Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity

Effects of surgical and cloth facemasks during a submaximal exercise test in healthy adults

BACKGROUND

Surgical (SM) or cloth facemasks (CM) has become mandatory in many public spaces during the COVID-19 pandemic. They may interfere with the participation in physical activities.

OBJECTIVE

To evaluate how these masks influence dyspnoea (primary outcome), exercise performance and cardiorespiratory response during a 1-min sit-to-stand test (1STST), and to assess masks discomfort sensations.

METHODS

A randomized crossover trial was conducted in healthy adults. They performed 3 1STST (with either no mask (NM), a SM, or a CM) separated from each other by 24-72 h. The number of 1STST repetitions and leg rate of perceived exertion (RPE) were measured. Dyspnoea (Borg scale), hearth rate, respiratory rate and SpO₂ were recorded before and at the end of 1STST, as well as after a short resting period. Several domains of subjective discomfort perceptions with masks were assessed.

RESULTS

Twenty adults aged 22 ± 2y (11 males) were recruited. Wearing the CM generated significantly higher dyspnoea than NM at all time points, but it only became clinically relevant after the 1STST (median difference, 1 [95%CI 0 to 1]). The SM generated a small but significant higher leg RPE than NM (median difference, 1 [95%CI 0 to 1]). The masks had no impact on 1STST performance nor cardiorespiratory parameters. Both masks were rated similarly for discomfort perceptions except for breathing resistance where CM was rated higher.

CONCLUSIONS

In healthy adults, the CM and SM had minimal to no impact on dyspnoea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise test.

Can remotely supervised exercise positively affect self-reported depressive symptoms and physical activity levels during social distancing?

The main objective of this cross-sectional study was to compare the self-reported depressive symptoms and physical activity (PA) levels among participants who performed self- nonexercising (NE), guided exercise (SGE), remotely supervised exercise (RSE), and face-to-face supervised exercise (FFE) during social distancing. Three hundred and forty-four individuals (≥18 years and 67% women) answered a self-reported online survey that included questions related to the physical exercise practice (e.g., supervised and remote) during social distancing and questions about perceptions of depressive symptoms (Montgomery-Åsberg Depression Rating Scale-Self Rated [MADRS-S] scores) and metabolic equivalent task minutes per week (METs min•wk^-1) of moderate- and vigorous-intensity PA, and total PA scores (International Physical Activity Questionnaire-Short Form) before and during social distancing. The RSE group (n=45) showed higher METs of vigorous-intensity PA than the SGE (n=146) and NE (n=109) groups. The RSE and FFE (n=44) groups showed higher METs of the total PA scores than the SGE and NE groups. The NE group showed higher MADRS-S scores than the other groups. Lower MADRS-S scores depend on the exercise practice and higher METs of vigorous-intensity PA depend on the supervised exercise practice. Thus, telehealth interventions can be implemented during the pandemic to enhance vigorous PA.

Decreased exercise capacity in young athletes using self-adapted mouthguards

PURPOSE

There is evidence of both the preventive effects and poor acceptance of mouthguards. There are various effects on performance depending on the type of mouthguard model. Hemodynamic responses to wearing a mouthguard have not been described. The aim of this study was to investigate the effects of self-adapted mouthguards with breathing channels (SAMGvent).

METHODS

In this randomized crossover study, 17 healthy, active subjects (age 25.12 ± 2.19 years) underwent body plethysmography and performed two incremental exertion tests wearing a (SAMGvent) and not wearing (CON) a mouthguard. Blood lactate, spirometrics, and thoracic impedance were measured during these maximum exercise tests.

RESULTS

The mean values using a SAMGvent revealed significantly greater airway resistance compared to CON (0.53 ± 0.16 kPa·L-1 vs. 0.35 ± 0.10 kPa·L-1, respectively; p = < 0.01). At maximum load, ventilation with SAMGvent was less than CON (118.4 ± 28.17 L min-1 vs. 128.2 ± 32.16 L min-1, respectively; p = < 0.01). At submaximal loads, blood lactate responses with SAMGvent were higher than CON (8.68 ± 2.20 mmol·L-1 vs. 7.89 ± 1.65 mmol·L-1, respectively; p < 0.01). Maximum performance with a SAMGvent was 265.9 ± 59.9 W, and without a mouthguard was 272.9 ± 60.8 W (p < 0.01). Maximum stroke volume was higher using a SAMGvent than without using a mouthguard (138.4 ± 29.9 mL vs. 130.2 ± 21.2 mL, respectively; p < 0.01).

CONCLUSION

Use of a self-adapted mouthguard led to increased metabolic effort and a significant reduction in ventilation parameters. Unchanged oxygen uptake may be the result of cardiopulmonary compensation and increased breathing efforts, which slightly affects performance. These results and the obvious preventive effects of mouthguards support their use in sports.

[Effects of surgical face masks on exercise performance and perceived exertion of exercise in well-trained healthy boys]

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.

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

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.

Ultrafine PVDF Nanofibers for Filtration of Air-Borne Particulate Matters: A Comprehensive Review

The ongoing global pandemic has bestowed high priority uponthe separation of air-borne particulate matters (PMs), aerosols, etc. using nonwoven fibrous materials, especially for face masks as a means of personal protection. Although spunbond or meltblown nonwoven materials are amongst the forerunners for polymer microfiber-based face mask or air filter development in mass scale, relatively new process of nonwoven manufacturing such as electrospinning is gaining a lot of momentum amongst the filter membrane manufacturers for its scalability of nanofiber-based filter membrane fabrication. There are several nanofiber-based face masks developing industries, which claim a very high efficiency in filtration of particulate matters (PM0.1-10) as well as other aerosols for their products. Polyvinylidene fluoride (PVDF), which is commonly known for its use of tactile sensors and energy harvesters, due to its piezoelectric property, is slowly gaining popularity among researchers and developers as an air filter material. Electrospun PVDF nanofibers can be as fine as 50 nm in mass scale, which allows the membrane to have large surface area compared to its volume, enhancing nanofiber-PM interaction. At the same time, the breathability index can be improved through these PVDF nanofiber membranes due to their architectural uniqueness that promotes slip flow around the fibers. The conductive nature of PVDF makes it advantageous as a promising electret filter allowing better capturing of ultrafine particles. This review aims to provide a comprehensive overview of such PVDF nanofiber-based filter membranes and their roles in air filtration, especially its application in filtrate of air-borne PMs.

Impact of in-flight use of FFP2 masks on oxygen saturation: an experimental crossover study

This study was able to show in a crossover design that neither at resting conditions nor during a simulated 80 min flight wearing the examined FFP2 face mask leads to changes in the SpO2, the heart rate or the parameters of the capillary blood gas analysis.

Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue

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.

The impact of face masks on children-A mini review

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.

Effect of a Warm-Up Protocol with and without Facemask-Use against COVID-19 on Cognitive Function: A Pilot, Randomized Counterbalanced, Cross-Sectional Study

The present study aimed to verify the effect of a warm-up protocol with and without facemask-use on cognitive function. The sample was composed of 17 healthy, non-smoking physical education students (age = 17.6 years, height = 1.71 m, and body mass = 69.7 kg). They were randomized to perform 15 min of warm-up exercises, while wearing a cloth facemask (EXP) or no mask (CON) on two separate occasions, with at least 48-h separating conditions. Rate of perceived exertion (RPE) and d2 Attention assessment were used to verify cognitive function, using a repeated measures general linear model. The warm-up improved cognitive abilities and the results demonstrated significant differences between the EXP vs. CON groups in post-concentration performance (186.06 ± 15.47 EXP-score vs. 178.12 ± 13.66 CON-score), post the total number of errors (23.47 ± 14.50 EXP-frequency < 29.06 ± 13.74 CON-frequency), and in the post RPE (6.0 ± 1.37 EXP-index > 4.7 ± 0.85 CON-index). Wearing a cloth facemask caused positive effects on cognitive function. This data suggests that wearing a cloth facemask during warm-up may stimulate/improve the cognitive function.

Impact of wearing a surgical and cloth mask during cycle exercise

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 (P_etCO₂) and oxygen (P_etO₂), 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 P_etO₂ (-3.5 ± 3.7 mm Hg) and increased P_etCO₂ (+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.

The effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints

PURPOSE

The aim of this study was to reveal the effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints.

METHODS

Sixty participants were enrolled in this study, including 30 people in N95 mask group and 30 people in surgical mask group. Two interviews, three days apart, were performed with all participants. The participants were asked not to use any mask before the first interview while they were asked to use the determined mask just before the second interview for 8 h. In both interviews, the mucociliary clearance times (MCTs) were measured and participants were asked to score ten distinct sinonasal complaints using visual analog scale (VAS). Data obtained from first interview were named pre-mask data, data obtained from second interview were called after-mask data. In both groups, pre-mask MCTs and VAS scores were compared with after-mask MCTs and VAS scores.

RESULTS

After-mask MCTs (mean = 13.03 ± 6.05 min) were significantly longer than pre-mask MCTs (mean = 10.19 ± 4.21 min) in N95 mask group (p = 0.002). No significant difference was found between after-mask and pre-mask MCTs (mean = 12.05 ± 5.21 min, mean = 11.00 ± 5.44 min, respectively) in surgical mask group (p = 0.234). When after-mask VAS scores were compared with pre-mask VAS scores, it was found that N95 mask use increased nasal blockage and postnasal discharge, surgical mask usage increased nasal blockage.

CONCLUSION

While the use of N95 mask leads to nasal blockage and postnasal discharge, surgical mask use results in nasal blockage. N95 masks cause impairment in mucociliary clearance function. But all these effects are mild. Surgical masks have not been found to have any effect on mucociliary clearance function.

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

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.

COVID-19 and physical activity in sedentary individuals: differences in metabolic, cardiovascular, and respiratory responses during aerobic exercise performed with and without a surgical face masks

BACKGROUND

The Coronavirus-19 (COVID-19) impairs metabolic, cardiovascular, and pulmonary functions in human metabolism, and wearing face masks is recommended for the prevention of contracting or exposing others to cardio-respiratory infections. Since the effect of wearing a surgical face mask (SFM) on cardiopulmonary exercise capacity has not been systematically reported we aimed to determine the effects of wearing SFM during an incremental walking test on metabolic, cardiovascular, and pulmonary gas exchange responses in sedentary individuals.

METHODS

The evaluations were performed using a repeated measures study design. Seven sedentary males (age:40years, height:178cm, weight:88kg, BMI:28kg/m2, VO2max:32.7±3.9ml/kg/min) and 7 sedentary female participants (age:34years, height:169cm, weight:62kg, BMI:22kg/m2, VO2max:32.1±6.8 ml/kg/min) volunteered to participate in the current study. Anthropometric parameters were measured using a Bioelectrical impedance analysis prior to each testing session. The measures of lung function assessed by spirometry, breathing pattern, maximal exercise capacity with-and-without mask were measured with a breath-by-breath automated exercise metabolic system during incremental Bruce protocol on a treadmill with two consecutive sessions with 48-h intervals. Blood pressure values (systolic and diastolic pressure) of the individuals were taken and recorded within 1 minute at the end of every ten minutes, without speed changes.

RESULTS

VO2, VCO2, and VE were significantly lower during exercise performed with SFM (p<0.001). Heart rate, systolic and diastolic blood pressure were also found significantly higher during exercise performed with SFM (p<0.01).

CONCLUSIONS

Wearing a SFM during incremental walking predispose a decrease in oxygen delivery while increasing pulmonary ventilation in sedentary individuals. Thus, it could be speculated that surgical face masks have a negative impact on oxygen delivery during exercise which results in decreased exercise performance due to the restricted ventilatory conditions.

Validity of the 6-Minute Walk Test in Patients with End-Stage Lung Diseases Wearing an Oronasal Surgical Mask in Times of the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The 6-minute walk test (6MWT), as a clinical assessment tool for functional exercise capacity, is an integral component of lung allocation scores (LASs). In times of the coronavirus disease (COVID-19) pandemic, patients underwent 6MWTs wearing a surgical mask in ambulatory care. We investigated the impact of wearing a mask on 6-minute walk distances (6MWDs).

METHOD

6MWDs of 64 patients with end-stage lung diseases wearing an oronasal surgical mask were retrospectively compared to previously investigated 6MWDs of the same cohort, in a pre-COVID-19 pandemic era, without wearing a mask. Four patients were excluded due to a primary vascular disease, 29 patients due to clinically unstable pulmonary functions, and 1 patient due to a psychiatric disorder.

RESULTS

The median age of the patients included was 55 (46-58) years; 15 (48%) were male. Ten (32.2%) were on the Eurotransplant lung transplant waiting list with a median LAS of 34.3 (31.9-36.2). Twenty (64.5%) patients had chronic obstructive pulmonary diseases, 7 (22.6%) had interstitial lung diseases, and 4 (12.9%) had other end-stage lung diseases. The mean 6MWD without versus with wearing a mask was 306.9 (101.9) versus 305.7 (103.8) m, with a mean difference of -1.19 m (95% confidence interval -13.4 to 11.03). The observed difference is statistically equivalent to zero (p < 0.001). No significant differences in 6MWDs were observed between the clinical groups.

CONCLUSION

Wearing an oronasal surgical mask did not affect the 6MWDs of patients with advanced lung diseases. Therefore, a masked 6MWT appears to provide a reliable examination of functional exercise capacity in this cohort.

Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?

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.

Intraocular pressure responses to walking with surgical and FFP2/N95 face masks in primary open-angle glaucoma patients

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.

Masks and Face Coverings for the Lay Public : A Narrative Update

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.

Exercise testing in COVID-19 era: Clinical profile, results and feasibility wearing a facemask

BACKGROUND

No data are available about whether Coronavirus disease 2019 (COVID-19) pandemic have led to changes in clinical profiles or results of exercise testing once the usual activity was reassumed, as well as if wearing a facemask has any impact on the tests. The aim of this study is to evaluate differences in the patients referred to exercise stress testing in the context of COVID-19 pandemic and analyse the feasibility and results of these tests wearing a facemask.

METHODS

We included all patients referred for an exercise test from 1 June to 30 September 2020 and compared them with the patients attended within the same period in 2019 before and after propensity score matching. All patients referred in 2020 wore a facemask.

RESULTS

A total of 854 patients were included: 398 in the 2020 group and 456 in 2019. No significant differences in baseline characteristics of the patients were observed, with the exception of dyspnoea, which was nearly twice as high in 2020 as compared with 2019. Regarding the results of the tests, no differences were observed, with almost 80% of maximal tests, similar functional capacity and over a 20% of positive exercise tests in both groups. These results remained after propensity score matching.

CONCLUSION

COVID-19 pandemic has not changed the clinical profile of patients referred to exercise testing. In addition, performing exercise testing wearing a facemask is feasible, with no influence in functional capacity and clinical results.

Antibacterial Activity and Protection Efficiency of Polyvinyl Butyral Nanofibrous Membrane Containing Thymol Prepared through Vertical Electrospinning

Human safety, health management, and disease transmission prevention have become crucial tasks in the present COVID-19 pandemic situation. Masks are widely available and create a safer and disease transmission-free environment. This study presents a facile method of fabricating masks through electrospinning nontoxic polyvinyl butyral (PVB) polymeric matrix with the antibacterial component Thymol, a natural phenol monoterpene. Based on the results of Japanese Industrial Standards and American Association of Textile Chemists and Colorists methods, the maximum antibacterial value of the mask against Gram-positive and Gram-negative bacteria was 5.6 and 6.4, respectively. Moreover, vertical electrospinning was performed to prepare Thymol/PVB nanofiber masks, and the effects of parameters on the submicron particulate filtration efficiency (PFE), differential pressure, and bacterial filtration efficiency (BFE) were determined. Thorough optimization of the small-diameter nanofiber-based antibacterial mask led to denser accumulation and improved PFE and pressure difference; the mask was thus noted to meet the present pandemic requirements. The as-developed nanofibrous masks have the antibacterial activity suggested by the National Standard of the Republic of China (CNS 14774) for general medical masks. Their BFE reaches 99.4%, with a pressure difference of <5 mmH2O/cm2. The mask can safeguard human health and promote a healthy environment.

[Indirect and direct psychosocial consequences of the corona pandemic-part 1 of a (preliminary) review]

The pandemic triggered by the coronavirus disease 2019 (COVID-19) has, apart from a few positive effects, led to massive and manifold impairments of human living conditions for which this article suggests a taxonomy. According to the severity, these impairments have resulted in a deterioration of the psychological well-being for many people and an increased vulnerability for psychological disorders. This has been confirmed by numerous studies and review articles, which also dealt with the question of factors that positively as well as negatively influencing mental health. This review shows that, e.g. suffering from COVID-19 disease, younger age and female gender as well as a pre-existing psychiatric or somatic disease must be considered as special risk factors. Psychotherapists are confronted with the pandemic in different ways. In view of the societal impact psychotherapists have a special role. In addition, the pandemic raises questions on specific issues and specific groups which must be addressed.

Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Retinal and choroidal vascularity changes in healthcare professionals wearing FFP3 respirators

PURPOSE

To evaluate short-term retinal and choroidal vascularity changes in the healthcare professionals after four hours of use filtering facepiece respirators (FFR).

MATERIALS AND METHODS

This prospective study included 20 healthcare professionals. Oxygen saturation, pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), and spectral domain optical coherence tomography (OCT) imaging were evaluated at baseline and after four hours wearing of FFP3 FFRs without an exhalation valve. Superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), and inferior temporal vein (ITV) diameter were measured from OCT images. The total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA) choroidal vascularity index [(CVI), the ratio of LA to TCA] were determined after binarization of enhanced depth imaging OCT (EDI-OCT) images of the choroid.

RESULTS

The mean age of the participants was 27.35 ± 2.80 years (range, 25-34). Eight of them were female and 12 were male. After wearing the FFR for four hours, a significant decrease was observed in the mean DBP (p = 0.018), MAP (p = 0.016), and MOPP (p = 0.007) when compared to base-line values. STV diameter (p = 0.019) and ITV diameter (p = 0.046) measurements were found significantly higher than baseline measurements. A significant increase in the choroidal vascularity was observed in the LA (p = 0.004) and TCA values (p = 0.043) after wearing the FFR for four hours.

CONCLUSION

The current study shows that after four hours usage of FFR, in addition to systemic changes, retinal and choroidal vascularity might be affected significantly. With further studies, long-term effects and clinical significance of these short-term changes should be investigated on healthcare professionals.

Acute Effects of Surgical and FFP2 Face Masks on Physiological Responses and Strength Performance in Persons with Sarcopenia

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.

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

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.

Protective Face Masks: Effect on the Oxygenation and Heart Rate Status of Oral Surgeons during Surgery

Background: Safety in medical work requires eye protection, such as glasses, and protective facial masks (PFM) during clinical practice to prevent viral respiratory infections. The use of facial masks and other full personal protective equipment increases air flow resistance, facial skin temperature and physical discomfort. The aim of the present study was to measure surgeons’ oxygenation status and discomfort before and after their daily routine activities of oral interventions. Methods: 10 male voluntary dentists, specializing in oral surgery, and 10 male voluntary doctors in dentistry, participating in master’s courses in oral surgery in the Department of Oral Surgery of the University of Chieti, with mean age 29 ± 6 (27–35), were enrolled. This study was undertaken to investigate the effects of wearing a PFM on oxygenation status while the oral surgeons were actively working. Disposable sterile one-way surgical paper masks (Surgical Face Mask, Euronda, Italy) and FFP2 (Surgical Face Mask, Euronda, Italy) were used and the mask position covering the nose did not vary during the procedures. The FFP2 was covered by a surgical mask during surgical treatment. A pulse oximeter was used to measure the blood oximetry saturation during the study. Results: In all 20 surgeons wearing FFP2 covered by surgical masks, a reduction in arterial O₂ saturation from around 97.5% before surgery to 94% after surgery was recorded with increase of heart rates. A shortness of breath and light-headedness/headaches were also noted. Conclusions: In conclusion, wearing an FFP2 covered by a surgical mask induces a reduction in circulating O₂ concentrations without clinical relevance, while an increase of heart frequency and a sensation of shortness of breath, light-headedness/headaches were recorded.

Effects of Wearing the Elevation Training Mask During Low-intensity Cycling Exercise on Intraocular Pressure

PRCIS

Low-intensity aerobic exercise is recommended to reduce intraocular pressure (IOP) levels. However, this effect depends on several factors. We found that using an elevation training mask (ETM) during low-intensity aerobic exercise causes an IOP rise.

PURPOSE

The aim was to assess the influence of wearing an ETM on IOP during low-intensity endurance training.

METHODS

Sixteen physically active young adults (age=23.9±2.9 y) cycled during 30 minutes at 10% of maximal power production with and without an ETM in 2 different days and randomized order. A rebound tonometer was used to measure IOP at baseline, after a warm-up of 5 minutes, during cycling (6, 12, 18, 24, and 30 min), and recovery (5 and 10 min) by rebound tonometry.

RESULTS

The use of an ETM significantly affects the IOP behaviour during exercise (P<0.001, ηp²=0.66). In the ETM condition, there was an IOP increment during exercise (P<0.001, ηp²=0.28) whereas an IOP-lowering effect was observed in the control condition (P<0.001, ηp²=0.41). Post hoc comparisons showed that there were greater IOP values during exercise in the ETM condition in comparison to the control condition (average IOP difference=3.7±2.2 mm Hg; corrected P<0.01, and the Cohen d's >1.10, in all cases).

CONCLUSION

Low-intensity endurance exercise causes an increment in IOP when it is performed wearing an ETM and a decrease in IOP when the air flow is not restricted (control condition). Therefore, the ETM should be discouraged during low-intensity endurance exercise for individuals who need to reduce IOP levels (eg, glaucoma patients or those at risk). However, the external validity of these results needs to be addressed in future studies with the inclusion of glaucoma patients.

The Physiological Impact of Masking Is Insignificant and Should Not Preclude Routine Use During Daily Activities, Exercise, and Rehabilitation

PURPOSE

Masking has been employed as a strategy for reducing transmission of a variety of communicable diseases. With the outbreak of SARS-CoV-2, many countries have implemented mandatory public masking. However, the perceived impact of mask use on pulmonary function has been a deterrent to public compliance with recommendations. COVID-19 has shed light on the impact that comorbid cardiac and pulmonary conditions may have on disease severity. This knowledge has led to increased primary and secondary prevention efforts for which exercise and rehabilitation are central. The importance of safe methods of exercise while mitigating risk of viral transmission is paramount to global recovery from the pandemic and prevention of future outbreaks.

METHODS

We constructed a focused literature review of the impact of various masks on pulmonary function at rest and with exercise. This was then incorporated into recommendations for the integration of masks with exercise and rehabilitation in the COVID-19 era.

RESULTS

While there is a paucity of evidence, we identified the physiological effects of masking at rest and during exercise to be negligible. The perceived impact appears to be far greater than the measured impact, and increased frequency of mask use leads to a physiological and psychological adaptive response.

CONCLUSIONS

Masking during daily activities, exercise, and rehabilitation is safe in both healthy individuals and those with underlying cardiopulmonary disease. Rehabilitation participants should be reassured that the benefits of masking during COVID-19 far outweigh the risks, and increased frequency of mask use invokes adaptive responses that make long-term masking tolerable.

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

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

Resistance Training Safety during and after the SARS-Cov-2 Outbreak: Practical Recommendations

In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.

Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemic

In this commentary, we discuss the physiological effects of wearing masks for prolonged periods of time, including special considerations, such as mask wearing among those who engage in exercise training, and concerns for individuals with pre-existing chronic diseases. In healthy populations, wearing a mask does not appear to cause any harmful physiological alterations, and the potentially life-saving benefits of wearing face masks seem to outweigh the documented discomforts (e.g. headaches). However, there continues to be controversy over mask wearing in the United States, even though wearing a mask appears to have only minor physiological drawbacks. While there are minimal physiological impacts on wearing a mask, theoretical evidence suggests that there may be consequential psychological impacts of mask wearing on the basic psychological needs of competence, autonomy, and relatedness. These psychological impacts may contribute to the controversy associated with wearing masks during the COVID-19 pandemic in the United States. After we discuss the physiological impacts of mask wearing, we will discuss psychological effects associated with wearing masks during the COVID-19 pandemic.

Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemic

Face masks can prevent the spread of the virus SARS-CoV-2, in particular as this spread can occur from people with no symptoms. However, covering the lower half of the face reduces the ability to communicate, interpret, and mimic the expressions of those with whom we interact. Positive emotions become less recognizable, and negative emotions are amplified. Emotional mimicry, contagion, and emotionality in general are reduced and (thereby) bonding between teachers and learners, group cohesion, and learning - of which emotions are a major driver. The benefits and burdens of face masks in schools should be seriously considered and made obvious and clear to teachers and students. The school's specific situation must also inform any decision regarding face mask use.