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Fukushi I, Nakamura M, Kuwana SI. Effects of wearing facemasks on the sensation of exertional dyspnea and exercise capacity in healthy subjects. PLoS One 2021; 16:e0258104. [PMID: 34591935 PMCID: PMC8483295 DOI: 10.1371/journal.pone.0258104] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/18/2021] [Indexed: 11/18/2022] Open
Abstract
Due to the currently ongoing pandemic of coronavirus disease 2019 (COVID-19), it is strongly recommended to wear facemasks to minimize transmission risk. Wearing a facemask may have the potential to increase dyspnea and worsen cardiopulmonary parameters during exercise; however, research-based evidence is lacking. We investigated the hypothesis that wearing facemasks affects the sensation of dyspnea, pulse rate, and percutaneous arterial oxygen saturation during exercise. Healthy adults (15 men, 9 women) underwent a progressive treadmill test under 3 conditions in randomized order: wearing a surgical facemask, cloth facemask, or no facemask. Experiment was carried out once daily under each condition, for a total of 3 days. Each subject first sat on a chair for 30 minutes, then walked on a treadmill according to a Bruce protocol that was modified by us. The experiment was discontinued when the subject’s pulse rate exceeded 174 beats/min. After discontinuation, the subject immediately sat on a chair and was allowed to rest for 10 minutes. Subjects were required to rate their levels of dyspnea perception on a numerical scale. Pulse rate and percutaneous arterial oxygen saturation were continuously monitored with a pulse oximeter. These parameters were recorded in each trial every 3 minutes after the start of the exercise; the point of discontinuation; and 5 and 10 minutes after discontinuation. The following findings were obtained. Wearing a facemask does not worsen dyspnea during light to moderate exercise but worsens dyspnea during vigorous exercise. Wearing a cloth facemask increases dyspnea more than wearing a surgical facemask during exercise and increases pulse rate during vigorous exercise, but it does not increase pulse rate during less vigorous exercise. Wearing a surgical facemask does not increase pulse rate at any load level. Lastly, wearing a facemask does not affect percutaneous arterial oxygen saturation during exercise at any load level regardless of facemask type.
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Affiliation(s)
- Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, Chiba, Japan
- Clinical Research Center, Murayama Medical Center, Musashimurayama, Japan
- * E-mail:
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Shun-ichi Kuwana
- Faculty of Health Sciences, Uekusa Gakuen University, Chiba, Japan
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102
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Spang RP, Pieper K. The tiny effects of respiratory masks on physiological, subjective, and behavioral measures under mental load in a randomized controlled trial. Sci Rep 2021; 11:19601. [PMID: 34599253 PMCID: PMC8486780 DOI: 10.1038/s41598-021-99100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Since the outbreak of the coronavirus disease (COVID-19), face coverings are recommended to diminish person-to-person transmission of the SARS-CoV-2 virus. Some public debates concern claims regarding risks caused by wearing face masks, like, e.g., decreased blood oxygen levels and impaired cognitive capabilities. The present, pre-registered study aims to contribute clarity by delivering a direct comparison of wearing an N95 respirator and wearing no face covering. We focused on a demanding situation to show that cognitive efficacy and individual states are equivalent in both conditions. We conducted a randomized-controlled crossover trial with 44 participants. Participants performed the task while wearing an N95 FFR versus wearing none. We measured physiological (blood oxygen saturation and heart rate variability), behavioral (parameters of performance in the task), and subjective (perceived mental load) data to substantiate our assumption as broadly as possible. We analyzed data regarding both statistical equivalence and differences. All of the investigated dimensions showed statistical equivalence given our pre-registered equivalence boundaries. None of the dimensions showed a significant difference between wearing an FFR and not wearing an FFR.Trial Registration: Preregistered with the Open Science Framework: https://osf.io/c2xp5 (15/11/2020). Retrospectively registered with German Clinical Trials Register: DRKS00024806 (18/03/2021).
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Affiliation(s)
- Robert P Spang
- Quality and Usability Lab, Institute of Software Engineering and Theoretical Computer Science, Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany.
| | - Kerstin Pieper
- Quality and Usability Lab, Institute of Software Engineering and Theoretical Computer Science, Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany
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103
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Akbari HA, Ghram A, Yoosefi M, Arena R, Lavie CJ, Chtourou H, Saad HB, Chamari K. The COVID-19 pandemic and physical activity during intermittent fasting, is it safe? A call for action. Biol Sport 2021; 38:729-732. [PMID: 34937984 PMCID: PMC8670795 DOI: 10.5114/biolsport.2021.108300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/09/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023] Open
Abstract
Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the "Sunna" also encourages Muslims to practice IF all along the year (e.g.; two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic.
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Affiliation(s)
- Hesam Addin Akbari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Amine Ghram
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
- Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL, USA
- Department of Cardiac Rehabilitation, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yoosefi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL, USA
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL, USA
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School the University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Hamdi Chtourou
- Institut Supérieur du Sport et de l’éducation physique de Sfax, Université de Sfax, Sfax, Tunisia
- Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, Tunis, Tunisia
| | - Helmi Ben Saad
- Université de Sousse, Faculté de Médecine de Sousse, Hôpital Farhat HACHED de Sousse, Laboratoire de Recherche «Insuffisance Cardiaque» (LR12SP09), Sousse, Tunisie
| | - Karim Chamari
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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104
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Zhang G, Li M, Zheng M, Cai X, Yang J, Zhang S, Yilifate A, Zheng Y, Lin Q, Liang J, Guo L, Ou H. Effect of Surgical Masks on Cardiopulmonary Function in Healthy Young Subjects: A Crossover Study. Front Physiol 2021; 12:710573. [PMID: 34566679 PMCID: PMC8461071 DOI: 10.3389/fphys.2021.710573] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Mask plays an important role in preventing infectious respiratory diseases. The influence of wearing masks in physical exercise on the human body needs to be studied. The purpose of this study is to explore the influence of wearing surgical masks on the cardiopulmonary function of healthy people during exercise. Methods: The physiological responses of 71 healthy subjects (35 men and 36 women, age 27.77 ± 7.76 years) to exercises with and without surgical masks (mask-on and mask-off) were analyzed. Cardiopulmonary function and metabolic reaction were measured by the cardiopulmonary exercise test (CPET). All tests were carried out in random sequence and should be completed in 1 week. Results: The CPETs with the mask-on condition were performed undesirably (p < 0.05), and the Borg scale was higher than the mask-off (p < 0.001). Rest oxygen uptake ( V . O 2 ) and carbon dioxide production ( V . CO2) with the mask-on condition were lower than mask-off (p < 0.01), which were more obvious at peak exercise ( V . O2 peak : 1454.8 ± 418.9 vs. 1628.6 ± 447.2 ml/min, p < 0.001; V . CO2 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 (PetO2), end-tidal carbon dioxide partial pressure (PetCO2), oxygen ventilation equivalent ( V . E / V . O2), and carbon dioxide ventilation equivalent ( V . E / V . CO2) with mask-on, which reflected pulmonary ventilation efficiency, were significantly different from mask-off at different stages of CPET (p < 0.05), but no significant difference in percutaneous oxygen saturation (SpO2) was found. Differences in oxygen pulse ( V . O2/HR), oxygen uptake efficiency slope (OUES), work efficiency (△ V . O2/△W), peak heart rate (HR), and peak systolic blood pressure (BP) existed between two conditions (p < 0.05). Conclusion: Wearing surgical masks during aerobic exercise showed certain negative impacts on cardiopulmonary function, especially during high-intensity exercise in healthy young subjects. These results provide an important recommendation for wearing a mask at a pandemic during exercises of varying intensity. Future research should focus on the response of wearing masks in patients with related cardiopulmonary diseases.
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Affiliation(s)
- Guolin Zhang
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Mei Li
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, China
| | - Meifeng Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Cai
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jinyu Yang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shengqing Zhang
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Anniwaer Yilifate
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuxin Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Key Laboratory of Enhanced Recovery After Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junjie Liang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lan Guo
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Haining Ou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Key Laboratory of Enhanced Recovery After Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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105
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Effect of Different Types of Face Masks on the Ventilatory and Cardiovascular Response to Maximal-Intensity Exercise. BIOLOGY 2021; 10:biology10100969. [PMID: 34681068 PMCID: PMC8533493 DOI: 10.3390/biology10100969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
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.
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106
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Pimenta T, Tavares H, Ramos J, Oliveira M, Reis D, Amorim H, Rocha A. Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic. Rev Port Cardiol 2021; 40:957-964. [PMID: 34566256 PMCID: PMC8455281 DOI: 10.1016/j.repc.2021.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction and objectives During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training. Methods Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage. Results Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions. Conclusions Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.
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Affiliation(s)
- Tiago Pimenta
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Helena Tavares
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - João Ramos
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Mafalda Oliveira
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - David Reis
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Hugo Amorim
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Afonso Rocha
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
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107
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Yoshihara A, Dierickx EE, Brewer GJ, Sekiguchi Y, Stearns RL, Casa DJ. Effects of Face Mask Use on Objective and Subjective Measures of Thermoregulation During Exercise in the Heat. Sports Health 2021; 13:463-470. [PMID: 34196240 PMCID: PMC8404762 DOI: 10.1177/19417381211028212] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While increased face mask use has helped reduce COVID-19 transmission, there have been concerns about its influence on thermoregulation during exercise in the heat, but consistent, evidence-based recommendations are lacking. HYPOTHESIS No physiological differences would exist during low-to-moderate exercise intensity in the heat between trials with and without face masks, but perceptual sensations could vary. STUDY DESIGN Crossover study. LEVEL OF EVIDENCE Level 2. METHODS Twelve physically active participants (8 male, 4 female; age = 24 ± 3 years) completed 4 face mask trials and 1 control trial (no mask) in the heat (32.3°C ± 0.04°C; 54.4% ± 0.7% relative humidity [RH]). The protocol was 60 minutes of walking and jogging between 35% and 60% of relative VO2max. Rectal temperature (Trec), heart rate (HR), temperature and humidity inside and outside of the face mask (Tmicro_in, Tmicro_out, RHmicro_in, RHmicro_out) and perceptual variables (rating of perceived exertion (RPE), thermal sensation, thirst sensation, fatigue level, and overall breathing discomfort) were monitored throughout all trials. RESULTS Mean Trec and HR increased at 30- and 60-minute time points compared with 0-minute time points, but no difference existed between face mask trials and control trials (P > 0.05). Mean Tmicro_in, RHmicro_in, and humidity difference inside and outside of the face mask (ΔRHmicro) were significantly different between face mask trials (P < 0.05). There was no significant difference in perceptual variables between face mask trials and control trials (P > 0.05), except overall breathing discomfort (P < 0.01). Higher RHmicro_in, RPE, and thermal sensation significantly predicted higher overall breathing discomfort (r2 = 0.418; P < 0.01). CONCLUSION Face mask use during 60 minutes of low-to-moderate exercise intensity in the heat did not significantly affect Trec or HR. Although face mask use may affect overall breathing discomfort due to the changes in the face mask microenvironment, face mask use itself did not cause an increase in whole body thermal stress. CLINICAL RELEVANCE Face mask use is feasible and safe during exercise in the heat, at low-to-moderate exercise intensities, for physically active, healthy individuals.
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Affiliation(s)
- Ayami Yoshihara
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut
| | - Erin E. Dierickx
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut
| | - Gabrielle J. Brewer
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut
| | - Yasuki Sekiguchi
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut
| | - Rebecca L. Stearns
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut
| | - Douglas J. Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut
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108
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van Veelen MJ, Voegele A, Rauch S, Kaufmann M, Brugger H, Strapazzon G. COVID-19 Pandemic in Mountainous Areas: Impact, Mitigation Strategies, and New Technologies in Search and Rescue Operations. High Alt Med Biol 2021; 22:335-341. [PMID: 34319777 PMCID: PMC8558066 DOI: 10.1089/ham.2020.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/29/2021] [Indexed: 12/03/2022] Open
Abstract
van Veelen, Michiel J., Anna Voegele, Simon Rauch, Marc Kaufmann, Hermann Brugger, and Giacomo Strapazzon. COVID-19 pandemic in mountainous areas: impact, mitigation strategies, and new technologies in search and rescue operations. High Alt Med Biol. 22:335-341, 2021.-Mitigating the spread of COVID-19, an airborne infection, can lead to delays in the prehospital response and impair the performance of search and rescue (SAR) services in mountainous and remote areas. We provide an overview of the developing epidemiological situation related to the COVID-19 pandemic in mountainous areas and review current protocols to determine their suitability for mountain rescue teams. We also discuss using novel technologies to reduce the adverse effects caused by COVID-19 mitigation strategies such as delays caused by donning personal protective equipment (PPE) and reduced rescuer performance due to impaired movement and ventilation. COVID-19 has spread even in mountainous and remote locations. Dedicated protocols for the use of PPE appropriate for SAR rescuers exerting physical effort in remote areas and using technologies such as drones, telemedicine, and localization and contact tracing applications could contribute to an effective and timely emergency response in mountainous and remote settings.
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Affiliation(s)
- Michiel J. van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Emergency Medical Services (COVID-1 Intermediate Care Unit), Bolzano Hospital, Bolzano, Italy
| | - Anna Voegele
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesia and Intensive Care, “F. Tappeiner” Hospital, Merano, Italy
| | - Marc Kaufmann
- Emergency Medical Services (COVID-1 Intermediate Care Unit), Bolzano Hospital, Bolzano, Italy
- Emergency Medical Services 112, Health Care System Alto Adige, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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Fitzgerald HT, Rubin ST, Fitzgerald DA, Rubin BK. Covid-19 and the impact on young athletes. Paediatr Respir Rev 2021; 39:9-15. [PMID: 34090827 PMCID: PMC8087861 DOI: 10.1016/j.prrv.2021.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
The Covid-19 pandemic has disrupted organised sport in the community as authorities cancelled, greatly modified or postponed sporting participation as part of a strategy to reduce transmission of the virus. This had a significant impact on young athletes and their families in relation to their psycho-social, physical and career progression considerations. The disruption is likely to continue for some years, considering the constraints of lockdowns, the need to overcome dysfunctional national logistics for delivery of medical care, fund and implement an efficacious vaccine programme locally, nationally and worldwide, develop sufficient herd immunity and create an environment of confidence in the safety of returning to sports for participants, coaches, umpires, administrators and observers. This article will consider the interim challenges regarding the physical and psychosocial importance of maintaining an active sporting programme for young athletes, reflect on safety measures for modifying sporting equipment and environmental protections to allow safest participation in training and competition and provide advice on protocols for a gradual return to sport for the young athlete after infection with Covid-19.
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Affiliation(s)
- Hugh T Fitzgerald
- Exercise Physiology, School of Medical Sciences, University of New South Wales, Kensington, NSW 2052, Australia
| | - Sam T Rubin
- Biomedical Engineering, Clemson University, Clemson, SC, USA
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital at Westmead Clinical School, Faculty of Health Sciences, University of Sydney, Westmead 2145, Australia
| | - Bruce K Rubin
- Jessie Ball duPont Distinguished Professor, Dept. of Pediatrics Professor of Biomedical Engineering Virginia Commonwealth University School of Medicine Virginia Eminent Scholar in Pediatrics 1000 East Broad St.Richmond, VA 23298 USA.
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Rosa BV, Rossi FE, Moura HPDSND, Santos AMDS, Véras-Silva AS, Ribeiro SLG, Nakamura FY, Pereira Dos Santos MA. Effects of FFP2/N95 face mask on low- and high-load resistance exercise performance in recreational weight lifters. Eur J Sport Sci 2021; 22:1326-1334. [PMID: 34365900 DOI: 10.1080/17461391.2021.1953613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
COVID-19 pandemic, has led to several countries adopting the use of masks in public spaces. Mask used during physical exercise it may induce early fatigue. However, despite the results with aerobic exercise, as far as we know, no studies have been carried out on wearing a mask during resistance exercise.This randomized, crossover study verified the acute effect of an FFP2/N95 face mask on moderate- and high-load upper body resistance exercise performance in recreational weight lifters.The FFP2/N95 face mask impacted performance, evaluated with bar velocity, in the high-intensity resistance bench press exercise until movement failure but decreased oxygen saturation and increased rate of perceived effort only in the moderate-intensity exercise.
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Affiliation(s)
- Bruno Viana Rosa
- Master's student in Science and Health, Immunometabolism of Skeletal Muscle and Exercise Research Group and Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Department of Physical Education, Federal University of Piaui (UFPI), Teresina-PI, Brazil
| | - Fabrício Eduardo Rossi
- Immunometabolism of Skeletal Muscle and Exercise Research Group, Department of Physical Education and Associate Professor at Graduation Program in Science and Health, Federal University of Piaui (UFPI), Teresina-PI, Brazil
| | - Helton Pereira Dos Santos Nunes de Moura
- Master's student in Science and Health and Immunometabolism of Skeletal Muscle and Exercise Research Group, Department of Physical Education, Federal University of Piaui (UFPI), Teresina-PI, Brazil
| | - Arilene Maria da Silva Santos
- Master's student in Science and Health and Immunometabolism of Skeletal Muscle and Exercise Research Group, Department of Physical Education, Federal University of Piaui (UFPI), Teresina-PI, Brazil
| | | | | | - Fabio Yuzo Nakamura
- Research Center in Sports Sciences, Health Sciences, and Human Development, University Institute of Maia, Maia, Portugal. . Associate Graduate Program in Physical Education Universidade de Pernambuco/Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Marcos Antonio Pereira Dos Santos
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Department of Biophysics and Physiology, Federal University of Piaui, Teresina-PI, Brazil
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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112
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Fietsam AC, Deters JR, Workman CD, Rudroff T. Personal Protective Equipment Alters Leg Muscle Fatigability Independent of Transcranial Direct Current Stimulation: A Comparison with Pre-COVID-19 Pandemic Results. Brain Sci 2021; 11:brainsci11080962. [PMID: 34439581 PMCID: PMC8392507 DOI: 10.3390/brainsci11080962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 01/12/2023] Open
Abstract
In response to the COVID-19 pandemic, the use of personal protective equipment (PPE; e.g., face mask) has increased. Mandating subjects to wear PPE during vigorous exercise might affect the fatigue outcomes of transcranial direct current stimulation (tDCS) studies. The purpose of this study was to investigate whether the use of PPE affected the performance of a tDCS-influenced fatigue task in healthy adults. A total of 16 young and healthy subjects were recruited and wore PPE during an isokinetic fatigue task in conjunction with sham, 2 mA, and 4 mA tDCS conditions. Subjects were matched to subjects who did not wear PPE during our previous pre-pandemic study in which right knee extensor fatigability increased under these same conditions. The results show that right knee extensor fatigability, derived from torque and work (FI-T and FI-W, respectively), was higher in the PPE study compared to the No PPE study in the sham condition. Additionally, there were no differences in knee extensor fatigability or muscle activity between sham, 2 mA, and 4 mA tDCS in the present study, which contrasts with our previous results. Thus, PPE worn by subjects and researchers might have a detrimental effect on fatigue outcomes in tDCS studies irrespective of the stimulation intervention.
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Affiliation(s)
- Alexandra C. Fietsam
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
| | - Justin R. Deters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
| | - Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
- Department of Neurology, University of Iowa Health Clinics, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-0363
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113
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Implications of surgical mask use in physical education lessons. Physiol Behav 2021; 239:113513. [PMID: 34216593 DOI: 10.1016/j.physbeh.2021.113513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
COVID-19 is being a huge challenge for education systems. Mandatory use of face masks in presential classes may lead to psychophysiological impairment of students, which affect lessons. Thus, the aim of the present research was to analyze the effect of mask use in basal psychophysiological status of physical education students prior to a physical education lesson. We analyzed 72 physical education students in two moments prior to two physical education lessons with 48 h between them. Blood oxygen saturation, body, temple and face temperatures, perceived stress and exertion, and heart rate variability were measured. Results showed that the use of surgical masks in physical education students produced a significant increase on subjective stress perception, sympathetic modulation, cardiovascular response, face, and temple temperature while decreasing blood oxygen saturation. We concluded that the use of surgical masks by physical education students induce modifications on the organic status, which could represent a handicap compromising the academic objectives of physical education lessons. This information can help teachers design efficient physical education lessons.
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114
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Yasui H, Okachi S, Fukatsu N, Sato K. Development of a Mask for Bronchoscopy to Prevent Infection Under COVID-19 Pandemic: Image Evaluation. Am J Respir Crit Care Med 2021; 204:e56-e58. [PMID: 34129446 PMCID: PMC8491257 DOI: 10.1164/rccm.202010-4037im] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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115
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[Effects of surgical face masks on exercise performance and perceived exertion of exercise in well-trained healthy boys]. Wien Med Wochenschr 2021; 172:59-62. [PMID: 34101084 PMCID: PMC8185696 DOI: 10.1007/s10354-021-00851-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/26/2021] [Indexed: 11/02/2022]
Abstract
This study investigated the effects of surgical "everday" face masks on the physical performance and perceived exertion in trained eleven-year-old boys.No decrease in objective performance parameters was found in the aerobic and aerobic-anaerobic transition zones. However, at the maximum performance level with surgical face mask, there was a significant reduction in running time as well as a significant increase in the subjective perception of exertion with otherwise unchanged performance parameters. In summary, the use of surgical face masks in trained children does not affect athletic activities as long as the loads are performed primarily in the aerobic intensity range.
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116
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Egger F, Blumenauer D, Fischer P, Venhorst A, Kulenthiran S, Bewarder Y, Zimmer A, Böhm M, Meyer T, Mahfoud F. Effects of face masks on performance and cardiorespiratory response in well-trained athletes. Clin Res Cardiol 2021; 111:264-271. [PMID: 34091726 PMCID: PMC8179953 DOI: 10.1007/s00392-021-01877-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, compulsory masks became an integral part of outdoor sports such as jogging in crowded areas (e.g. city parks) as well as indoor sports in gyms and sports centers. This study, therefore, aimed to investigate the effects of medical face masks on performance and cardiorespiratory parameters in athletes. METHODS In a randomized, cross-over design, 16 well-trained athletes (age 27 ± 7 years, peak oxygen consumption 56.2 ± 5.6 ml kg-1 min-1, maximum performance 5.1 ± 0.5 Watt kg-1) underwent three stepwise incremental exercise tests to exhaustion without mask (NM), with surgical mask (SM) and FFP2 mask (FFP2). Cardiorespiratory and metabolic responses were monitored by spiroergometry and blood lactate (BLa) testing throughout the tests. RESULTS There was a large effect of masks on performance with a significant reduction of maximum performance with SM (355 ± 41 Watt) and FFP2 (364 ± 43 Watt) compared to NM (377 ± 40 Watt), respectively (p < 0.001; ηp2 = 0.50). A large interaction effect with a reduction of both oxygen consumption (p < 0.001; ηp2 = 0.34) and minute ventilation (p < 0.001; ηp2 = 0.39) was observed. At the termination of the test with SM 11 of 16 subjects reported acute dyspnea from the suction of the wet and deformed mask. No difference in performance was observed at the individual anaerobic threshold (p = 0.90). CONCLUSION Both SM and to a lesser extent FFP2 were associated with reduced maximum performance, minute ventilation, and oxygen consumption. For strenuous anaerobic exercise, an FFP2 mask may be preferred over an SM.
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Affiliation(s)
- Florian Egger
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany.
- Institute of Sports and Preventive Medicine, Saarland University, Campus, Building B8 2, 66123, Saarbrücken, Germany.
| | - Dominic Blumenauer
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany
| | - Patrick Fischer
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany
| | - Andreas Venhorst
- Institute of Sports and Preventive Medicine, Saarland University, Campus, Building B8 2, 66123, Saarbrücken, Germany
| | | | - Yvonne Bewarder
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany
| | - Angela Zimmer
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Campus, Building B8 2, 66123, Saarbrücken, Germany
| | - Felix Mahfoud
- Department of Internal Medicine, Saarland University Hospital, Homburg, Saar, Germany
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Roy S, Soteras I, Sheets A, Price R, Oshiro K, Rauch S, McPhalen D, Nerin MA, Strapazzon G, Allen M, Read A, Paal P. Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue. High Alt Med Biol 2021; 22:128-141. [PMID: 34166103 PMCID: PMC8252899 DOI: 10.1089/ham.2021.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
Roy, Steven, Inigo Soteras, Alison Sheets, Richard Price, Kazue Oshiro, Simon Rauch, Don McPhalen, Maria Antonia Nerin, Giacomo Strapazzon, Myron Allen, Alistair Read, and Peter Paal. Guidelines for mountain rescue during the COVID-19 pandemic: official guidelines of the International Commission for Alpine Rescue. High Alt Med Biol. 22: 128-141, 2021. Background: In mountain rescue, uncertainty exists on the best practice to prevent coronavirus disease 2019 (COVID-19) transmission. The aim of this work was to provide a state-of-the-art overview of the challenges caused by the COVID-19 pandemic in mountain rescue. Methods: Original articles or reviews, published until December 27, 2020 in Cochrane COVID-19 Study Register, EMBASE, PubMed, and Google Scholar were included. Articles were limited to English, French, German, or Spanish with the article topic COVID-19 or other epidemics, addressing transmission, transport, rescue, or cardiopulmonary resuscitation. Results: The literature search yielded 6,190 articles. A total of 952 were duplicates and 5,238 were unique results. After exclusion of duplicates and studies that were not relevant to this work, 249 articles were considered for this work. Finally, 72 articles and other sources were included. Conclusions: Recommendations are provided for protection of the rescuer (including screening, personal protective equipment [PPE], and vaccination), protection of the patient (including general masking if low risk, specific PPE if high risk), equipment hygiene (including disinfection after every mission), use of single-use products, training and medical measures under COVID-19 precautions, and psychological wellbeing of rescuers during the COVID-19 pandemic. Adapted COVID-19 precautions for low-and-medium-income countries are also discussed.
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Affiliation(s)
- Steven Roy
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
- International Society for Mountain Medicine, Bern, Switzerland
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
| | - Inigo Soteras
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Emergency Medical System, University of Girona, Catalonia, Spain
| | - Alison Sheets
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Emergency Medicine, Boulder Community Health, Boulder, Colorado, USA
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Richard Price
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- LandSAR, Christchurch, New Zealand
| | - Kazue Oshiro
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Mountain Medicine, Research, and Survey Division, Department of Cardiovascular Medicine, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Simon Rauch
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Don McPhalen
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Maria Antonia Nerin
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Jose Ramon Morandeira Mountain Medicine Association-CUEMUM, Chía, Spain
| | - Giacomo Strapazzon
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - Myron Allen
- National Ski Patrol, Lakewood, Colorado, USA
- Terrestrial Commission of the International Commission for Alpine Rescue (ICAR), Zurich, Switzerland
| | - Alistair Read
- Terrestrial Commission of the International Commission for Alpine Rescue (ICAR), Zurich, Switzerland
- Mountain Rescue, England and Wales, Tamworth, United Kingdom
| | - Peter Paal
- Medical Commission of the International Commission for Alpine Rescue (ICAR MEDCOM), Zurich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
- Austrian Board for Mountain Safety, Innsbruck, Austria
- Austrian Society of Mountain and High Altitude Medicine, Mieming, Austria
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118
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Eberhart M, Orthaber S, Kerbl R. The impact of face masks on children-A mini review. Acta Paediatr 2021; 110:1778-1783. [PMID: 33533522 PMCID: PMC8014099 DOI: 10.1111/apa.15784] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/22/2022]
Abstract
Aim Face masks are essential during the COVID‐19 pandemic, and the United Nations Children's Fund and the World Health Organization, recommend that they are used for children aged six years and older. However, parents are increasingly expressing concerns about whether these might be physically harmful. This mini review assessed the evidence. Method We conducted a narrative review on the effects of mask wearing on physiological variables in children, using PubMed, the Cochrane Library and the World Health Organization COVID‐19 Database up to 7 November 2020. The lack of paediatric studies prompted a second search for adult studies. Results We only found two paediatric studies, published in 2019 and 2020. The 2020 study was not related to COVID‐19. Only one study, performed with N95 respirators, collected medical parameters, and this did not suggest any harmful effects of gas exchange. The eight adult studies, including four prompted by the pandemic and one on surgeons, reported that face masks commonly used during the pandemic did not impair gas exchange during rest or mild exercise. Conclusion International guidelines recommend face masks for children aged six years and older, but further studies are needed to provide evidence‐based recommendations for different age groups.
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Affiliation(s)
- Martin Eberhart
- Department of Paediatrics and Adolescent Medicine LKH Hochsteiermark Leoben Austria
| | - Stefan Orthaber
- Department of Paediatrics and Adolescent Medicine LKH Hochsteiermark Leoben Austria
| | - Reinhold Kerbl
- Department of Paediatrics and Adolescent Medicine LKH Hochsteiermark Leoben Austria
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119
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Friedrich L, Levin G, Maixner N, Bart Y, Tsur A, Yinon Y, Meyer R. Hematologic adaptation to mask-wearing among pregnant women and obstetrical outcome during the coronavirus disease 2019 pandemic. Int J Gynaecol Obstet 2021; 154:297-303. [PMID: 33872397 PMCID: PMC9087669 DOI: 10.1002/ijgo.13715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effect of the coronavirus disease 2019 (COVID-19) mask-wearing on hematological laboratory components and obstetrical outcomes among women delivering during the COVID-19 pandemic. METHODS Laboratory results and obstetrical outcomes of women with singleton gestations, admitted for delivery during the COVID-19 mask-wearing period (April-June 2020) were compared with those of women delivering during the parallel period in 2019 and with a larger cohort derived from nine pre-pandemic years (March 2011-April 2020). RESULTS Overall, 1838 women delivered during the COVID-19 pandemic. Compared with the pre-pandemic period, mean hemoglobin and fibrinogen levels were significantly higher during the mask-wearing period (12.15 ± 1.1 vs 11.96 ± 1.2, P < 0.001 and 472 ± 103.6 vs 448 ± 85.1 mg/dl, P < 0.001, respectively). Platelet levels were lower (200 ± 56.0 vs 206 ± 57.5 K/µl, P < 0.001). The rate of delivery at <34 weeks of gestation was lower during the mask-wearing period (1.1% vs 2%, odds ratio [OR] 0.57, 95% confidence intervals [CI] 0.37-0.88, P = 0.01), whereas cesarean delivery and postpartum hemorrhage rates were higher (26.7% vs 24.4%, OR 1.13, 95% CI 1.02-1.25, P = 0.022 and 4.1% vs 2.8%, OR 1.5, 95% CI 1.2-1.8, P = 0.001, respectively). CONCLUSION A hard-to-ventilate space created by wearing a mask during the COVID-19 era may be the underlying cause of the observed higher hemoglobin level among pregnant women, possibly affecting obstetrical outcomes.
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Affiliation(s)
- Lior Friedrich
- Faculty of Health Sciences, The Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Nitzan Maixner
- Faculty of Health Sciences, The Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yossi Bart
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Tsur
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Yinon
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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120
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Doherty CJ, Mann LM, Angus SA, Chan JS, Molgat-Seon Y, Dominelli PB. Impact of wearing a surgical and cloth mask during cycle exercise. Appl Physiol Nutr Metab 2021; 46:753-762. [PMID: 33960846 DOI: 10.1139/apnm-2021-0190] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We sought to determine the impact of wearing cloth or surgical masks on the cardiopulmonary responses to moderate-intensity exercise. Twelve subjects (n = 5 females) completed three, 8-min cycling trials while breathing through a non-rebreathing valve (laboratory control), cloth, or surgical mask. Heart rate (HR), oxyhemoglobin saturation (SpO2), breathing frequency, mouth pressure, partial pressure of end-tidal carbon dioxide (PetCO2) and oxygen (PetO2), dyspnea were measured throughout exercise. A subset of n = 6 subjects completed an additional exercise bout without a mask (ecological control). There were no differences in breathing frequency, HR or SpO2 across conditions (all p > 0.05). Compared with the laboratory control (4.7 ± 0.9 cmH2O [mean ± SD]), mouth pressure swings were smaller with the surgical mask (0.9 ± 0.7; p < 0.0001), but similar with the cloth mask (3.6 ± 4.8 cmH2O; p = 0.66). Wearing a cloth mask decreased PetO2 (-3.5 ± 3.7 mm Hg) and increased PetCO2 (+2.0 ± 1.3 mm Hg) relative to the ecological control (both p < 0.05). There were no differences in end-tidal gases between mask conditions and laboratory control (both p > 0.05). Dyspnea was similar between the control conditions and the surgical mask (p > 0.05) but was greater with the cloth mask compared with laboratory (+0.9 ± 1.2) and ecological (+1.5 ± 1.3) control conditions (both p < 0.05). Wearing a mask during short-term moderate-intensity exercise may increase dyspnea but has minimal impact on the cardiopulmonary response. Novelty: Wearing surgical or cloth masks during exercise has no impact on breathing frequency, tidal volume, oxygenation, and heart rate However, there are some changes in inspired and expired gas fractions that are physiologically irrelevant. In young healthy individuals, wearing surgical or cloth masks during submaximal exercise has few physiological consequences.
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Affiliation(s)
- Connor J Doherty
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Leah M Mann
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah A Angus
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Jason S Chan
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Yannick Molgat-Seon
- Centre for Heart Lung Innovation, St. Paul's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.,The Gupta Faculty of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
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121
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Shaw KA, Zello GA, Butcher SJ, Ko JB, Bertrand L, Chilibeck PD. The impact of face masks on performance and physiological outcomes during exercise: a systematic review and meta-analysis. Appl Physiol Nutr Metab 2021; 46:693-703. [PMID: 33901405 DOI: 10.1139/apnm-2021-0143] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Face masks are promoted for preventing spread of viruses; however, wearing a mask during exercise might increase CO2 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 CO2 (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.
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Affiliation(s)
- Keely A Shaw
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon A Zello
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Scotty J Butcher
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jong Bum Ko
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Leandy Bertrand
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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122
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Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, Kempski O, Hirsch O. Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4344. [PMID: 33923935 PMCID: PMC8072811 DOI: 10.3390/ijerph18084344] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.
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Affiliation(s)
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Wendlingweg 2, 52074 Aachen, Germany;
| | - Bernd Klosterhalfen
- Institute of Pathology, Dueren Hospital, Roonstrasse 30, 52351 Dueren, Germany;
| | - David Graessel
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, 52425 Jülich, Germany;
| | | | - Oliver Kempski
- Institute of Neurosurgical Pathophysiology, University Medical Centre of the Johannes Gutenberg University of Mainz Langenbeckstr. 1, 55131 Mainz, Germany;
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, 57078 Siegen, Germany
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Behind the mask: Rethinking the use of face masks while exercising. Sci Sports 2021; 36:430-432. [PMID: 33897100 PMCID: PMC8053250 DOI: 10.1016/j.scispo.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
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Rauch S, van Veelen MJ, Oberhammer R, Dal Cappello T, Roveri G, Gruber E, Strapazzon G. Effect of Wearing Personal Protective Equipment (PPE) on CPR Quality in Times of the COVID-19 Pandemic-A Simulation, Randomised Crossover Trial. J Clin Med 2021; 10:jcm10081728. [PMID: 33923620 PMCID: PMC8072569 DOI: 10.3390/jcm10081728] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
Cardiopulmonary resuscitation (CPR) is considered an aerosol-generating procedure. Consequently, COVID-19 resuscitation guidelines recommend the use of personal protective equipment (PPE) during resuscitation. In this simulation of randomised crossover trials, we investigated the influence of PPE on the quality of chest compressions (CCs). Thirty-four emergency medical service BLS-providers performed two 20 min CPR sequences (five 2 min cycles alternated by 2 min of rest) on manikins, once with and once without PPE, in a randomised order. The PPE was composed of a filtering facepiece 3 FFP3 mask, safety glasses, gloves and a long-sleeved gown. The primary outcome was defined as the difference between compression depth with and without PPE; secondary outcomes were defined as differences in CC rate, release and the number of effective CCs. The participants graded fatigue and performance, while generalised estimating equations (GEE) were used to analyse data. There was no significant difference in CC quality between sequences without and with PPE regarding depth (mean depth 54 ± 5 vs. 54 ± 6 mm respectively), rate (mean rate 119 ± 9 and 118 ± 6 compressions per minute), release (mean release 2 ± 2 vs. 2 ± 2 mm) and the number of effective CCs (43 ± 18 vs. 45 ± 17). The participants appraised higher fatigue when equipped with PPE in comparison to when equipped without PPE (p < 0.001), and lower performance was appraised when equipped with PPE in comparison to when equipped without PPE (p = 0.031). There is no negative effect of wearing PPE on the quality of CCs during CPR in comparison to not wearing PPE.
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Affiliation(s)
- Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100 Bolzano, Italy; (M.J.v.V.); (T.D.C.); (G.R.); (G.S.)
- Department of Anaesthesia and Intensive Care, “F. Tappeiner” Hospital, Via Rossini 5, 39012 Merano, Italy
- Southtyrolean Helicopter Emergency Medical Service, Via Lorenz Böhler 3, 39100 Bolzano, Italy; (R.O.); (E.G.)
- Correspondence:
| | - Michiel Jan van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100 Bolzano, Italy; (M.J.v.V.); (T.D.C.); (G.R.); (G.S.)
| | - Rosmarie Oberhammer
- Southtyrolean Helicopter Emergency Medical Service, Via Lorenz Böhler 3, 39100 Bolzano, Italy; (R.O.); (E.G.)
- Department of Anaesthesia and Intensive Care, Brunico General Hospital, Via Ospedale 11, 39031 Brunico, Italy
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100 Bolzano, Italy; (M.J.v.V.); (T.D.C.); (G.R.); (G.S.)
| | - Giulia Roveri
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100 Bolzano, Italy; (M.J.v.V.); (T.D.C.); (G.R.); (G.S.)
| | - Elisabeth Gruber
- Southtyrolean Helicopter Emergency Medical Service, Via Lorenz Böhler 3, 39100 Bolzano, Italy; (R.O.); (E.G.)
- Department of Anaesthesia and Intensive Care, Brunico General Hospital, Via Ospedale 11, 39031 Brunico, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100 Bolzano, Italy; (M.J.v.V.); (T.D.C.); (G.R.); (G.S.)
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Janicijevic D, Redondo B, Jiménez R, Lacorzana J, García-Ramos A, Vera J. Intraocular pressure responses to walking with surgical and FFP2/N95 face masks in primary open-angle glaucoma patients. Graefes Arch Clin Exp Ophthalmol 2021; 259:2373-2378. [PMID: 33825030 PMCID: PMC8023773 DOI: 10.1007/s00417-021-05159-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose The use of face mask is globally recommended as a preventive measure against COVID-19. However, the intraocular pressure (IOP) changes caused by face masks remain unknown. The objective of this study was to assess the impact of wearing surgical and FFP2/N95 face masks during a 400-m walking protocol on IOP in primary open-angle glaucoma (POAG) patients. Methods Thirteen subjects diagnosed of POAG (21 eyes) were enrolled in this study. IOP was measured at baseline, during the 400-m walking protocol and after 5 min of passive recovery while POAG patients wore a surgical mask, FFP2/N95 mask and no mask in randomized order. From the 21 POAG eyes, we analyzed the IOP changes caused by physical exercise with two face masks and without wearing any face mask. Results At rest (baseline and recovery measurements), the use of the different face masks did not affect IOP levels (mean differences ranging from 0.1 to 0.6 mmHg). During physical activity, wearing an FFP2/N95 mask caused a small (mean differences ranging from 1 to 2 mmHg), but statistically significant, IOP rise in comparison to both the surgical mask and control conditions (Cohen’s d = 0.63 and 0.83, respectively). Conclusion Face masks must be used to minimize the risk of SARS-CoV-2 transmission, and POAG patients can safely use FFP2/N95 and surgical masks at rest. However, due to the IOP rise observed while walking with the FFP2/N95 mask, when possible, POAG patients should prioritized the use of surgical masks during physical activity.
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Affiliation(s)
- Danica Janicijevic
- Research Academy of Human Biomechanics, The Affiliated Hospital of Medical School of Ningbo University, Ningbo University, Ningbo, China.,Faculty of Sports Science, Ningbo University, Ningbo, China.,Faculty of Sport and Physical Education, The Research Centre, University of Belgrade, Belgrade, Serbia
| | - Beatríz Redondo
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Campus de la Fuentenueva 2, 18001, Granada, Spain.
| | - Raimundo Jiménez
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Campus de la Fuentenueva 2, 18001, Granada, Spain
| | - Javier Lacorzana
- Department of Ophthalmology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Amador García-Ramos
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Sports Sciences and Physical Conditioning, Faculty of Education, Catholic University of the Most Holy Conception, Concepción, Chile
| | - Jesús Vera
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of Sciences, University of Granada, Campus de la Fuentenueva 2, 18001, Granada, Spain
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Czypionka T, Greenhalgh T, Bassler D, Bryant MB. Masks and Face Coverings for the Lay Public : A Narrative Update. Ann Intern Med 2021; 174:511-520. [PMID: 33370173 PMCID: PMC7774036 DOI: 10.7326/m20-6625] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Whether and when to mandate the wearing of facemasks in the community to prevent the spread of coronavirus disease 2019 remains controversial. Published literature across disciplines about the role of masks in mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is summarized. Growing evidence that SARS-CoV-2 is airborne indicates that infection control interventions must go beyond contact and droplet measures (such as handwashing and cleaning surfaces) and attend to masking and ventilation. Observational evidence suggests that masks work mainly by source control (preventing infected persons from transmitting the virus to others), but laboratory studies of mask filtration properties suggest that they could also provide some protection to wearers (protective effect). Even small reductions in individual transmission could lead to substantial reductions in population spread. To date, only 1 randomized controlled trial has examined a community mask recommendation. This trial did not identify a significant protective effect and was not designed to evaluate source control. Filtration properties and comfort vary widely across mask types. Masks may cause discomfort and communication difficulties. However, there is no evidence that masks result in significant physiologic decompensation or that risk compensation and fomite transmission are associated with mask wearing. The psychological effects of masks are culturally shaped; they may include threats to autonomy, social relatedness, and competence. Evidence suggests that the potential benefits of wearing masks likely outweigh the potential harms when SARS-CoV-2 is spreading in a community. However, mask mandates involve a tradeoff with personal freedom, so such policies should be pursued only if the threat is substantial and mitigation of spread cannot be achieved through other means.
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Affiliation(s)
- Thomas Czypionka
- Institute for Advanced Studies, Vienna, Austria, and London School of Economics, London, United Kingdom (T.C.)
| | | | - Dirk Bassler
- University Hospital of Zurich and University of Zurich, Zurich, Switzerland (D.B., M.B.B.)
| | - Manuel B Bryant
- University Hospital of Zurich and University of Zurich, Zurich, Switzerland (D.B., M.B.B.)
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127
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Stradford J, Sakhare A, Ravichandran R, Schroeder ET, Michener LA, Pa J. Conducting a VR Clinical Trial in the Era of COVID-19. FRONTIERS IN VIRTUAL REALITY 2021; 2:639478. [PMID: 35928984 PMCID: PMC9348517 DOI: 10.3389/frvir.2021.639478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2, also known as Coronavirus Disease 2019 (COVID-19) sparked a global public health pandemic that has impacted every aspect of daily life. Medical research was affected, and many clinical trials were halted to minimize COVID-19 transmission risk and spread while the world navigated this novel virus. Here we describe the relaunch of our virtual reality (VR) pilot clinical trial that uses an in-lab brain and body training program to promote brain health in mid-to-late life older adults, in the era of COVID-19. This case series includes five healthy female participants between 51 and 76 years of age, a subset of a larger VR pilot clinical trial that started pre-pandemic. We developed a revised study protocol based on the Center for Disease Control and World Health Organization guidelines to help manage the spread of COVID-19. Since the limited resumption of clinical trials at our institution in August 2020, we successfully completed over 200 in-lab virtual reality training sessions using our revised protocol. During this time, none of the five participants or three study staff reported any COVID-19 symptoms or reported a positive COVID-19 test. More than 40 voluntary COVID-19 tests were completed by our study staff over the last 6 months. All participants rated our safety protocol as very satisfied or extremely satisfied and that they would be very likely or extremely likely to participate in a VR clinical trial during the pandemic. Based on these findings, we suggest that continued VR clinical trial research during the COVID-19 pandemic is achievable and can be safely resumed if specific safety protocols are in place to mitigate the risk of exposure and spread of COVID-19.
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Affiliation(s)
- Joy Stradford
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Ashwin Sakhare
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Roshan Ravichandran
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - E. Todd Schroeder
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Lori A. Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Judy Pa
- Department of Neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
- University of Southern California Alzheimer’s Disease Research Center, Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
- Correspondence: Judy Pa,
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128
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Pulmonary Effects Due to Physical Exercise in Polluted Air: Evidence from Studies Conducted on Healthy Humans. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11072890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Physical inactivity has caused serious effects on the health of the population, having an impact on the quality of life and the cost of healthcare for many countries. This has motivated government and private institutions to promote regular physical activity, which, paradoxically, can involve health risks when it is carried out in areas with poor air quality. This review collects information from studies conducted on healthy humans related to the pulmonary effects caused by the practice of physical activity when there is poor air quality. In addition, several challenges related to the technological and educational areas, as well as to applied and basic research, have been identified to facilitate the rational practice of exercise in poor air quality conditions.
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129
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Ramos-Campo DJ, Pérez-Piñero S, Muñoz-Carrillo JC, López-Román FJ, García-Sánchez E, Ávila-Gandía V. Acute Effects of Surgical and FFP2 Face Masks on Physiological Responses and Strength Performance in Persons with Sarcopenia. BIOLOGY 2021; 10:biology10030213. [PMID: 33799555 PMCID: PMC8001820 DOI: 10.3390/biology10030213] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022]
Abstract
Simple Summary Study comparing the use of a surgical mask, FFP2 or none in people with sarcopenia during a resistance training session on strength performance, heart rate, heart rate variability, blood lactate concentration or rating of perceived effort. Abstract Due to COVID-19, wearing a face mask to reduce virus transmission is currently mandatory in some countries when participants practice exercise in sports centers. Therefore, the aim of the present study was to analyze the effect of wearing a surgical or FFP2 mask during a resistance training session. Fourteen people with sarcopenia (age: 59.40 ± 5.46 years; weight: 68.78 ± 8.31 kg; height: 163.84 ± 9.08 cm) that participated in the study performed three training sessions in a randomized order: 4 sets of 10 repetitions of a half-squat at 60% of the one-repetition maximum and 90 s of rest between set and were either (a) without a mask (NM), (b) wearing a surgical face mask (SM), and (c) wearing a FFP2 face mask (FFP2). We found that wearing face masks had no effect on strength performance (session mean propulsive velocity (m/s): WM: 0.396 ± 0.042; SM: 0.387 ± 0.037; and FFP2: 0.391 ± 0.042 (p = 0.918)). Additionally, no impact of wearing a mask was found on heart rate, heart rate variability, blood lactate concentration (WM: 4.17 ± 1.89; SM: 4.49 ± 2.07; and FFP2: 5.28 ± 2.45 mmol/L (p = 0.447)), or rating of perceived exertion. Wearing a surgical or FFP2 face mask during a resistance training session resulted in similar strength performance and physiological responses than the same exercise without a mask in persons with sarcopenia.
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Affiliation(s)
| | - Silvia Pérez-Piñero
- Department of Exercise Physiology, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (J.C.M.-C.); (F.J.L.-R.); (V.Á.-G.)
- Correspondence:
| | - Juan Carlos Muñoz-Carrillo
- Department of Exercise Physiology, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (J.C.M.-C.); (F.J.L.-R.); (V.Á.-G.)
| | - Francisco Javier López-Román
- Department of Exercise Physiology, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (J.C.M.-C.); (F.J.L.-R.); (V.Á.-G.)
- Primary Care Research Group, Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain
| | - Esther García-Sánchez
- Fundación para la Formación e Invetigación Sanitarias de la Región de Murcia, 30003 Murcia, Spain;
| | - Vicente Ávila-Gandía
- Department of Exercise Physiology, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (J.C.M.-C.); (F.J.L.-R.); (V.Á.-G.)
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Mapelli M, Salvioni E, De Martino F, Mattavelli I, Gugliandolo P, Vignati C, Farina S, Palermo P, Campodonico J, Maragna R, Lo Russo G, Bonomi A, Sciomer S, Agostoni P. “You can leave your mask on”: effects on cardiopulmonary parameters of different airway protective masks at rest and during maximal exercise. Eur Respir J 2021; 58:13993003.04473-2020. [DOI: 10.1183/13993003.04473-2020] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/03/2021] [Indexed: 01/23/2023]
Abstract
During the COVID-19 pandemic, the use of protective masks has been essential to reduce contagions. However, public opinion is that there is an associated subjective shortness of breath. We evaluated cardiorespiratory parameters at rest and during maximal exertion to highlight any differences with the use of protective masks.12 healthy subjects performed three identical cardiopulmonary exercise tests, one without wearing a protective mask, one wearing a surgical mask and one with a filtering face piece particles class 2 (FFP2) mask. Dyspnoea was assessed using the Borg scale. Standard pulmonary function tests were also performed.All the subjects (40.8±12.4 years; six male) completed the protocol with no adverse events. Spirometry showed a progressive reduction of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from no mask to surgical to FFP2 (FEV1: 3.94±0.91 L, 3.23±0.81 L, 2.94±0.98 L; FVC: 4.70±1.21 L, 3.77±1.02 L, 3.52±1.21 L; p<0.001). Rest ventilation, O2 uptake (V˙O2) and CO2 production (V˙CO2) were progressively lower, with a reduction in respiratory rate. At peak exercise, subjects had a progressively higher Borg scale when wearing surgical and FFP2 masks. Accordingly, at peak exercise, V˙O2 (31.0±23.4 mL·kg−1·min−1, 27.5±6.9 mL·kg−1·min−1, 28.2±8.8 mL·kg−1·min−1; p=0.001), ventilation (92±26 L, 76±22 L, 72±21 L; p=0.003), respiratory rate (42±8 breaths·min−1, 38±5 breaths·min−1, 37±4 breaths·min−1; p=0.04) and tidal volume (2.28±0.72 L, 2.05±0.60 L, 1.96±0.65 L; p=0.001) were gradually lower. There was no significant difference in oxygen saturation.Protective 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 increased airflow resistance. However, because exercise ventilatory limitation is far from being reached, their use is safe even during maximal exercise, with a slight reduction in performance.
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131
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Shaw K, Butcher S, Ko J, Zello GA, Chilibeck PD. Wearing of Cloth or Disposable Surgical Face Masks has no Effect on Vigorous Exercise Performance in Healthy Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8110. [PMID: 33153145 PMCID: PMC7662944 DOI: 10.3390/ijerph17218110] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Wearing face masks is recommended for the prevention of contracting or exposing others to cardiorespiratory infections, such as COVID-19. Controversy exists on whether wearing face masks during vigorous exercise affects performance. We used a randomized, counterbalanced cross-over design to evaluate the effects of wearing a surgical mask, a cloth mask, or no mask in 14 participants (7 men and 7 women; 28.2 ± 8.7 y) during a cycle ergometry test to exhaustion. Arterial oxygen saturation (pulse oximetry) and tissue oxygenation index (indicator of hemoglobin saturation/desaturation) at vastus lateralis (near-infrared spectroscopy) were assessed throughout the exercise tests. Wearing face masks had no effect on performance (time to exhaustion (mean ± SD): no mask 622 ± 141 s, surgical mask 657 ± 158 s, cloth mask 637 ± 153 s (p = 0.20); peak power: no mask 234 ± 56 W, surgical mask 241 ± 57 W, cloth mask 241 ± 51 W (p = 0.49)). When expressed relative to peak exercise performance, no differences were evident between wearing or not wearing a mask for arterial oxygen saturation, tissue oxygenation index, rating of perceived exertion, or heart rate at any time during the exercise tests. Wearing a face mask during vigorous exercise had no discernable detrimental effect on blood or muscle oxygenation, and exercise performance in young, healthy participants (ClinicalTrials.gov, NCT04557605).
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Affiliation(s)
- Keely Shaw
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (K.S.); (J.K.)
| | - Scotty Butcher
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada;
| | - Jongbum Ko
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (K.S.); (J.K.)
| | - Gordon A. Zello
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
| | - Philip D. Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (K.S.); (J.K.)
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Epstein D, Korytny A, Isenberg Y, Marcusohn E, Zukermann R, Bishop B, Minha S, Raz A, Miller A. Return to training in the COVID-19 era: The physiological effects of face masks during exercise. Scand J Med Sci Sports 2020; 31:70-75. [PMID: 32969531 PMCID: PMC7646657 DOI: 10.1111/sms.13832] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
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 8 mm Hg at exhaustion (none vs N95, P = .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.
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Affiliation(s)
- Danny Epstein
- Internal Medicine "B" Department, Rambam Health Care Campus, Haifa, Israel
| | - Alexander Korytny
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Yoni Isenberg
- Internal Medicine "B" Department, Rambam Health Care Campus, Haifa, Israel
| | - Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Robert Zukermann
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Boaz Bishop
- Department of Nephrology, Rambam Medical Center, Haifa, Israel
| | - Sa'ar Minha
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Asaf Miller
- Medical Intensive Care unit, Rambam Health Care Campus, Haifa, Israel
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Ramagole DA, Janse van Rensburg DC, Pillay L, Viviers P, Zondi P, Patricios J. Implications of COVID-19 for resumption of sport in South Africa: A South African Sports Medicine Association (SASMA) position statement - Part 2. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2020; 32:v32i1a8986. [PMID: 36818971 PMCID: PMC9924523 DOI: 10.17159/2078-516x/2020/v32i1a8986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The lockdown regulations due to the coronavirus pandemic (COVID-19) that broke out towards the end of 2019 and continued to spread throughout most countries in the world had a negative effect on the sporting community. The South African government eased the lockdown rules to Level 1 from 21 September 2020. In Part 2 of this Position Statement of the South African Sports Medicine Association (SASMA), the authors address the position regarding the safe return to sports for athletes who were infected by the virus. An update on clinical manifestations and multi-organ involvement, testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), prolonged positive real time polymerase chain reaction (RT-PCR) and the role of quantitative real time polymerase chain reaction (RT-qPCR) in informing return to sports, grading of disease severity, individualised management of infected athletes and graduated return to play guidelines (GRTP) is provided. The authors also share thoughts on athletes with disabilities, immunisation, the using of masks during exercise and utilising biologically safe environments (BSE). Finally the SASMA Guidelines for Safe RTP in Level 1 lockdown during SARS-Cov-2 are introduced.
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Affiliation(s)
- DA Ramagole
- Section Sports Medicine & Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria,
South Africa
| | - DC Janse van Rensburg
- Section Sports Medicine & Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria,
South Africa
- Medical Board Member, International Netball Federation, Manchester,
UK
| | - L Pillay
- Section Sports Medicine & Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria,
South Africa
| | - P Viviers
- Campus Health Service, Stellenbosch University,
South Africa
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
- FIFA Medical Centre of Excellence,
South Africa
| | - P Zondi
- Sports Science Institute of South Africa, Newlands,
South Africa
- South African Sports Confederation and Olympic Committee, Medical Advisory Committee
| | - J Patricios
- Wits Sport and Health (WiSH), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
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