. [12] found no impact of surgical masks on ratings of perceived exertion when studies with a high risk of bias were excluded from analyses. ...
Article
Full-text available
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).
... 4,5 Previous studies have shown that facemask wearing has only a modest or no significant impact the physiological or the perceptual responses to exercise, even in patients with severe lung disease. [6][7][8] Nonetheless, little is known about the effect of facemask wearing in patients with pulmonary arterial hypertension (PAH) who may be challenged by both gas exchange abnormalities and right heart dysfunction. Our objective was to evaluate whether facemask wearing impacted distanced covered, rating of perceived exertion (RPE), and arterial oxygen saturation (SpO 2 ) during a 6-minute walk test (6MWT) in PAH. ...
... 4,5 Despite these concerns, there is growing evidence that any negative effects of wearing a facemask during physical activity are negligible, and unlikely impact the thermal, cardiopulmonary (including heart rate, respiratory frequency, and pulmonary gas exchange), and perceptual responses to exercise. [6][7][8]14 Importantly, our data suggest that the distance covered (ie, exercise capacity), the perceptual response, and SpO 2 during a 6MWT are not negatively affected by the wearing of a facemask in clinically stable PAH patients with moderate-to-severe disease. Ventilatory inefficiency coupled with impaired pulmonary gas exchange and breathlessness during exercise is a hallmark of PAH. ...
Article
Full-text available
Little is known about the effect of wearing a facemask on the physiological and perceptual responses to exercise in patients with pulmonary arterial hypertension (PAH). We performed a single-center retrospective study to evaluate whether facemask wearing impacted distanced covered, rating of perceived exertion (RPE), and arterial oxygen saturation (SpO2) during a 6-minute walk test (6MWT) in PAH patients. Forty-five patients being treated for group 1 PAH and who performed a 6MWT before and after implementation of a facemask mandate were included in the analysis. Each included patient performed a 6MWT without (test 1) and with (test 2) a facemask between October 1, 2019, and October 31, 2020. At both time points, all patients also underwent a submaximal cardiopulmonary exercise test, echocardiogram, and blood laboratory tests, with a Registry to Evaluate Early and Long-Term PAH Disease Management Lite 2.0 score calculated. The two 6MWTs were performed 81±51 days apart, and all patients were clinically stable at both testing timepoints. Six-minute walk test distance was not different between test 1 and test 2 (405±108 m vs 400±103 m, P=.81). Similarly, both end-test RPE and lowest SpO2 during the 6MWT were not different in test 1 and test 2 (RPE: 2.5±1.7 vs 2.5±2.1, P=.91; SpO2 nadir: 92.8±3.4% vs 93.3±3.3%, P=.55). Our findings show that wearing a facemask has no discernable impact on the arterial oxygen saturation and perceptual responses to exercise or exercise capacity in patients with moderate-to-severe PAH. This study reinforces the evidence that wearing a facemask is safe in PAH patients, even during exercise.
... This was also demonstrated in other studies conducted in adults during an exercise of mild to moderate intensity (9,16,18,19). This feeling was demonstrated to progressively increase proportionally to the exercise intensity in adults [22]. This higher perceived exertion at elevated exercise intensity is probably related to the increase in inspiratory and expiratory resistances that were previously highlighted [22,23]. ...
... This feeling was demonstrated to progressively increase proportionally to the exercise intensity in adults [22]. This higher perceived exertion at elevated exercise intensity is probably related to the increase in inspiratory and expiratory resistances that were previously highlighted [22,23]. Similarly, there was a signi cant reduction in running time with facemasks in trained children, at the maximum performance level [24]. ...
Preprint
Full-text available
Background Only a few data associated to wearability of facemask during exercise are available in children. The aim of the study was to evaluate the effect of wearing a facemask on perceived exertion (primary aim), dyspnea, physical performance, and cardiorespiratory response during a submaximal exercise test in children aged between 8 and 12 years. Method This study was performed in 2021 in healthy volunteer children from 8 to 12 years. They performed prospectively two one-minute sit-to-stand test (STST), with or without a surgical facemask. The perceived exertion (modified Borg scale), dyspnea (Dalhousie scale), heart rate and pulsed oxygen saturation were recorded before and after STST. The STST measured the submaximal performance. ResultsThirty-eight healthy children were recruited (8-9 years: n=19 and 10-11 years: n=19). After the STST, the perceived exertion increased with or without a facemask (8-9 years group: +1 [0.6; 1.4] and +1.6 [1.0; 2.1]) –10-11 years group: +1.3 [0.7; 1.8]) and +1.9 [1.3; 2.6]) and it was higher with the facemask. The difference between the two conditions in perceived exertion was not clinically relevant in any group (mBorgf: 0.56 pts and 0.68 pts, respectively). The different domains of dyspnea assessed with Dalhousie scale were not influenced by the facemask. The submaximal performance measured by the STST was not changed by the mask whatever the age group. The cardio-respiratory demand was not clinically modified.Conclusion The surgical facemask had no impact on dyspnoea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise in healthy children.
... If the benefits of masks are to be considered (i.e., reduction of respiratory infectious disease transmission, mutual protection, positive prosocial signaling), potential downsides should not be utterly disregarded [407,517]. The latter include shortage of medical masks and FFRs for HCWs [518,519], cross-contamination due to inappropriate mask wearing [520,521], risk compensation or complacency toward other preventive measures (evidence in favor [522][523][524], evidence against [525][526][527][528][529][530][531]), psychosocial effects (e.g., threats to autonomy, psychological relatedness, competence) [441,532,533], communication and learning difficulties [505,[534][535][536][537][538][539], physiological effects (e.g., subjective breathing discomfort or difficulties 22 , skin problems, headache, ocular dryness and irritation; these effects are more likely if there is a related predisposing condition) [440,441,[540][541][542][543][544], and environmental pollution from mask waste [545][546][547][548]. Of note, these lingering concerns are not reasons to refrain from community masking (using medical masks or face cloth coverings) but are opportunities to maximize the benefits of masking, improve mask designs, and sharpen public health policies and messaging. ...
... However, claims pertaining to decreased oxygen saturation are unfounded. Recent studies assessing medical masks and cloth face coverings in the general adult population have not demonstrated major physiologic changes related to gas exchange [440,441,544,[643][644][645][646][647]. ...
Preprint
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk (“Emmentaler cheese model”), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
... If the benefits of masks are to be considered (i.e., reduction of respiratory infectious disease transmission, mutual protection, positive prosocial signaling), potential downsides should not be utterly disregarded [55,59]. The latter include shortage of medical masks and FFRs for HCWs [534,535], cross-contamination due to inappropriate mask wearing [536,537], risk compensation or complacency toward other preventive measures (evidence in favor [538][539][540], evidence against [541][542][543][544][545][546][547]), psychosocial effects (e.g., threats to autonomy, psychological relatedness, competence) [455,548,549], communication and learning difficulties [518,[550][551][552][553][554][555], physiological effects (e.g., subjective breathing discomfort or difficulties 22 , skin problems, headache, ocular dryness and irritation; these effects are more likely if there is a related predisposing condition) [454,455,556,[562][563][564][565], and environmental pollution from mask waste [566][567][568][569]. Of note, these lingering concerns are not reasons to refrain from community masking (using medical masks or face cloth coverings) but are opportunities to maximize the benefits of masking, improve mask designs, and sharpen public health policies and messaging. ...
... However, claims pertaining to decreased oxygen saturation are unfounded. Recent studies assessing medical masks and cloth face coverings in the general adult population have not demonstrated major physiologic changes related to gas exchange [454,455,[556][557][558][559][560][561]. ...
Article
Full-text available
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk (“Emmentaler cheese model”), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
... Mask use in public settings is recommended to limit the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes the disease known as COVID-19 1,2 and endorsed by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Wearing a mask during exercise may have implications for recreational exercisers and athletes that train and compete at a high exercise intensities as it has been shown to limit ventilation (VE) and increase end-tidal CO 2 compared to a nomask control [3][4][5][6] . For example, N95 masks are designed to fit more tightly around the nose and mouth than other types of masks 7 and have been shown to reduce markers of maximal exercise performance compared to a no-mask control for individuals performing an incremental ramp protocol on a cycle ergometer 3,5 . ...
... Wearing a mask during exercise may have implications for recreational exercisers and athletes that train and compete at a high exercise intensities as it has been shown to limit ventilation (VE) and increase end-tidal CO 2 compared to a nomask control [3][4][5][6] . For example, N95 masks are designed to fit more tightly around the nose and mouth than other types of masks 7 and have been shown to reduce markers of maximal exercise performance compared to a no-mask control for individuals performing an incremental ramp protocol on a cycle ergometer 3,5 . ...
Article
Objective: The purpose of this study was to investigate the effects of surgical mask use during high intensity interval exercise (HIIE) on physiological and perceptual responses in hot and temperate environments. Methods: In a randomized fashion, 10 healthy participants completed two HIIE sessions in a 36°C hot (HUE-HOT) and two HIIE sessions in a 23°C temperate environment (HIIE-TEMP) while wearing (MASK) and not wearing a surgical mask (CON). Results: No differences in physiological variables were found between MASK and CON during HIIE. An increase in perceived dyspnea and average RPE was found comparing MASK and CON. Interaction effects showed the greatest changes in perceived dyspnea and average RPE occurred in the HIIE-HOT/MASK condition. Conclusion: Wearing a surgical mask during HIIE increases the perception of dyspnea and exertion with the greatest effect occurring in hot environments.
... This was also demonstrated in other studies conducted in adults during an exercise of mild to moderate intensity (9,16,18,19). This feeling was demonstrated to progressively increase proportionally to the exercise intensity in adults [24]. This higher perceived exertion at elevated exercise intensity is probably related to the increase in inspiratory and expiratory resistances that were previously highlighted [24,25]. ...
... This feeling was demonstrated to progressively increase proportionally to the exercise intensity in adults [24]. This higher perceived exertion at elevated exercise intensity is probably related to the increase in inspiratory and expiratory resistances that were previously highlighted [24,25]. Similarly, there was a significant reduction in running time with facemasks in trained children, at the maximum performance level [26]. ...
Article
Full-text available
Only a few data associated to wearability of facemask during exercise are available in children. The aim of the study was to evaluate the effect of wearing a facemask on perceived exertion (primary aim), dyspnea, physical performance, and cardiorespiratory response during a submaximal exercise test in children aged between 8 and 12 years. This study was performed in 2021 in healthy volunteer children from 8 to 12 years. They performed prospectively two 1-min sit-to-stand tests (STST), with or without a surgical facemask. The perceived exertion (modified Borg scale), dyspnea (Dalhousie scale), heart rate, and pulsed oxygen saturation were recorded before and after STST. The STST measured the submaximal performance. Thirty-eight healthy children were recruited (8-9 years: n = 19 and 10-11 years: n = 19). After the STST, the perceived exertion increased with or without a facemask (8-9 years group: + 1 [0.6; 1.4] and + 1.6 [1.0; 2.1] - 10-11 years group: + 1.3 [0.7; 1.8] and + 1.9 [1.3; 2.6]) and it was higher with the facemask. The difference between the two conditions in perceived exertion was not clinically relevant in any group (mBorgf: 0.56 pts and 0.68 pts, respectively). The different domains of dyspnea assessed with Dalhousie scale were not influenced by the facemask. The submaximal performance measured by the STST was not changed by the mask whatever the age group. The cardio-respiratory demand was not clinically modified.Conclusion: The surgical facemask had no impact on dyspnea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise in healthy children.
... Goh et al. examined end-tidal pCO 2, and oxygen saturation in 106 children aged 7-14 at rest and on exertion, finding no relevant hypoxemia or hypercapnia [3]. 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]. ...
... 1,A,2,B,3,C, etc.). Outcome parameters were reaction time (RT) for processing numbers (items 2-26), RT for processing letters (items 2-13), and switch costs (switch costs = switch RT [items 2-26]-numbers RT [items 2-26]-(letters RT [items 2-13]-numbers RT [items [2][3][4][5][6][7][8][9][10][11][12][13]). Negative switch costs indicating inadequate responses (at least one of the trials was not completed on time) were regarded as implausible and excluded from the analysis. ...
Article
In the current SARS-CoV-2 pandemic, wearing a face mask is mandatory again during school lessons. There are no controlled studies in children to date indicating an effect on cognitive performance from wearing face masks. In a randomized controlled trial, we analysed the influence of face masks on cognitive performance of pupils during regular school lessons. Pupils (n = 133, fifth to seventh grade) were randomized by alternating allocation into control (with masks, n = 65) and intervention groups (without mask, n = 68). After two school lessons with (control) and without (intervention) face masks in class, all pupils performed digital tests for cognitive performance regarding attention and executive functions (switch, Corsi block-tapping, 2-back and flanker task). Overall, there were no significant differences in cognitive performance between both groups, masks vs. no masks. Wearing face masks has no significant influence on attention and executive functions of pupils and can still be recommended during school lessons.
... This lower blood oxygen saturation would be expected due to increased partial pressure of CO 2 at high exercise intensity, increased tidal volume, and an inadequate oxygen and carbon dioxide exchange due re-breathing enriching inhaled air with CO 2 [8]. Contrary to our results, authors did not find a blood oxygen saturation decrease with surgical masks, either during extenuated [33], vigorous [11] or steady exercise [34]. However, a key factor explaining the differences lies in the intensity and level of previous training. ...
Article
Full-text available
COVID-19 restrictions stipulate the mandatory use of surgical masks during outdoor and indoor physical activities. The impact of this on athletic performance and especially on anaerobic physical activities is poorly known. The aim of the present research was to analyze the effect of surgical mask use on the anaerobic running performance of athletes. Modifications in running time, blood lactate, blood glucose, blood oxygen saturation, subjective perceived stress, rating of perceived exertion, and heart rate variability were measured in 50 m and 400 m maximal running tests with and without the use of surgical masks in 72 athletes. The use of a surgical mask increased blood lactate concentration, sympathetic autonomic modulation, perceived exertion, perceived stress, and decreased blood oxygen saturation in 50 and 400 m running tests. Thus, the higher levels of blood lactate and lower blood oxygen saturation require adaptation of the athlete’s rest and recovery periods to the acute workload. The higher level of sympathetic activation makes the acute and chronic control of autonomic modulation essential for an efficient training periodization. Finally, the use of acid buffers such as bicarbonate or sodium citrate would be a recommended ergogenic strategy.
... Most importantly, summer data were obtained while wearing a facial mask, which clearly implies an extra work of breathing (Lassing et al., 2020;Hopkins et al., 2021;Mapelli et al., 2021). Nevertheless, recently published data show that even in patients with lung disease, SpO 2 during a six-minute walking test is not worse with a mask ( Just et al., 2021). ...
Article
Full-text available
Vignati, Carlo, Massimo Mapelli, Benedetta Nusca, Alice Bonomi, Elisabetta Salvioni, Irene Mattavelli, Susanna Sciomer, Andrea Faini, Gianfranco Parati, and Piergiuseppe Agostoni. A breathtaking lift: sex and body mass index differences in cardiopulmonary response in a large cohort of unselected subjects with acute exposure to high altitude. High Alt Med Biol 00:000-000, 2021. Background: Every year, thousands of people travel to high altitude and experience hypoxemia. At high altitude, the partial pressure of oxygen decreases. The aim of this observational study was to determine if there is a relationship between anthropometric features and basic cardiorespiratory variables, including oxygen saturation (SpO2), heart rate (HR), and blood pressure (BP), following acute exposure to high altitude. Materials and Methods: At the 3,466 m top of a cableway station, we installed an automated system for measuring peripheral SpO2, HR, BP, height, weight, and body mass index (BMI). Results: Between January and October 2020, out of 4,874 volunteers (age 39.9 ± 15.4 years, male 54.4%), 3,267 provided complete data (1,808 cases during winter and 1,459 during summer). SpO2 was 86.8% ± 6.8%. At multivariable analysis, SpO2 was significantly associated with age, sex, season, BMI, and HR but not with BP. We identified 391 (12%) subjects with SpO2 ≤80%: they were older, with a higher BMI and HR but without sex or BP differences. Finally, winter season was associated with greater frequency of SpO2 ≤80% (13.3% vs. 10.3%, p = 0.008). Conclusion: Our data show that high BMI, older age, and male sex were associated with greater degrees of hypoxemia following exposure to high altitude, particularly during the winter.
... Prolonged use (≥12 h) of masks (N95 or N95 with a surgical mask overly) was found to be associated with increased frequency of headaches and physical discomfort [5,7,8]. With respect to exercise training, there is emerging evidence suggesting that performing exercise while wearing a face mask poses no significant effect on cardiorespiratory function and exercise performance among healthy individuals [9][10][11]. However, some recent investigations reported otherwise [12,13]. ...
Article
Full-text available
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.
... Second, surgical masks had influences on lung function. Both this study and Mapelli's (Mapelli et al., 2021) study found out that after wearing masks, Ti and Te increased since rest period, especially Ti, which indirectly reflected that masks could increase the inspiratory and expiratory resistance of the oronasal airway. The increase of facial temperature and humidity during exercise could also cause moisture and deformation of the mask, which could further increase respiratory resistance. ...
Article
Full-text available
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 . CO 2 ) 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 (PetO 2 ), end-tidal carbon dioxide partial pressure (PetCO 2 ), oxygen ventilation equivalent ( V . E / V . O 2 ), and carbon dioxide ventilation equivalent ( V . E / V . CO 2 ) 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 (SpO 2 ) was found. Differences in oxygen pulse ( V . O 2 /HR), oxygen uptake efficiency slope (OUES), work efficiency (△ V . O 2 /△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.
... Generally, effects of mask wearing during maximal efforts such as graded exercise tests until volitional exhaustion are well described 3,9,[11][12][13][14] . On contrary, the effects of mask wearing during steady state exercise, mirroring situations of daily living (exercise training, physical labour and leisure time activities), are rare. ...
Article
Full-text available
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.
... It is possible that an older, used filter could have a higher airflow resistance due to entrapment of particles or moisture. This higher airflow resistance could theoretically lead to greater user work of breathing and ultimately adverse changes to HR, tcCO 2 , or SpO 2 (Mapelli et al., 2021). However, prior work evaluating filter function such as pressure drop among EHMR filters similar to the ones used in this study showed that the filters met NIOSH acceptability criteria, even after 150 cycles of cleaning (Heimbuch and Harnish, 2019). ...
Article
Full-text available
Objectives Elastomeric half-mask respirator (EHMR) use in healthcare increased significantly during the COVID-19 pandemic. Concern for potential release of infectious aerosols from EHMR exhalation valves prompted recommendations to cover them with surgical masks (SMs), thereby improving source control. The physiological and subjective effects of wearing a SM over the exhalation valve of an EHMR, however, are unknown. Methods Twelve healthy healthcare worker volunteers completed a 30-min series of simulated healthcare-related tasks, including resting, talking, walking, and bending, proning and supinating a weighted manikin, and performing cardiopulmonary resuscitation. This series recurred three times with different mask configurations—SM only, EHMR only, or EHMR with SM covering the exhalation valve. A transcutaneous sensor continuously measured carbon dioxide (tcPCO2), oxygen saturation (SpO2), and heart rate (HR) from each subject. Subjects scored their rates of perceived exertion (RPE) and levels of discomfort after each round. Physiological parameters and subjective scores were analyzed using mixed linear models with a fixed effect for mask type, activity, age, body mass index (BMI), and gender. Analysis also tested for interaction between mask type and activity. Results Physiological parameters remained within normal ranges for all mask configurations but varied by task. Statistically significant but small decreases in mean tcPCO2 (37.17 versus 37.88 mmHg, P < 0.001) and SpO2 (97.74 versus 97.94%, P < 0.001) were associated with wearing EHMR with SM over the exhalation valve compared with EHMR alone. Mean HR did not differ between these mask configurations. Wearing SM only was associated with lower RPE and level of discomfort compared with EHMR, but these subjective scores did not differ when comparing EHMR with SM to EHMR only. Age, BMI, and gender had no significant effect on any outcomes. Conclusions Wearing a SM over an EHMR did not produce clinically significant changes in tcPCO2, SpO2, or HR compared with uncovered EHMR during healthcare-related tasks. Covered EHMR use also did not affect perceived exertion or discomfort compared with uncovered EHMR use. Covering the exhalation valve of an EHMR with a SM for source control purposes can be done safely.
... Whereas wearing face masks during outdoor exercise seems an inacceptable mitigation strategy, clean air systems may efficiently decrease exposure levels to air pollutants (mostly PM of different categories) and thereby make home based physical exercise healthier. Whereas cloth or surgical face masks seem to have no direct negative effects on physical exercise performance and health outcome [162], N95 masks slightly but significantly increased heart rate [163] and FFP2 masks caused a significant but modest impairment of spirometry and cardiorespiratory parameters at rest and peak exercise that was mostly based on decreased ventilation by higher airflow resistance [164]. Taken together, wearing a face mask during exercise is highly annoying but seems to be more or less safe, although some experts warrant caution due to development of hypercapnic hypoxia with negative health effects, which may become more significant with N95 face masks [165]. ...
Article
Full-text available
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.
... However, not all states/countries adopted this mandate for players. Although most early evidence suggests that healthy individuals are only mildly impacted while wearing a FM during exercise (Shaw et al., 2020;Hopkins et al., 2021;Mapelli et al., 2021;Shein et al., 2021), others have reported significant reductions in respiratory capacity in healthy adults Lässing et al., 2020;Driver et al., 2021). To date the impact of mask wearing on aspects of exercise or sports participation, such as player safety, has received little attention. ...
Article
Full-text available
Wearing a facemask (FM) reduces the spread of COVID-19, but it also blocks a person's lower visual field. Many new public safety rules were created in response to COVID-19, including mandated FM wearing in some youth sports like youth ice hockey. We hypothesized that FM wearing in youth hockey players obstructs the lower field of view and may impact safety. Youth hockey players ( n = 33) aged 12.03 (1.6) years button press when they saw an LED on the floor turn on in two conditions (wearing FM or no FM) in random order. An interleaved one-up/one-down two-alternative-forced-choice adaptive staircase design was used. Visual thresholds were calculated for each condition and participant. The visual angle threshold (VAT) was determined using standing eye height and the linear distance from the tip of the skates to the visual threshold. Paired t -tests determined whether mask wearing changed the VAT. We modeled the probability a player could see the puck on their stick in four distinct scenarios to estimate the potential impact of FM wearing during hockey play. The average unmasked VAT (11.4 degrees) was significantly closer to the skates than the masked VAT (20.3 degrees) ( p < 0.001). Our model indicated a significant reduction in ability to visualize the puck using peripheral vision when more upright while wearing a FM. FM wearing compromised their lower visual field, suggesting a downward head tilt may be necessary to see the puck. Playing ice hockey while wearing a FM may lead to unsafe on-ice playing conditions due to downward head tilt to see the puck.
... Goh et al. examined End-Tidal pCO2, and oxygen saturation in 106 children aged 7-14 at rest and on exertion finding no relevant hypoxemia or hypercapnia [3]. 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]. ...
Preprint
In the current Sars-CoV-2 pandemic, wearing a face mask was mandatory and is still desired during school lessons. There are no controlled studies in children to date indicating an effect on cognitive performance wearing face masks. In a randomized controlled trial, we analysed the influence of face masks on cognitive performance of pupils during regular school lessons. Pupils (n=133, 5th to 7th grade) were randomized by alternating allocation into control (with masks, n=65) and intervention groups (without mask, n=68). After two school lessons with (control) and without (intervention) face masks in class all pupils performed digital tests for cognitive performance regarding attention and executive functions (Switch, CORSI block tapping, 2-back and flanker task). Overall, there were no significant differences in cognitive performance between both groups, masks vs. no masks. Wearing face masks has no significant influence on attention and executive functions of pupils and can still be recommended during school lessons.
... This year, Mapelli et al. evaluated the cardiorespiratory effects of facemasks via exercise tests on 12 healthy subjects. They found that subjects had higher mean ETCO 2 values with FFP2 respirators ( 19 ). Özdemir et al. also noted a significant increase in ETCO 2 with FFP respirators in their study in which 12 healthy male HCWs' physiological variables were monitored for 30 min in resting position ( 18 ). ...
Article
Full-text available
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.
... Several studies indicated that mask-wearing could induce increased airway resistance. Mapelli and their colleagues reported a significant worsening of cardiorespiratory parameters (forced expiratory volume in one second, forced vital capacity, oxygen uptake, carbon dioxide production) when wearing face masks at rest [24]. Lässing et al. also reported an increase in airway resistance when wearing surgical masks [25]. ...
Article
Full-text available
Background: Since the onset of the COVID-19 pandemic, there have been many reported cases showing the consequences-or the collateral damages-of COVID-19 on patients with non-COVID-related diseases. This study aimed to compare the clinical manifestations and treatment results of non-COVID-related pneumothorax patients before and during the pandemic. Methods: We retrospectively reviewed non-COVID-related pneumothorax patients who visited our hospital before the onset of the pandemic and during the pandemic. The primary outcome was the difference in the amount of pneumothorax between the two periods, and the secondary outcome was the difference in the treatment results between them. Multivariable logistic regression was conducted to find risk factors related to massive pneumothorax. Results: There were 122 and 88 patients in the pre-pandemic and pandemic groups, respectively. There was no significant difference between the two groups with respect to the preoperative demographic variables. However, the median amount of pneumothorax was significantly higher in the pandemic group (pre-pandemic: 34.75% [interquartile range (IQR) 18.30-62.95] vs. pandemic: 53.55% [IQR 33.58-88.80], p < 0.0001) and massive pneumothorax were more frequent in the pandemic group (52.3% vs. 30.3%, p = 0.002). Furthermore, more patients experienced re-expansion pulmonary edema after treatments during the pandemic (p = 0.0366). In multivariable analysis, the pandemic (OR: 2.70 [95% CI 1.49-4.90], p = 0.0011) was related to the occurrence of massive pneumothorax. Conclusion: During the pandemic, patients presented with a larger size of pneumothorax and had more re-expansion pulmonary edema, even in a country that handled the COVID-19 pandemic relatively well.
... Fikenzer et al. 24 found no differences in tidal volume and VE at rest while wearing SM or N95 compared to NM. Mapelli et al. 25 found that the tidal volume was not different, but VE was reduced at rest, while wearing an SM or an N95, and only VO 2 was reduced while wearing an N95 compared to NM. However, we found that tidal volume, VE, VO 2 , and VO 2 /HR were decreased both at rest and warm-up, regardless of whether an SM or an N95 was worn. ...
Article
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.
Article
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.
Article
Objective: The aim of this study was to evaluate the effects of the use of both surgical masks and FFP2 respirators on the inspiratory muscle strength, metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception, before and during 30 min stable load exercise at "conversational level". Methods: A randomized cross-over study was carried out. Nineteen healthy adults completed 3 conditions (without a mask, with a surgical mask or an FFP2 respirator) during a 30-min steady-state test at the lactate threshold intensity. Inspiratory muscle strength was measured before and after the test, and metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception were collected at baseline, during, and after the test. Results: There was a significant reduction in inspiratory muscle strength after the 30-min test in all conditions (control: 6.26 mm Hg, p < 0.5; surgical mask: 8.55 mm Hg, p < 0.01; FFP2 respirator: 12.42 mm Hg, p < 0.001), but without significant differences between them (p = 0.283). Data showed a statistically significant effect for time, but did not show a statistically significant interaction between condition and time for heart rate (p = 0.674), oxygen saturation (p = 0.297), blood lactate level (p = 0.991), rating perceived exertion (p = 0.734) and dyspnea (p = 0.532) comparisons. Conclusions: The present study findings suggested that inspiratory muscle strength and physiological parameters during "conversational level" exercise were not impaired under wearing masks in healthy, nonsmoking young adults.
Article
Full-text available
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 (VO2peak) 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 were 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.
Article
Full-text available
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 twofold 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.
Article
Full-text available
To minimize transmission of SARS-CoV-2, the novel coronavirus responsible for COVID-19, the Center for Disease Control and World Health Organization recommend wearing facemasks in public. Some have expressed concern that these may affect the cardiopulmonary system by increasing the work of breathing (Wb), altering pulmonary gas exchange and increasing dyspnea, especially during physical activity. These concerns have been derived largely from studies evaluating devices intentionally designed to severely affect respiratory mechanics and gas exchange. We review the literature on the effects of various facemasks and respirators on the respiratory system during physical activity using data from several models: cloth face coverings and surgical masks, N95 respirators, industrial respirators and applied high resistive or high deadspace respiratory loads. Overall, the available data suggest that although dyspnea may be increased and alter perceived effort with activity, the effects on Wb, blood gases and other physiological parameters imposed by facemasks during physical activity are small, often too small to be detected, even during very heavy exercise. There is no current evidence to support sex-based or age-based differences in the physiological responses to exercise while wearing a facemask. While the available data suggest that negative effects of using cloth or surgical facemasks during physical activity in healthy individuals are negligible and unlikely to impact exercise tolerance significantly, for some individuals with severe cardiopulmonary disease, any added resistance and/or minor changes in blood gases may evoke considerably more dyspnea and, thus, affect exercise capacity.
Article
Full-text available
COVID-19 outbreak has a profound impact on almost every aspect of life. Universal masking is recommended as a means of source control. Routinely exercising in a safe environment is an important strategy for healthy living during this crisis. As sports clubs and public spaces may serve a source of viral transmission, masking may become an integral part of physical activity. This study aimed to assess the physiological effects of wearing surgical masks and N95 respirators during short term strenuous workout. This was a multiple cross-over trial of healthy volunteers. Using a standard cycle ergometry ramp protocol, each subject performed a maximal exercise test without a mask, with a surgical mask, and with an N95 respirator. Physiological parameters and time to exhaustion were compared. Each subject served his own control. Sixteen male volunteers (mean age and BMI of 34 ±4 years and 28.72 ±3.78 kg/m2, respectively) completed the protocol. Heart rate, respiratory rate, blood pressure, oxygen saturation, and time to exhaustion did not differ significantly. Exercising with N95 mask was associated with a significant increase in end-tidal carbon-dioxide (EtCO2 ) levels. The differences were more prominent as the load increased, reaching 8mmHg at exhaustion (none vs. N95, p=0.001). In conclusion, in healthy subjects, short term moderate-strenuous aerobic physical activity with a mask is feasible, safe, and associated with only minor changes in physiological parameters, particularly a mild increase in EtCO2 . Subjects suffering from lung diseases should have a cautious evaluation before attempting physical activity with any mask.
Article
Full-text available
Background Due to the SARS-CoV2 pandemic, medical face masks are widely recommended for a large number of individuals and long durations. The effect of wearing a surgical and a FFP2/N95 face mask on cardiopulmonary exercise capacity has not been systematically reported.Methods This prospective cross-over study quantitated the effects of wearing no mask (nm), a surgical mask (sm) and a FFP2/N95 mask (ffpm) in 12 healthy males (age 38.1 ± 6.2 years, BMI 24.5 ± 2.0 kg/m2). The 36 tests were performed in randomized order. The cardiopulmonary and metabolic responses were monitored by ergo-spirometry and impedance cardiography. Ten domains of comfort/discomfort of wearing a mask were assessed by questionnaire.ResultsThe pulmonary function parameters were significantly lower with mask (forced expiratory volume: 5.6 ± 1.0 vs 5.3 ± 0.8 vs 6.1 ± 1.0 l/s with sm, ffpm and nm, respectively; p = 0.001; peak expiratory flow: 8.7 ± 1.4 vs 7.5 ± 1.1 vs 9.7 ± 1.6 l/s; p < 0.001). The maximum power was 269 ± 45, 263 ± 42 and 277 ± 46 W with sm, ffpm and nm, respectively; p = 0.002; the ventilation was significantly reduced with both face masks (131 ± 28 vs 114 ± 23 vs 99 ± 19 l/m; p < 0.001). Peak blood lactate response was reduced with mask. Cardiac output was similar with and without mask. Participants reported consistent and marked discomfort wearing the masks, especially ffpm.Conclusion Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals. These data are important for recommendations on wearing face masks at work or during physical exercise.
Article
Full-text available
We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
Article
Full-text available
During exercise, heart failure patients (HF) show an out-of-proportion ventilation increase, which in patients with COPD is blunted. When HF and COPD coexist, the ventilatory response to exercise is unpredictable. We evaluated a human model of respiratory impairment in 10 COPD-free HF patients and in 10 healthy subjects, tested with a progressive workload exercise with different added dead space. We hypothesized that increased serial dead space upshifts the VE vs. VCO2 relationship and that the VE-axis intercept might be an index of dead space ventilation. All participants performed a cardiopulmonary exercise test with 0, 250 and 500 mL of additional dead space. Since DS does not contribute to gas exchange, ventilation relative to dead space is ventilation at VCO2 = 0, i.e. VE-axis intercept. We compared dead space volume, estimated dividing VE-axis intercept by the intercept on respiratory rate axis of the respiratory rate vs. VCO2 relationship with standard method measured DS. In HF, adding dead space increased VE-axis intercept (+0 mL = 4.98±1.63 L; +250 mL = 9.69±2.91 L; +500 mL = 13.26±3.18 L; p<0.001) and upshifted the VE vs.VCO2 relationship, with a minor slope rise (+0 mL = 27±4 L; +250 = 28±5; +500 = 29±4; p<0.05). In healthy, adding dead space increased VE-axis intercept (+0 mL = 4.9±1.4 L; +250 = 9.3±2.4; +500 = 13.1±3.04; p<0.001) without slope changes. Measured and estimated dead space volumes were similar both in HF and healthy subjects. VE-axis intercept is related to dead space ventilation and dead space volume can be non-invasively estimated.
Article
Full-text available
Spirometry and maximal respiratory pressures are pulmonary function parameters commonly used to evaluate respiratory function. Prediction values are available for conventional lung function devices using a standard tube or flanged type of mouthpiece connection. This equipment is not suitable for patients with facial or buccal muscle weakness, because of air leakage around the mouthpiece. A face mask was used for the portable lung function devices used in the neuromuscular department. The aim of this study was to compare the face mask and the conventional mouthpiece for the measurement of spirometry and of respiratory pressures in 22 healthy subjects. Values obtained with the conventional mouthpiece differed significantly from values obtained with the face mask. With the mask, forced vital capacity and forced expiratory volume in one second were 200 mL lower, and maximal expiratory pressure was 3.2 kPa lower than with the mouthpiece. Subsequently, new prediction values for face mask spirometry and maximal respiratory pressures were obtained from 252 other healthy subjects, from which new prediction equations were derived. It was concluded that the face mask connection to the lung function device is a valid alternative, is easy to use and is most useful to monitor changes in patients. This study confirms the importance of appropriate prediction equations, depending on subject-instrument interfaces.
Article
Full-text available
Governments are preparing for a potential influenza pandemic. Therefore they need data to assess the possible impact of interventions. Face-masks worn by the general population could be an accessible and affordable intervention, if effective when worn under routine circumstances. We assessed transmission reduction potential provided by personal respirators, surgical masks and home-made masks when worn during a variety of activities by healthy volunteers and a simulated patient. All types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity, but with a high degree of individual variation. Personal respirators were more efficient than surgical masks, which were more efficient than home-made masks. Regardless of mask type, children were less well protected. Outward protection (mask wearing by a mechanical head) was less effective than inward protection (mask wearing by healthy volunteers). Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection. Masks worn by patients may not offer as great a degree of protection against aerosol transmission.
Article
Background Cardiopulmonary exercise test and 6-minute walking test are frequently used tools to evaluate physical performance in heart failure (HF), but they do neither represent activities of daily living (ADLs) nor fully reproduce patients’ symptoms. We assessed differences in task oxygen uptake, both as absolute value and as percentage of peak oxygen consumption (peakVO 2 ), ventilation efficiency (VE/VCO 2 ratio), and dyspnea intensity (Borg scale) in HF and healthy subjects during standard ADLs and other common physical actions. Methods Healthy and HF subjects (ejection fraction <45%, stable conditions) underwent cardiopulmonary exercise test. All of them, carrying a wearable metabolic cart, performed a 6-minute walking test, two 4-minute treadmill exercises (at 2 and 3 km/h), and ADLs: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 minutes), ADL6 (climbing 1 flight of stairs carrying a load). Results Sixty patients with HF (age 65.2±12.1 years; ejection fraction 30.4±6.7%, peakVO 2 14.2±4.0 mL/[min·kg]) and 40 healthy volunteers (58.9±8.2 years, peakVO 2 28.1±7.4 mL/[min·kg]) were enrolled. For each exercise, patients showed higher VE/VCO 2 ratio, percentage of peakVO 2 , and Borg scale value than controls, while absolute values of task oxygen uptake and exercise duration were lower and higher, respectively, in all activities, except for treadmill (fixed execution time and intensity). Differently from Borg Scale data, metabolic values and exercise time length changed in parallel with HF severity, except for ADL duration in very short (ADL3) and composite (ADL1) activities. Borg scale values correlated with percentage of peakVO 2 . Conclusions During ADLs, patients self-regulated activities in parallel with HF severity by decreasing intensity (VO 2 ) and prolonging the effort.
Article
To date, the pandemic spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has involved over 100 countries in a matter of weeks, and Italy suffers from almost 1/3 of the dead cases worldwide. In this report, we show the strategies adopted to face the emergency at Centro Cardiologico Monzino, a mono-specialist cardiology hospital sited in the region of Italy most affected by the pandemic, and specifically we describe how we have progressively modified in a few weeks the organization of our Heart Failure Unit in order to cope with the new COVID-19 outbreak. In fact, on the background of the pandemic, cardiovascular diseases still occur frequently in the general population, but we observed consistent reduction in hospital admissions for acute cardiovascular events and a dramatic increase of late presentation acute myocardial infarction. Despite a reduction of healthcare workers number, our ward has been rearranged in order to take care of both COVID-19 and cardiovascular patients. In particular according to a triple step procedure we divided admitted patients in confirmed, suspected and excluded cases (respectively allocated in “red”, “pink” and “green” separated areas). Due to the absence of definite guidelines, our aim was to describe our strategy in facing the current emergency, in order to reorganize our hospital in a dynamic and proactive manner. To quote the famous Italian writer Alessandro Manzoni ‘It is less bad to be agitated in doubt than to rest in error.’
Article
In the present practice review, we will explain how to perform and interpret a cardiopulmonary exercise test (CPET)in heart failure patients. Specifically, we will explain why cycle ergometer should be preferred to treadmill, the type of protocol needed, and the ideal exercise duration. Thereafter, we will discuss how to interpret CPET findings and determine the parameters that should be included. We will focus specifically on: peak VO 2 (absolute value and a percentage of its predicted value), exercise duration, respiratory exchange ratio, peak work rate, heart rate, O 2 pulse, end-tidal carbon dioxide pressure (PetCO 2 ), PetO 2 , and -if blood gas samples are obtained-dead space to tidal volume ratio. Moreover, we will discuss the physiological and clinical value of anaerobic threshold, respiratory compensation point, ventilation vs. VCO 2 and VO 2 vs. work relationships. Finally, attention will be dedicated to exercise-induced periodic breathing. We will also discuss when and why CPET should be integrated with other measurements in the so-called complex CPET. Specifically: a)when and how to use a complex non-invasive CPET, which integrates CPET measurements with non-invasive cardiac output determination, working muscle near-infrared spectroscopy, transthoracic echocardiography, thoracic ultrasound, and lung diffusion analysis; b)when and how to use a complex minimally invasive CPET, in which CPET is combined with esophageal balloon recordings or with serial arterial blood sampling for blood gas analysis; c)when and how to use a complex invasive CPET, which usually implies the presence of a Swan Ganz catheter in the pulmonary artery and an arterial line.
Article
CO2 is generated when lactate is increased during exercise because its [H'] is buffered primarily by HCO: (22 ml for each meq of lactic acid). We developed a method to detect the anaerobic threshold (AT), using computerized regression analysis of the slopes of the CO, uptake (ko,) vs. 0, uptake (VO,) plot, which detects the beginning of the excess CO, output generated from the buffering of [H'], termed the V-slope method. From incremental exercise tests on 10 subjects, the point of excess CO, output (AT) predicted closely the lactate and HCO: thresholds. The mean gas exchange AT was found to correspond to a small increment of lactate above the mathematically defined lactate threshold [0.50 t 0.34 (SD) meq/l] and not to differ significantly from the estimated HCO: threshold. The mean VO, at AT computed by the V-slope analysis did not differ significantly from the mean value determined by a panel of six experienced reviewers using traditional visual methods, but the AT could be more reliably determined by the V-slope method. The respiratory compensation point, detected separately by examining the minute ventilation vs. VCO~ plot, was consistently higher than the AT (2.51 t 0.42 vs. 1.83 t 0.30 l/min of VOW). This method for determining the AT has significant advantages over others that depend on regular breathing pattern and respiratory chemosensitivity.
Article
Introduction: The objective of this study was to perform lung function measurements using a facemask in place of a cylindrical mouthpiece and to investigate the validity and intra-class reliability of the results. Methods: The subjects were 48 healthy university students. Spirometry was performed twice for the subjects, using a cylindrical mouthpiece (mouthpiece spirometry, MS) and a facemask (facemask spirometry, FS) in random order. We fitted a spirometer with either a spirometry conical mouthpiece (30 ml of dead space) or an airtight cardiopulmonary exercise test facemask (210 ml of dead space). The measurement parameters were vital capacity (VC), tidal volume (TV), inspiratory capacity (IC), forced expiratory volume in 1 second (FEV1), and forced expiratory volume % in 1 second (FEV1%). FS validity was verified by investigating the correlation between the measurement data for each parameter and MS and FS in terms of Spearman's rank correlation coefficient. Intra-class reliability was verified by calculating the intra-class correlation coefficient (1, 1) between the first and second measurements of each parameter by FS. Results: There was a strong correlation between the measurements of VC, TV, IC, FEV1, and FEV1% obtained with MS and those obtained with FS. There also was a strong intra-class correlation between the first and second measurements of VC, TV, IC, FEV1, and FEV1%. Conclusion: Our results confirmed the validity and intra-class reliability of lung function measurements performed using a facemask instead of a cylindrical mouthpiece. This suggests that it may be possible to substitute a facemask for a cylindrical mouthpiece during spirometry.
Article
ACC/AHA : American College of Cardiology/American Heart Association ACCF/AHA : American College of Cardiology Foundation/American Heart Association ACE : angiotensin-converting enzyme ACEI : angiotensin-converting enzyme inhibitor ACS : acute coronary syndrome AF : atrial fibrillation
We studied 120 asbestos-exposed workers seeking compensation for asbestos-related ventilatory impairment who were referred to us for evaluation of their complaint of dyspnea. We reviewed history, chest radiographs, pulmonary function studies, and exercise tests. The workers were 59.9 ± 9.5 (mean ± SD) yr of age and their first asbestos exposure had been 34.4 ± 10 yr prior to the study; 63% were smokers, 19% were ex-smokers, and 18% were nonsmokers. Chest radiographs were normal in 4%, showed only pleural disease in 35%, only parenchymal diseases in 5%, and pleuroparenchymal disease in 56%. Restrictive pulmonary function abnormalities were present in 25% of the workers, and obstructive abnormalities were present in 27%. Because the impairment of one of several organ systems (i.e., ventilatory, cardiac, pulmonary vascular, or peripheral circulatory) may limit exercise performance, we designed an exercise test score in an attempt to identify the system causing the limitation. No abnormal limitation was detectable in half (49.2%) of the subjects. Only 26% had a ventilatory limitation, which was much more frequent in smokers (32%) than in nonsmokers (9%) (p < 0.05). Unexpectedly, rather more (37%) had a cardiac rather than a ventilatory limitation. We conclude that the complaint of dyspnea in these asbestos-exposed workers was usually not caused by a ventilatory dysfunction.
Article
Twenty subjects treadmill exercised at 5.6 km/h for 1h with and without wearing a surgical mask while being monitored for heart rate, respiratory rate, oxygen saturation, transcutaneous CO2, SpO2, core and skin temperatures, mask deadspace heat and relative humidity, and skin temperature under the mask. Rating scales were utilized for exertion and heat perceptions. Surgical mask use resulted in increases in heart rate (9.5 beats/min; p<0.001), respiratory rate (1.6 breaths/min; p=0.02), and transcutaneous carbon dioxide (2.17 mmHg; p=0.0006), and decreased temperature of uncovered facial skin (0.40 °C; p=0.03). The 1.76 °C increase in temperature of the skin covered by the mask was associated with a mask deadspace apparent heat index of 52.9 °C. Perceptions of heat were neutral to slightly hot, and for exertion ranged from very, very light to fairly light. Surgical mask use for 1h at a low-moderate work rate is not associated with clinically significant physiological impact or significant subjective perceptions of exertion or heat.
Article
Excess CO2 is generated when lactate is increased during exercise because its [H+] is buffered primarily by HCO-3 (22 ml for each meq of lactic acid). We developed a method to detect the anaerobic threshold (AT), using computerized regression analysis of the slopes of the CO2 uptake (VCO2) vs. O2 uptake (VO2) plot, which detects the beginning of the excess CO2 output generated from the buffering of [H+], termed the V-slope method. From incremental exercise tests on 10 subjects, the point of excess CO2 output (AT) predicted closely the lactate and HCO-3 thresholds. The mean gas exchange AT was found to correspond to a small increment of lactate above the mathematically defined lactate threshold [0.50 +/- 0.34 (SD) meq/l] and not to differ significantly from the estimated HCO-3 threshold. The mean VO2 at AT computed by the V-slope analysis did not differ significantly from the mean value determined by a panel of six experienced reviewers using traditional visual methods, but the AT could be more reliably determined by the V-slope method. The respiratory compensation point, detected separately by examining the minute ventilation vs. VCO2 plot, was consistently higher than the AT (2.51 +/- 0.42 vs. 1.83 +/- 0.30 l/min of VO2). This method for determining the AT has significant advantages over others that depend on regular breathing pattern and respiratory chemosensitivity.
We studied 120 asbestos-exposed workers seeking compensation for asbestos-related ventilatory impairment who were referred to us for evaluation of their complaint of dyspnea. We reviewed history, chest radiographs, pulmonary function studies, and exercise tests. The workers were 59.9 +/- 9.5 (mean +/- SD) yr of age and their first asbestos exposure had been 34.4 +/- 10 yr prior to the study; 63% were smokers, 19% were ex-smokers, and 18% were nonsmokers. Chest radiographs were normal in 4%, showed only pleural disease in 35%, only parenchymal diseases in 5%, and pleuroparenchymal disease in 56%. Restrictive pulmonary function abnormalities were present in 25% of the workers, and obstructive abnormalities were present in 27%. Because the impairment of one of several organ systems (i.e., ventilatory, cardiac, pulmonary vascular, or peripheral circulatory) may limit exercise performance, we designed an exercise test score in an attempt to identify the system causing the limitation. No abnormal limitation was detectable in half (49.2%) of the subjects. Only 26% had a ventilatory limitation, which was much more frequent in smokers (32%) than in nonsmokers (9%) (p less than 0.05). Unexpectedly, rather more (37%) had a cardiac rather than a ventilatory limitation. We conclude that the complaint of dyspnea in these asbestos-exposed workers was usually not caused by a ventilatory dysfunction.
Article
There is a great demand for perceptual effort ratings in order to better understand man at work. Such ratings are important complements to behavioral and physiological measurements of physical performance and work capacity. This is true for both theoretical analysis and application in medicine, human factors, and sports. Perceptual estimates, obtained by psychophysical ratio-scaling methods, are valid when describing general perceptual variation, but category methods are more useful in several applied situations when differences between individuals are described. A presentation is made of ratio-scaling methods, category methods, especially the Borg Scale for ratings of perceived exertion, and a new method that combines the category method with ratio properties. Some of the advantages and disadvantages of the different methods are discussed in both theoretical-psychophysical and psychophysiological frames of reference.
Article
Cardiopulmonary exercise test (CPET) is used to evaluate patients with chronic heart failure (HF) usually by means of a personalized ramp exercise protocol. Our aim was to evaluate if exercise duration or ramp rate influences the results. Ninety HF patients were studied (peak V (O(2)): >20 ml/min/kg, n=28, 15-20 ml/min/kg, n=39 and <15 ml/min/kg, n=23). Each patient did four CPET studies. The initial study was used to separate the subjects into three groups, according to their exercise capacity. In the remaining studies, work-rate was increased at three different rates designed to have the subjects reach peak exercise in 5, 10 and 15 min from the start of the ramp increase in work-rate, respectively. The order was randomized. The work-rate applied for the total population averaged 22.7+/-8.0, 11.6+/-3.7, 7.5+/-2.9 W/min with effective loaded exercise duration of 5 min and 16 s+/-29 s, 9 min and 43 s+/-49 s and 14 min and 32 s+/-1 min and 12 s for the 5-, 10- and 15-min tests, respectively. Peak V (O(2)) averaged 16.9+/-4.3*, 18.0+/-4.4 and 18.0+/-5.4 ml/min/kg for the 5-, 10- and 15-min tests, (*=p<0.001 vs. 10 min). The shortest test had the lowest peak heart rate and ventilation and highest peak work-rate. Peak V (O(2)) and heart rate were lowest in 5-min tests regardless of HF severity. The DeltaV (O(2))/Deltawork-rate was lowest in 5-min tests and highest in 15-min tests. At all ramp rates, DeltaV (O(2))/Deltawork-rate was lower for the subjects with the lower peak V (O(2)). The V (e)/V (CO(2)) slope and V (O(2)) at anaerobic threshold were not affected by the protocol for any grade of HF. In chronic HF, exercise protocol has a small effect on peak V (O(2)) and DeltaV (O(2))/Deltawork but does not affect V (O(2)) at anaerobic threshold and V (e)/V (CO(2)) slope.
Clinical Exercise Testing
  • K Wasserman
  • J E Hansen
  • D Y Sue
  • W W Stringer
  • B J Whipp
Wasserman, K., Hansen JE, Sue DY, Stringer WW, Whipp BJ, Clinical Exercise Testing, in Principles of Exercise Testing and Interpretation Including Pathophysiology and Clinical Applications. 2012, Lippincott Williams & Wilkins. p. 18-39.
Facebook post falsely claims wearing masks for coronavirus shuts down the immune system
  • A Mahadevan
Mahadevan, A., Facebook post falsely claims wearing masks for coronavirus shuts down the immune system. A Facebook post makes six claims about wearing masks for the coronavirus, such as they 'decrease oxy. Poynter, 2020.