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Farah W, Abusalih MF, Hasan B, Lees EH, Fleti F, Elkhatib WY, Johnson BD, Toups G, Wolf M, Murad MH. Safety implications of mask use: a systematic review and evidence map. BMJ Evid Based Med 2024:bmjebm-2024-113028. [PMID: 39326926 DOI: 10.1136/bmjebm-2024-113028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Widespread use of respiratory protection masks has become a critical component of public health response. OBJECTIVES This systematic review synthesises the evidence on the acute physiological, cognitive and psychological impacts associated with different types of masks and provides an evidence map of research gaps. METHODS A comprehensive search from 2000 to 2023 was conducted across multiple databases (MEDLINE, EMBASE, Cochrane databases, Scopus and PubMed). An umbrella systematic overview was conducted for physiological outcomes using existing systematic reviews. We conducted de novo systematic reviews for cognitive and psychological outcomes. Pairs of independent reviewers determined eligibility, extracted data and assessed risk of bias. Certainty at an outcome level was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS The search resulted in 13 370 potential citations, leading to the inclusion of nine systematic reviews for physiological outcomes (87 primary studies) and 10 primary studies for cognitive and psychological outcomes (3815 participants), with the majority of participants being healthy adults. Studies evaluating physiological outcomes demonstrated that various types of masks have little to no significant difference in heart rate (surgical mask (mean difference (MD): 0.96 (-1.01 to 2.93)), N95 mask (MD: 1.63 (-2.79 to 6.05)) and cloth mask (MD: -0.94 (-6.39 to 4.52))) or respiratory rate during rest or exercise (surgical mask (MD: -1.35 (-3.00 to 0.29)), N95 mask (MD: 0.10 (-3.10 to 3.29)) and cloth mask (MD: -2.57 (-6.44 to 1.29)) (low certainty for most outcomes)). Mask use may be associated with very small changes in minute ventilation (surgical mask (MD: -13.9 (-20.30 to -7.53)) and N95 mask (MD: -16.3 (-28.7 to -3.9))), tidal volume (surgical mask (MD: -0.14 (-0.23 to -0.05)) and N95 mask (MD: -0.10 (-0.33 to 0.13))), oxygen saturation (surgical mask (MD: -0.59% (-0.87 to -0.30)), N95 mask (MD: -0.35% (-0.75 to 0.05)) and cloth mask (MD: -0.50% (-1.23; 0.24))), carbon dioxide partial pressure (surgical mask (standardised MD (SMD): 1.17 (0.70 to 1.64)) and N95 mask (SMD: 0.43 (0.08 to 0.79))) and exercise performance (surgical mask (SMD: -0.12 (-0.39 to 0.15)), N95 mask (SMD: -0.42 (-0.76 to -0.08)) and cloth mask (SMD: -0.26 (-0.54 to 0.02)) (low certainty for most outcomes)). Studies evaluating cognitive outcomes showed mixed results. Some studies reported reduced mental workload, and others showed no significant effect or decreased performance. The impact on attention, errors and reaction time was variable. These studies were small and at moderate to high risk of bias. Evidence was insufficient to estimate the effect of mask use on psychological outcomes (claustrophobia, depression and anxiety) as these studies were small, non-longitudinal and at high risk of bias. CONCLUSION This evidence map provides a comprehensive insight into the multifaceted impact of respiratory protection mask use, and highlights the limited certainty in the available body of evidence. This evidence map supports the development of future research agenda.
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Affiliation(s)
- Wigdan Farah
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed F Abusalih
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bashar Hasan
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth H Lees
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Farah Fleti
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wiaam Y Elkhatib
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce D Johnson
- Division of Preventive Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gary Toups
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Wolf
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lu F, Berkowitz J, Gaw A, Salvador V, DeAngelis J, Wu WC. Effect of Masking Secondary to the COVID-19 Pandemic on Functional Capacity Improvement in Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2024; 44:317-323. [PMID: 39230364 DOI: 10.1097/hcr.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
PURPOSE Given the difficulty to perform exercise training wearing a mask, we examined differences in functional capacity improvement between masking during the coronavirus disease 2019 (COVID-19) pandemic and non-masking prior to the pandemic for patients undergoing cardiac rehabilitation (CR). METHODS Records of 660 patients who underwent and completed ≥ 18 sessions of CR in 2018 (n = 318, non-masking) and in 2022 (n = 342, masking) at an academic health system were analyzed. The primary outcome was post-CR change in functional capacity in metabolic equivalents (MET) measured by exercise stress test. Sessions of CR participation and changes in depression, anxiety, and quality of life scores were secondary outcomes. We used multivariable linear regression to adjust for differences in baseline CR outcome measures, demographics, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) risk, and comorbid conditions. RESULTS Baseline age (64.6 ± 0.46 yr), sex (28% female), and racial distribution (85% white) were similar between the masking and non-masking groups. Non-masking patients were more likely to be classified in the AACVPR high risk category and had lower anxiety scores at baseline compared to masking patients. After CR, both groups had similar and significant improvements in depression, anxiety, and quality of life scores, but the improvement in functional capacity was lower in the masking group (-0.62 ± 0.12 MET, P < .001) compared to the non-masking group. Results remained significant after multivariable adjustment. CONCLUSIONS Cardiac rehabilitation patients requiring masking during the COVID-19 pandemic had less improvement in functional capacity than patients who did not wear masks during CR prior to the pandemic. Interventions to mitigate the potential side effects of masking for CR patients may require further exploration.
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Affiliation(s)
- Frederick Lu
- Author Affiliations : Department of Medicine (Drs Lu, Berkowitz, Salvador, and Wu), Center for Cardiac Fitness, Cardiovascular Institute, Miriam Hospital (Mss Gaw and DeAngelis and Dr Wu), Warren Alpert Medical School of Brown University, Providence, RI and Department of Medicine (Drs Berkowitz, Salvador, and Wu), Division of Cardiology (Dr Wu), Providence Veterans Affairs Medical Center, Providence, RI
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Go S, Yang Y, Park S, Moon HY, Yoon C. Physiological effects of filtering facepiece respirators based on age and exercise intensity. PLoS One 2024; 19:e0309403. [PMID: 39208252 PMCID: PMC11361601 DOI: 10.1371/journal.pone.0309403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
During the coronavirus disease 2019 pandemic, Filtering Facepiece Respirators (FFRs) were highly effective, but concerns arose regarding their physiological effects across different age groups. This study evaluated these effects based on age and exercise intensity in 28 participants (children, young adults, and older individuals). Physiological parameters such as respiratory frequency (Rf), minute ventilation (VE), carbon dioxide production (VCO2), oxygen consumption (VO2), heart rate (HR), metabolic equivalents (METs), percutaneous oxygen saturation (SpO2) and the concentration of O2 and CO2 in the FFRs were measured during treadmill tests with and without FFRs (cup-shaped, flat-folded, and with an exhalation valve). There was no significant difference in physiological effects between the control and FFR types, although Rf, VE, VCO2, VO2, METs, and HR increased with increasing exercise intensity. Depending on the exercise intensity, the O2 level in the FFR dead space decreased, and the CO2 level increased but this was independent of the dead space volume or FFR type. The study concluded that FFRs did not substantially impact daily life or short-term exercise, supporting their safe and effective use as a public health measure during pandemics and informing inclusive guidelines and policies.
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Affiliation(s)
- Sulbee Go
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yeram Yang
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Suhong Park
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Hyo Youl Moon
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
| | - Chungsik Yoon
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
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Bar-On O, Goldberg O, Stafler P, Levine H, Jacobi E, Shmueli E, Rothschild B, Prais D, Mei-Zahav M. Wearing face masks while climbing stairs influences respiratory physiology. J Breath Res 2024; 18:036002. [PMID: 38631331 DOI: 10.1088/1752-7163/ad3fde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/17/2024] [Indexed: 04/19/2024]
Abstract
During the COVID-19 pandemic wearing face masks was mandatory. Nowadays, face masks are still encouraged indoors, especially in hospitals. People climbing stairs with masks describe unpredictable dyspnea. In this study, healthy adults climbed 5 floors with and without a mask. Various cardio-respiratory parameters were measured, including O2-saturation (O2-Sat) and end-tidal CO2(EtCO2), at baseline and on the top floor. Subjective indexes, such as Borg's scale, were evaluated. Thirty-two volunteers (16 males), median age 39 years (IQR 32.5-43), median BMI = 23.6 (IQR 21.5-25.1), with good fitness levels, participated. Comparing baseline to end-activity, median (IQR): O2-Sat change was -1.0% (-2-0) without mask, versus -3.0% (-4-0) with mask,p= 0.003; EtCO2+ 7.0 (+3.3-+9) without mask, versus +8.0 (+6-+12) with mask,p= 0.0001. Hypercarbia was seen in 5 (15.6%) participants without mask, median = 48 mmHg (IQR 47.5-51), and in 11 (34%) participants with mask, median = 50 mmHg (IQR 47-54),p< 0.001. Desaturation (O2-Sat < 95%) was seen in 5 (15.6%) participants without mask, median = 94% (IQR 93%-94%), and in 10 (31%) participants with mask, median = 91.5% (IQR 90%-93%),p= 0.06. Regression analysis demonstrated that only male sex was significantly associated with abnormal EtCO2(OR = 26.4, 95% CI = 1.9-366.4,p= 0.005). Ascent duration increased from median (IQR) of 94 s (86-100) without mask to 98 s (89-107) with mask,p< 0.001. Borg's scale of perceived exertion (range 0-10) increased from median (IQR) of 3.0 (2.5-3.87) without mask to 4.0 (3.0-4.37) with mask,p< 0.001. To conclude, during routine daily activities, such as stair-climbing, face masks cause dyspnea, and have measurable influences on ventilation, including true desaturation and hypercapnia, especially in males.
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Affiliation(s)
- Ophir Bar-On
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Goldberg
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Pulmonary Service, Kaplan Medical Center (affiliated with the Faculty of Medicine, Hebrew University, Jerusalem, Israel), Rehovot, Israel
| | - Patrick Stafler
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagit Levine
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Jacobi
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Einat Shmueli
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Rothschild
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dario Prais
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
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He W, Liu Y, Zou Z, Cheng C, Wang W, Huang Z, Wu G, Zhu W, Sun H. Effects of prolonged face mask use among patients with hypertension or diabetes during the COVID-19 pandemic. J Int Med Res 2024; 52:3000605241232946. [PMID: 38456648 PMCID: PMC10924563 DOI: 10.1177/03000605241232946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE We aimed to investigate the impacts of prolonged mask use on patients with hypertension or diabetes during the COVID-19 pandemic. METHODS This study included patients with hypertension or diabetes who visited the outpatient department of Nanjing Yimin Hospital between 1 February 2022 and 31 January 2023. We compared the change in blood pressure (BP) and fasting plasma glucose in patients with hypertension or diabetes and adjustments to treatment between the group with prolonged mask-wearing group (≥20 hours/week) and the control group (<20 hours/week). RESULTS Compared with the control group of hypertensive patients, the prolonged mask-wearing group had significantly higher diastolic blood pressure (DBP) and mean arterial pressure (MAP). These two groups had had similar DBP and MAP 1 year earlier. Likewise, the prolonged mask-wearing group of patients with diabetes had a greater need than the control group for upgraded treatment to reach their therapeutic goals. CONCLUSIONS This study suggests that prolonged mask use by patients with hypertension or diabetes has negative effects on hypertension and plasma glucose control. BP and plasma glucose monitoring should be improved in these patient populations and their treatment should be adjusted in a timely manner.
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Affiliation(s)
- Weiwei He
- Department of Respiratory and Critical Care Medicine, Nanjing Yimin Hospital, Nanjing, Jiangsu Province, China
| | - Yang Liu
- Class 5 Grade 12, Nanjing Foreign Language School, Nanjing, Jiangsu Province, China
| | - Zhaoting Zou
- Department of Cardiology, Nanjing Yimin Hospital, Nanjing, Jiangsu Province, China
| | - Chunbao Cheng
- Department of Endocrinology, Nanjing Yimin Hospital, Nanjing, Jiangsu Province, China
| | - Wenjing Wang
- Department of Respiratory and Critical Care Medicine, Nanjing Yimin Hospital, Nanjing, Jiangsu Province, China
| | - Zhixin Huang
- Department of Respiratory and Critical Care Medicine, Nanjing Yimin Hospital, Nanjing, Jiangsu Province, China
| | - Guannan Wu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Weiquan Zhu
- Program in Molecular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Huiming Sun
- Department of Respiratory and Critical Care Medicine, Nanjing Yimin Hospital, Nanjing, Jiangsu Province, China
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Klophaus N, Wehmeier UF, Forstner J, Jansen A, Probst H, Grüter S, Hilberg T. The Impact of Medical Face Masks and Rehabilitation Duration on the Performance Output and Outcomes of Cardiologic Rehabilitants. J Clin Med 2024; 13:1086. [PMID: 38398399 PMCID: PMC10889284 DOI: 10.3390/jcm13041086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
During the COVID-19 pandemic, wearing a medical face mask became mandatory in daily life and also in cardiological rehabilitation. In order to investigate whether the performance and outcomes of cardiological rehabilitation were affected by face masks, we compared data from patients who underwent rehabilitation with face masks with data from patients without face masks. In total, 114 patients from an ambulant rehabilitation center were included. Of them, 60 patients completed rehabilitation without a face mask (NFM). In contrast, 54 patients (with a face mask, WFM) completed their rehabilitation during the COVID-19 pandemic and had to wear medical face masks for the entire day and also during ergometer training or other interventions. Subgroups were formed with patients who accepted to extend rehabilitation for one week (4 WG); the other patients only completed 3-week rehabilitation (3 WG). We analyzed the performance and outcomes of all groups (NFM; WFM, 3 WG and 4 WG). At baseline, no group differences were detected. All groups significantly improved their power output and heart rate recovery, without any group differences. We conclude that face masks and also an additional rehabilitation week do not affect the exercise performance or outcomes of out-house cardiological rehabilitation.
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Affiliation(s)
- Nils Klophaus
- Department of Sports Medicine, University of Wuppertal, Moritzstr. 14, 42117 Wuppertal, Germany; (N.K.); (T.H.)
- Cardiowell, Arrenberger Str. 20, 42117 Wuppertal, Germany
| | - Udo F. Wehmeier
- Department of Sports Medicine, University of Wuppertal, Moritzstr. 14, 42117 Wuppertal, Germany; (N.K.); (T.H.)
| | - Julia Forstner
- Department of Sports Medicine, University of Wuppertal, Moritzstr. 14, 42117 Wuppertal, Germany; (N.K.); (T.H.)
| | - Armin Jansen
- Cardiowell, Arrenberger Str. 20, 42117 Wuppertal, Germany
| | - Herbert Probst
- Cardiowell, Arrenberger Str. 20, 42117 Wuppertal, Germany
| | - Stephan Grüter
- Cardiowell, Arrenberger Str. 20, 42117 Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Moritzstr. 14, 42117 Wuppertal, Germany; (N.K.); (T.H.)
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Weigelt A, Schöffl I, Rottermann K, Wällisch W, Müller SK, Dittrich S, Hübner MJ. Sports despite masks: no negative effects of FFP2 face masks on cardiopulmonary exercise capacity in children. Eur J Pediatr 2024; 183:639-648. [PMID: 37950791 PMCID: PMC10912408 DOI: 10.1007/s00431-023-05316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
Face masks were recognized as one of the most effective ways to prevent the spread of the COVID-19 virus in adults. These benefits were extended to children and adolescents. However, the fear of negative consequences from wearing a face mask during physical exercise led to cancellations of physical education lessons. This further decreased the amount of physical activity available to children and adolescents during the pandemic. However, there is little published data on the potential adverse effects of wearing the most effective and partially mandatory FFP2/N95 face masks during PE or physical activity (PA) in this age. Even though the pandemic has been declared as passed by the WHO, the rise of a new pandemic and thus the use of face masks for limiting its spread is inevitable, so we need to be better prepared for alternative options to lockdown and limitation of PA in such a scenario. Twenty healthy children aged 8-10 years performed two identical cardiopulmonary exercise tests as an incremental step test on a treadmill within an interval of 2 weeks, one time without wearing a protective mask and one time wearing an FFP2 mask. The cardiopulmonary exercise parameter and especially the end-expiratory gas exchange for oxygen and carbon dioxide (petO2 and petCO2) were documented for each step, at rest and 1 min after reaching physical exhaustion. Twelve boys (mean age 8.5 ± 1.4 years) and 8 girls (mean age 8.8 ± 1.4 years) showed no adverse events until maximal exertion. The mean parameters measured at peak exercise did not differ significantly between both examinations (mean peak VO2 = 42.7 ± 9.5 vs 47.8 ± 12.9 ml/min/kg, p = 0.097, mean O2pulse 7.84 ± 1.9 ml/min vs. 6.89 ± 1.8, p = 0.064, mean VE/VCO2slope 33.4 ± 5.9 vs. 34.0 ± 5.3, p = 0.689). The only significant difference was the respiratory exchange rate (RER, 1.01 ± 0.08 vs 0.95 ± 0.08, p = 0.004). The measured respiratory gases (end-tidal O2 and CO2) decreased and respectively increased significantly in almost every step when wearing an FFP2 mask. However, these levels were well below hypercapnia and above hypoxia. CONCLUSION In this study, no significant differences in the cardiorespiratory function at peak exercise could be discerned when wearing an FFP2/N95 face mask. While the end-tidal values for CO2 increased significantly and the end-tidal values for O2 decreased significantly, these values did never reach levels of hypercapnia or hypoxia. Furthermore, the children terminated the exercise at a lower RER and heart rate (HR) suggesting a subconscious awareness of the higher strain. Since the detrimental effects of limiting sports during the pandemic are well documented, stopping PE lessons altogether because of the minor physiological effects of wearing these masks instead of simply stopping pushing children to perform at their best seems premature and should be reconsidered in the future. WHAT IS KNOWN • Wearing a face mask has an influence on psychological, social, and physiological functions in adults. • Because of the observed effects of wearing face masks in adults, physical activity in children was limited during the pandemic. WHAT IS NEW • Wearing an FFP2/N95 mask during physical activity did not lead to hypercapnia or hypoxia in children in this study. • Even though end-tidal CO2 values were significantly higher and end-tidal O2 values significantly lower when wearing an FFP2/N95 face mask, no pathological values were reached.
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Affiliation(s)
- Annika Weigelt
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
| | - Isabelle Schöffl
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, LS13HE Leeds, UK
| | - Kathrin Rottermann
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Wolfgang Wällisch
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otholaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Matthias Jens Hübner
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
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Shirata M, Nishioka K, Hamao N, Oi I, Hidaka Y, Ibi Y, Imai S, Sato S, Hirai T, Ito I. Impact of wearing a surgical facemask during exercise on dyspnea in patients with chronic pulmonary infections: A randomized crossover study. Respir Med 2023; 220:107453. [PMID: 37993025 DOI: 10.1016/j.rmed.2023.107453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Wearing facemasks in public is effective in preventing viral transmission. However, no study has evaluated the impact of wearing facemasks during exercise on dyspnea in patients with chronic pulmonary infections from multifaceted aspects, including sensory qualities and emotional responses. The aim of this study was to evaluate facemask-related dyspnea during exercise in this patient population. METHODS We conducted a randomized crossover study involving adult patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD) or bronchiectasis who participated in exercise sessions, both with (mask-on) and without (mask-off) surgical facemasks. The sensory and emotional dimensions of dyspnea during each exercise session were assessed using the Multidimensional Dyspnea Profile. Statistical analyses were performed to identify factors associated with worsening scores for each dimension. RESULTS Thirty-four patients (mean age [standard deviation]: 71.6 [8.6] years) were included in the analysis. The median [interquartile range] total scores for the sensory and emotional dimensions of dyspnea were 3.5 [1, 9.5] (mask-off) vs. 10 [5.5, 23.8] (mask-on) (P < 0.001) and 0 [0, 5] (mask-off) vs. 3 [0.8, 10.3] (mask-on) (P = 0.115), respectively. "Air hunger" was the primary sensory descriptor of mask-related dyspnea. Vital capacity (VC) < 80% of the predicted value was a significant risk factor for worsening sensory dimension scores when wearing masks (odds ratio [95% confidence interval]: 5.5 [1.16-26.1], P = 0.038). CONCLUSIONS The findings of this study indicate that patients with NTM-PD or bronchiectasis, particularly those with VC <80% of the predicted value, are likely to experience the sensory dimension of dyspnea during exercise while wearing surgical facemasks.
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Affiliation(s)
- Masahiro Shirata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Kensuke Nishioka
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Nobuyoshi Hamao
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Issei Oi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Yu Hidaka
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Yumiko Ibi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Seiichiro Imai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan; Preemptive Medicine and Lifestyle Disease Research Center, Kyoto University Hospital, 53 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8397, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan
| | - Isao Ito
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 606-8507, Japan.
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Mezghani N, Ammar A, Boukhris O, Masmoudi L, Boujelbane MA, Ben Ayed R, Alzahrani TM, Hadadi A, Abid R, Ouergui I, Glenn JM, Trabelsi K, Chtourou H. The Impact of Wearing Different Face Masks on Vigorous Physical Exercise Performance and Perceived Exertion among COVID-19 Infected vs. Uninfected Female Students. Eur J Investig Health Psychol Educ 2023; 13:2709-2723. [PMID: 37998077 PMCID: PMC10670499 DOI: 10.3390/ejihpe13110187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/28/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
Under certain circumstances, masks are an effective and immediate solution to reduce the spread of viral infection. However, the impact of masks on the ability to perform vigorous exercise remains an area of concern. Primarily, this impact has been explored in healthy subjects, yielding contradictory findings, and little is known of it among COVID-19-infected individuals. This study examined the effects of surgical masks, N-95 masks, and unmasked conditions on the performance and perceived exertion (RPE) of infected vs. non-infected young women during high-intensity, repeated sprint exercise (5mSRT). Following a familiarization session, eighty-three (42 COVID-19-previously infected (PIG) and 43 non-infected (NIG)), female participants (age 20.02 ± 1.05 years, BMI 21.07 ± 2.1 kg/m2) were randomly assigned to one of three mask conditions: unmasked, surgical mask, or N95 mask. All participants attended three test sessions (i.e., one session for each mask condition) at least one week apart. At the beginning of each test session, data related to participants' physical activity (PA) and sleep behaviours during the previous week were collected. In each test session, participants performed the 5mSRT, during which performance indicators (best distance (BD), total distance (TD), fatigue index (FI) and percentage decrement (PD)) were collected, along with RPE. ANOVA indicated no significant main effects of Groups and Masks, and no significant interaction for Groups × Masks for BD, FI, PD, RPE and most sleep and PA behaviours (p > 0.05). For TD, the Groups × Mask interaction was significant (p = 0.031 and ƞp2 = 0.042). Posthoc analysis revealed, in the unmasked condition, there was no difference in TD between PIG and NIG (p > 0.05). However, when wearing a surgical mask, PIG covered lower TD compared to NIG (p < 0.05). Additionally, different types of masks did not affect TD in NIG, while PIG performed the worst using the surgical mask (p < 0.05). These results suggest post-COVID-19 individuals can maintain physical fitness through regular exercise (i.e., sport science curricula) in unmasked conditions, but not when wearing a surgical mask. Furthermore, the impact of different types of face masks on physical performance seems to be minimal, particularly in uninfected populations; future research is warranted to further explore this impact in post-COVID conditions.
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Affiliation(s)
- Nourhen Mezghani
- Department of Sport Sciences, College of Education, Taif University, Taif 21944, Saudi Arabia; (N.M.); (T.M.A.); (A.H.)
| | - Achraf Ammar
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55099 Mainz, Germany;
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS (Faculty of Sport Sciences), UPL, Paris Nanterre University, 39200 Nanterre, France
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia; (L.M.); (K.T.); (H.C.)
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia;
| | - Omar Boukhris
- SIESTA Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia;
- Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
| | - Liwa Masmoudi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia; (L.M.); (K.T.); (H.C.)
- Research Laboratory, Education, Motricity, Sport and Health (EM2S), LR15JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
| | - Mohamed Ali Boujelbane
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55099 Mainz, Germany;
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia; (L.M.); (K.T.); (H.C.)
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia
| | - Rayda Ben Ayed
- National Institute of Agronomy of Tunisia (INAT), University of Carthage-Tunis, 43 Avenue Charles Nicolle, El Mahrajène 1082, Tunisia;
- Laboratory of Extremophile Plants, Centre of Biotechnology of Borj-Cédria, B.P. 901, Hammam Lif 2050, Tunisia
| | - Turki Mohsen Alzahrani
- Department of Sport Sciences, College of Education, Taif University, Taif 21944, Saudi Arabia; (N.M.); (T.M.A.); (A.H.)
| | - Atyh Hadadi
- Department of Sport Sciences, College of Education, Taif University, Taif 21944, Saudi Arabia; (N.M.); (T.M.A.); (A.H.)
| | - Rihab Abid
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia;
| | - Ibrahim Ouergui
- High Institute of Sport and Physical Education of Kef, University of Jendouba, El Kef 7100, Tunisia;
- Research Unit, Sports Science, Health and Movement, University of Jendouba, El Kef 7100, Tunisia
| | - Jordan M. Glenn
- Department of Health, Exercise Science Research Center Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA;
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia; (L.M.); (K.T.); (H.C.)
- Research Laboratory, Education, Motricity, Sport and Health (EM2S), LR15JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
| | - Hamdi Chtourou
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia; (L.M.); (K.T.); (H.C.)
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia
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10
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Cash-Goldwasser S, Reingold AL, Luby SP, Jackson LA, Frieden TR. Masks During Pandemics Caused by Respiratory Pathogens-Evidence and Implications for Action. JAMA Netw Open 2023; 6:e2339443. [PMID: 37906187 DOI: 10.1001/jamanetworkopen.2023.39443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Importance As demonstrated by the influenza virus and SARS-CoV-2, viruses spread by the respiratory route can cause deadly pandemics, and face masks can reduce the spread of these pathogens. The effectiveness of responses to future epidemics and pandemics will depend at least in part on whether evidence on masks, including from the COVID-19 pandemic, is utilized. Observations Well-designed observational studies have demonstrated the association of mask use with reduced transmission of SARS-CoV-2 in community settings, and rigorous evaluations of mask mandates have found substantial protection. Disagreement about whether face masks reduce the spread of SARS-CoV-2 has been exacerbated by a focus on randomized trials, which are limited in number, scope, and statistical power. Many effective public health policies have never been assessed in randomized clinical trials; such trials are not the gold standard of evidence for the efficacy of all interventions. Masking in the community to reduce the spread of SARS-CoV-2 is supported by robust evidence from diverse settings and populations. Data on the epidemiologic, environmental, and mask design parameters that influence the effectiveness of masking provide insights on when and how masks should be used to prevent transmission. Conclusions and Relevance During the next epidemic or pandemic caused by a respiratory pathogen, decision-makers will need to rely on existing evidence as they implement interventions. High-quality studies have shown that use of face masks in the community is associated with reduced transmission of SARS-CoV-2 and is likely to be an important component of an effective response to a future respiratory threat.
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Affiliation(s)
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle
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11
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Wissmüller M, Wartner V, Hohmann C, Adler J, Kramer T, Hellmich M, Gerhardt F, Baldus S, Rosenkranz S. Impact of face masks on the 6-minute walk distance in pulmonary hypertension patients during the COVID-19 pandemic: a prospective, randomised cross-over study. Eur Respir J 2023; 62:2201454. [PMID: 37827573 PMCID: PMC10627309 DOI: 10.1183/13993003.01454-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
In patients with pulmonary hypertension (PH) or with other pulmonary or cardiac diseases, the 6-minute walking test – accompanied by the Borg dyspnea score – is frequently utilised as a semi-quantitative measure of exercise capacity [1]. The 6-minute walking distance (6 MWD) also serves as primary or key secondary endpoint in numerous clinical trials assessing the efficacy of pharmacotherapies in various forms of PH [2, 3]. Furthermore, the 6MWD is among the key non-invasive measures of multi-modal risk assessment in pulmonary arterial hypertension (PAH) [4–6]. In this context, cut-off values of 440 m and 165 m have been validated to indicate low, intermediate and high mortality risk, respectively, in the 3-strata model proposed by the current ESC/ERS guidelines [1], with an additional cut-off of 320 m to discriminate between intermediate-high and intermediate-low risk in the recently introduced 4-strata approach [7, 8].
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Affiliation(s)
- Max Wissmüller
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
| | - Veit Wartner
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
| | - Christopher Hohmann
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
| | - Joana Adler
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
| | - Tilmann Kramer
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology; Faculty of Medicine and University Hospital Cologne; University of Cologne, Cologne, Germany
| | - Felix Gerhardt
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
| | - Stephan Baldus
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Universität zu Köln, Cologne, Germany
| | - Stephan Rosenkranz
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Universität zu Köln, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Universität zu Köln, Cologne, Germany
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12
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Chen X, Sani I, Xia X, Li Y, Li C, Yue F, Wang X, Bao S, Fan J. The impact of wearing facemask on COPD patients: A protocol of a systematic review and meta-analysis. PLoS One 2023; 18:e0292388. [PMID: 37768979 PMCID: PMC10538665 DOI: 10.1371/journal.pone.0292388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common, irreversible but preventable disease characterized by persistent respiratory symptoms. The mortality rate of COPD is predicted to reach 5.4 million by the year 2060. Despite its heavy burden on healthcare expenditure worldwide, only 15% of cases are medically identified. The potential benefits of facemask-wearing for COPD patients remain a topic of debate. METHODS We will conduct a systematic review of all randomized trials and non-randomized controlled trials to evaluate the impact of facemasks on COPD patients. Our review will be based on literature obtained through a comprehensive search strategy across multiple electronic databases, including the Cochrane Library, Embase, PubMed, Web of Science, the Chinese Biomedical Database (SinoMed), and China National Knowledge Infrastructure (CNKI), with no restrictions on language or date of publication. Two independent researchers will extract and assess all relevant data using pre-designed data extraction forms. The included studies will be assessed using the Cochrane RoB2 tool and the suggested risk of bias criteria proposed by the Effective Practice and Organization of Care reviews group of the Cochrane collaboration. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We will use Review Manager 5.4 software for statistical analysis. DISCUSSION In the context of COVID-19, it is important for COPD patients to wear facemasks. This study aims to conduct a comprehensive and systematic assessment of the impact of facemasks on the physiology and activity of COPD patients. TRIAL REGISTRATION PROSPERO registration number CRD42022326265.
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Affiliation(s)
- Xuwen Chen
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Ibrahim Sani
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xiaoli Xia
- Department of Geriatrics, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yi Li
- Department of Respiratory Cadres, Gansu Provincial People’s Hospital, Lanzhou, Gansu, China
| | - Caiyun Li
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Feiyan Yue
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xinhua Wang
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Shisan Bao
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jingchun Fan
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
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13
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Marek EM, van Kampen V, Jettkant B, Hoffmeyer F, Bünger J. Comment on 'Limitations in evaluating COVID-19 protective face masks using open circuit spirometry systems: respiratory measurement mask introduces bias in breathing pressure and perceived respiratory effort'. Physiol Meas 2023; 44:098001. [PMID: 37655496 DOI: 10.1088/1361-6579/acebb4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023]
Abstract
We comment on the paper by Seibt and coworkers (Seibtet al2023) which investigates whether wearing an additional respiratory measurement mask during open-circuit spirometry assessments (respirometry mask) shows any effect on breathing pressure and perceived respiratory effort when wearing protective face masks commonly worn during the COVID-19 pandemic.
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Affiliation(s)
- Eike Maximilian Marek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Birger Jettkant
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Frank Hoffmeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Jürgen Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
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14
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AlSamhori JF, Alshrouf MA, AlSamhori ARF, Alshadeedi FM, Madi AS, Alzoubi O. Implications of the COVID-19 pandemic on athletes, sports events, and mass gathering events: Review and recommendations. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:165-173. [PMID: 37753427 PMCID: PMC10518794 DOI: 10.1016/j.smhs.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 09/28/2023] Open
Abstract
Since the coronavirus disease 19 (COVID-19), which caused several respiratory diseases, was formally declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, it affected the lifestyle and health of athletes, both directly through cardiorespiratory and other health related effects, and indirectly as the pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world. In this review, we explore the journey of athletes throughout the pandemic and during their return to their competitive routine. We also highlight potential pitfalls during the process and summarize the recommendations for the optimal return to sport participation. We further discuss the impact of the pandemic on the psychology of athletes, the variance between the team and individual athletes, and their ability to cope with the changes. Moreover, we specifically reviewed the pandemic impact on younger professional athletes in terms of mental and fitness health. Finally, we shaded light on the various impacts of mass gathering events and recommendations for managing upcoming events.
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Affiliation(s)
| | - Mohammad Ali Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan
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15
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Yang SC, Lee CW. Physiological effects of N95 respirators on rescuers during cardiopulmonary resuscitation. Heliyon 2023; 9:e18970. [PMID: 37600379 PMCID: PMC10432712 DOI: 10.1016/j.heliyon.2023.e18970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives There is a lack of evidence in the medical literature reporting the physiological stress imposed by the wearing of N95 respirators during cardiopulmonary resuscitation (CPR) in healthcare providers. The aim of this study is to monitor the changes in hemodynamics and blood gas profiles in rescuers during the performance of CPR while wearing N95 respirators. Methods Thirty-two healthy healthcare workers performed standard CPR on manikins, each participant conducted 2 min of chest compression followed by 2 min of rest for 3 cycles. A non-invasive blood gas measuring device via a fingertip detector was used to collect arterial blood gas and hemodynamic data. Student t-test was used for comparison of various physiologic parameters before and after each session of chest compression. Results There were no significant differences in arterial blood gas profiles including partial pressure of arterial carbon dioxide and partial pressure of arterial oxygen before and after each session of chest compression (p > 0.05 for all). Heart rate and cardiac output were significantly higher after CPR (p < 0.05 for all), but no significant changes were found on blood pressure. Conclusions Our data suggest that healthcare providers wearing N95 respirators during provision of CPR in a short period of time does not cause any significant abnormalities in blood gas profiles and blood pressure. This may provide evidence to reassure the safe use of N95 respirator during performance of CPR.
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Affiliation(s)
- Shih-Chia Yang
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Lee
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
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16
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Fukushima A, Manabe Y, Kosaka Y, Akagi S. Sustained exercise load by young adult females while wearing surgical mask raises core body temperature measured with zero-heat-flux thermometer. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023:10.1007/s00484-023-02501-8. [PMID: 37365382 DOI: 10.1007/s00484-023-02501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
When a pandemic such as that caused by the novel coronavirus disease termed COVID-19 emerges, it is recommended to wear a mask when in public situations, with information regarding the impact on thermoregulation essential, especially during exercise or hard physical labor. The present study investigated changes in core body temperature (CBT) while wearing a surgical mask (SM) during exercise (TCBT) using a non-invasive zero-heat-flux (ZHF) thermometer. Nine young adult females performed ergometer exercise for 30 min at 60 W with (mask group) and without (control) a SM under a non-hot condition, shown by wet bulb globe temperature (WBGT) findings. TCBT, mean skin temperature (TMST), heart rate (HR), and humidity in the perioral region of the face (%RH) were determined. Each of those markers showed increased values during exercise, with the increases in TCBT, HR, and %RH, but not TMST, during exercise found to be significantly greater in the mask group. HR reserve (%HRR), derived as load intensity during exercise, was also significantly higher in the mask group. Each subject completed all of the experimental protocols without noting pain or discomfort. These results suggest that wearing a SM while performing mild exercise contributes to increased TCBT associated with increased exercise intensity, expressed as %HRR in a non-heated condition. Furthermore, the ZHF thermometer was shown to be safe and is considered useful for conducting such studies. Additional examinations will be necessary to examine gender and age group differences, as well as the use of different exercise methods and intensity and ambient conditions.
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Affiliation(s)
- Ayako Fukushima
- Graduate School of Contemporary Science, Chugoku Gakuen University, 83 Niwase Kita-Ku, Okayama, 701-0197, Japan
| | - Yoshie Manabe
- Graduate School of Contemporary Science, Chugoku Gakuen University, 83 Niwase Kita-Ku, Okayama, 701-0197, Japan
- Department of Human Nutrition, Faculty of Contemporary Science, Chugoku Gakuen University, Okayama, Japan
| | - Yuri Kosaka
- Department of Human Nutrition, Faculty of Contemporary Science, Chugoku Gakuen University, Okayama, Japan
| | - Shuji Akagi
- Graduate School of Contemporary Science, Chugoku Gakuen University, 83 Niwase Kita-Ku, Okayama, 701-0197, Japan.
- Department of Human Nutrition, Faculty of Contemporary Science, Chugoku Gakuen University, Okayama, Japan.
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17
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van Kampen V, Marek EM, Sucker K, Jettkant B, Kendzia B, Strauß B, Ulbrich M, Deckert A, Berresheim H, Eisenhawer C, Hoffmeyer F, Weidhaas S, Behrens T, Brüning T, Bünger J. Influence of face masks on the subjective impairment at different physical workloads. Sci Rep 2023; 13:8133. [PMID: 37208370 DOI: 10.1038/s41598-023-34319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
To quantify the subjective and cognitive impairment caused by wearing face masks at work, 20 men and 20 women (median age 47 years, range 19-65) were tested under different ergometer workloads while wearing surgical mask, community mask, FFP2 respirator or no mask in a randomized and partially double-blinded design. Masks were worn also at the workplace for four hours. Subjective impairment was recorded by questionnaires. Cognitive performance was tested before and after the workplace examination. Subjective feeling of heat, humidity, and difficult breathing increased with rising physical exertion and wearing time for all three mask types, most notably for FFP2. Even when blinded, participants with FFP2 reported difficult breathing already at rest. During physical exertion, individuals with low tolerance to discomfort reported significantly stronger impairment (OR 1.14, 95% CI 1.02-1.27). Regarding light work, older subjects (OR 0.95, 95% CI 0.92-0.98) and women (OR 0.84, 95% CI 0.72-0.99) showed significantly lower and atopic subjects stronger impairment (OR 1.16, 95% CI 1.06-1.27). No significant influence of mask wearing was detected on cognitive performance. Wearing a mask had no effect on cognitive performance, but led to discomfort which increased with physical exertion and wearing time. Individuals who tolerate discomfort poorly felt more impaired by wearing a mask during physical exertion.
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Affiliation(s)
- Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Eike-Maximillian Marek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Kirsten Sucker
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Birger Jettkant
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Bianca Strauß
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Melanie Ulbrich
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Anja Deckert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hans Berresheim
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Christian Eisenhawer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Frank Hoffmeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Simon Weidhaas
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jürgen Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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18
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Han JH, Jang MH, Kim DH, Kim JH. Added Breathing Resistance during Exercise Impairs Pulmonary Ventilation and Exaggerates Exercise-Induced Hypoxemia Leading to Impaired Aerobic Exercise Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105757. [PMID: 37239486 DOI: 10.3390/ijerph20105757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Protective masks impose variable breathing resistance (BR) on the wearer and may adversely affect exercise performance, yet existing literature shows inconsistent results under different types of masks and metabolic demands. The present study was undertaken to determine whether added BR impairs cardiopulmonary function and aerobic performance during exercise. Sixteen young healthy men completed a graded exercise test on a cycle ergometer under the four conditions of BR using a customized breathing resistor at no breathing resistance (CON), 18.9 (BR1), 22.2 (BR2), and 29.9 Pa (BR3). The results showed that BR significantly elevates respiratory pressure (p < 0.001) and impairs ventilatory response to graded exercise (reduced VE; p < 0.001) at a greater degree with an increased level of BR which caused mild to moderate exercise-induced hypoxemia (final mean SpO2: CON = 95.6%, BR1 = 94.4%, BR2 = 91.6%, and BR3 = 90.6%; p < 0.001). Especially, such a marked reduction in SpO2 was significantly correlated with maximal oxygen consumption at the volitional fatigue (r = 0.98, p < 0.001) together with exaggerated exertion and breathing discomfort (p < 0.001). In conclusion, added BR commonly experienced when wearing tight-fitting facemasks and/or respirators could significantly impair cardiopulmonary function and aerobic performance at a greater degree with an increasing level of BR.
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Affiliation(s)
- Jean-Hee Han
- Department of Physical Education, General Graduate School, Kyung Hee University, Yongin-si 17104, Republic of Korea
| | - Min-Hyeok Jang
- Department of Physical Education, General Graduate School, Kyung Hee University, Yongin-si 17104, Republic of Korea
| | - Dae-Hwan Kim
- Department of Physical Education, General Graduate School, Kyung Hee University, Yongin-si 17104, Republic of Korea
| | - Jung-Hyun Kim
- Department of Sports Medicine, Kyung Hee University, Yongin-si 17104, Republic of Korea
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19
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Marek EM, van Kampen V, Jettkant B, Kendzia B, Strauß B, Sucker K, Ulbrich M, Deckert A, Berresheim H, Eisenhawer C, Hoffmeyer F, Weidhaas S, Behrens T, Brüning T, Bünger J. Effects of wearing different face masks on cardiopulmonary performance at rest and exercise in a partially double-blinded randomized cross-over study. Sci Rep 2023; 13:6950. [PMID: 37117320 PMCID: PMC10141827 DOI: 10.1038/s41598-023-32180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/23/2023] [Indexed: 04/30/2023] Open
Abstract
The use of face masks became mandatory during SARS-CoV-2 pandemic. Wearing masks may lead to complaints about laboured breathing and stress. The influence of different masks on cardiopulmonary performance was investigated in a partially double-blinded randomized cross-over design. Forty subjects (19-65 years) underwent body plethysmography, ergometry, cardiopulmonary exercise test and a 4-h wearing period without a mask, with a surgical mask (SM), a community mask (CM), and an FFP2 respirator (FFP2). Cardiopulmonary, physical, capnometric, and blood gas related parameters were recorded. Breathing resistance and work of breathing were significantly increased while wearing a mask. During exercise the increase in minute ventilation tended to be lower and breathing time was significantly longer with mask than without mask. Wearing a mask caused significant minimal decreases in blood oxygen pressure, oxygen saturation, an initial increase in blood and inspiratory carbon dioxide pressure, and a higher perceived physical exertion and temperature and humidity behind the mask under very heavy exercise. All effects were stronger when wearing an FFP2. Wearing face masks at rest and under exercise, changed breathing patterns in the sense of physiological compensation without representing a health risk. Wearing a mask for 4-h during light work had no effect on blood gases.
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Affiliation(s)
- Eike-Maximillian Marek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany.
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Birger Jettkant
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Bianca Strauß
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Kirsten Sucker
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Melanie Ulbrich
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Anja Deckert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Hans Berresheim
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Christian Eisenhawer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Frank Hoffmeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Simon Weidhaas
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
| | - Jürgen Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle‑de‑la‑Camp Platz 1, 44789, Bochum, Germany
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20
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Kisielinski K, Hirsch O, Wagner S, Wojtasik B, Funken S, Klosterhalfen B, Kanti Manna S, Prescher A, Sukul P, Sönnichsen A. Physio-metabolic and clinical consequences of wearing face masks-Systematic review with meta-analysis and comprehensive evaluation. Front Public Health 2023; 11:1125150. [PMID: 37089476 PMCID: PMC10116418 DOI: 10.3389/fpubh.2023.1125150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/17/2023] [Indexed: 04/08/2023] Open
Abstract
Background As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation. Methods A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes. Results We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, p < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31-0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01). Discussion Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health. Conclusion Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.
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Affiliation(s)
- Kai Kisielinski
- Orthopaedic and Trauma Surgery, Clinical Medicine, Private Practice, Düsseldorf, Germany
| | - Oliver Hirsch
- Department of Psychology, Fachhochschule für Oekonomie und Management (FOM) University of Applied Sciences, Siegen, Germany
| | - Susanne Wagner
- Veterinary Medicine, Wagner Medical Science Liason (MSL) Management, Blankenfelde-Mahlow, Germany
| | - Barbara Wojtasik
- Department of Genetics and Biosystematics, Faculty of Biology, University of Gdańsk, Gdansk, Poland
| | - Stefan Funken
- Internal Medicine, Clinical Medicine, Private Practice, Moers, Germany
| | | | - Soumen Kanti Manna
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, Kolkata, India
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Rhine-Westphalia Technical University of Aachen, Aachen, Germany
| | - Pritam Sukul
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anesthesiology and Intensive Care, University Medicine Rostock, Rostock, Germany
| | - Andreas Sönnichsen
- Internal Medicine, Clinical Medicine, Private Practice, Gesundheit für Österreich e.V. (Health for Austria), Vienna, Austria
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21
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Response and Adaptation of the Cardiac Autonomic System to Functional High-intensity Interval Training with Respiratory Facemasks: Impacts of the Training Period and Facemask Modality During a COVID-19 Pandemic. Asian J Sports Med 2023. [DOI: 10.5812/asjsm-130134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Background: Following the SARS-CoV-2 pandemic in 2019, medical face masks were widely recommended for large numbers of people and for long periods of time. The effect of wearing surgical and N95 face masks during long-term high-intensity interval training on the cardiac autonomic system has not been reported. Methods: Eighteen healthy men were randomly divided into three groups (surgical mask, N95 mask, and no mask) and performed high-intensity interval training with (80-90%-heart rate max) intensity three times a week, three repetitions in a session for four weeks. Heart rate variability parameters were evaluated with an electrocardiogram device and Kubius software. The R-R interval was recorded for 5 minutes in a sitting position in the pre-and post-modified Bruce test before and after four weeks of interval training to extract parasympathetic (RMSSD, HF, SD1), sympathetic indices (LF, LF/HF) and RR mean. We used the two-way ANOVA test and the Bonferroni post hoc test. Results: In all groups, four-week functional HIIT exercises increased the resting parasympathetic indices (RMSSD, SD1) compared to baseline levels. This increase was more evident in the N95 mask group than in the surgical mask group. In addition, the five-minute recovery of the cardiac autonomic system after a modified Bruce test following functional HIIT exercise increased parasympathetic tone (RMSSD, HFn.u) in all groups compared to baseline levels. Therefore, a four-week adaptation to HIIT exercises leads to faster recovery of sympathetic indices (LFn.u, LF/HF) in the Nomask group, as compared to the surgical and N95 groups. Despite the above, there was no significant difference in the recovery and resting values of cardiac autonomic system indices between the two types of surgical masks and N95 compared to the control group (No mask). Conclusions: Four weeks of high-intensity interval training using surgical and N95 face masks improved the cardiac autonomic nervous system. This data is important for recommending the use of face masks during physical activity.
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22
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Ferguson ON, Mitchell RA, Schaeffer MR, Ramsook AH, Dhillon SS, Dominelli PB, Molgat-Seon Y, Guenette JA. Effects of Face Masks on the Multiple Dimensions and Neurophysiological Mechanisms of Exertional Dyspnea. Med Sci Sports Exerc 2023; 55:450-461. [PMID: 36469484 DOI: 10.1249/mss.0000000000003074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION During the coronavirus disease 2019 pandemic, public health officials widely adopted the use of face masks (FM) to minimize infections. Despite consistent evidence that FMs increase dyspnea, no studies have examined the multidimensional components of dyspnea or their underlying physiological mechanisms. METHODS In a randomized crossover design, 16 healthy individuals ( n = 9 women, 25 ± 3 yr) completed incremental cycling tests over three visits, where visits 2 and 3 were randomized to either surgical FM or no mask control. Dyspnea intensity and unpleasantness were assessed throughout exercise (0-10 Borg scale), and the Multidimensional Dyspnea Profile was administered immediately after exercise. Crural diaphragmatic EMG and esophageal pressure were measured using a catheter to estimate neural respiratory drive and respiratory muscle effort, respectively. RESULTS Dyspnea unpleasantness was significantly greater with the FM at the highest equivalent submaximal work rate achieved by a given participant in both conditions (iso-work; 5.9 ± 1.7 vs 3.9 ± 2.9 Borg 0-10 units, P = 0.007) and at peak exercise (7.8 ± 2.1 vs 5.9 ± 3.4 Borg 0-10 units, P = 0.01) with no differences in dyspnea intensity ratings throughout exercise compared with control. There were significant increases in the sensory quality of "smothering/air hunger" ( P = 0.01) and the emotional response of "anxiousness" ( P = 0.04) in the FM condition. There were significant increases in diaphragmatic EMG and esophageal pressure at select submaximal work rates, but no differences in heart rate, pulse oximetry-derived arterial oxygen saturation, or breathing frequency throughout exercise with FMs compared with control. FMs significantly reduced peak work rate and exercise duration (both P = 0.02). CONCLUSIONS FMs negatively impact the affective domain of dyspnea and increase neural respiratory drive and respiratory muscle effort during exercise, although the impact on other cardiorespiratory responses are minimal.
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Affiliation(s)
| | | | | | | | - Satvir S Dhillon
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, CANADA
| | - Paolo B Dominelli
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, CANADA
| | - Yannick Molgat-Seon
- Faculty of Kinesiology and Applied Health, The University of Winnipeg, Winnipeg, Manitoba, CANADA
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23
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Manchanda A, Lee K, Poznanski GD, Hassani A. Automated Adjustment of PPE Masks Using IoT Sensor Fusion. SENSORS (BASEL, SWITZERLAND) 2023; 23:1711. [PMID: 36772747 PMCID: PMC9921841 DOI: 10.3390/s23031711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/13/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has led to a dramatic increase in the use of PPE by the general public as well as health professionals. Scientists and health organizations have developed measures to protect people and minimize the catastrophic outcomes of COVID, including social distancing, frequent and periodic sanitizing, vaccinations, protective coverings, and face masks. During this time, the usage of protective face masks has increased dramatically. A mask only provides full safety to the user if it is a proper fit on their face. The aim of this paper is to automatically analyze and improve the fit of a face mask using IoT sensors. This paper describes the creation of a 3D-printed smart face mask that uses sensors to determine the current mask fit and then automatically tightens mask straps. This is evaluated using adjustment response time and the quality of fit achieved using the automatic adjustment approach with a range of sensor types.
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Affiliation(s)
- Ashish Manchanda
- School of Information Technology, Deakin University, Geelong, VIC 3220, Australia
| | - Kevin Lee
- School of Information Technology, Deakin University, Geelong, VIC 3220, Australia
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24
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Hung A, Koch S, Bougault V, Gee CM, Bertuzzi R, Elmore M, McCluskey P, Hidalgo L, Garcia-Aymerich J, Koehle MS. Personal strategies to mitigate the effects of air pollution exposure during sport and exercise: a narrative review and position statement by the Canadian Academy of Sport and Exercise Medicine and the Canadian Society for Exercise Physiology. Br J Sports Med 2023; 57:193-202. [PMID: 36623867 DOI: 10.1136/bjsports-2022-106161] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 01/11/2023]
Abstract
Air pollution is among the leading environmental threats to health around the world today, particularly in the context of sports and exercise. With the effects of air pollution, pollution episodes (eg, wildfire conflagrations) and climate change becoming increasingly apparent to the general population, so have their impacts on sport and exercise. As such, there has been growing interest in the sporting community (ie, athletes, coaches, and sports science and medicine team members) in practical personal-level actions to reduce the exposure to and risk of air pollution. Limited evidence suggests the following strategies may be employed: minimising all exposures by time and distance, monitoring air pollution conditions for locations of interest, limiting outdoor exercise, using acclimation protocols, wearing N95 face masks and using antioxidant supplementation. The overarching purpose of this position statement by the Canadian Academy of Sport and Exercise Medicine and the Canadian Society for Exercise Physiology is to detail the current state of evidence and provide recommendations on implementing these personal strategies in preventing and mitigating the adverse health and performance effects of air pollution exposure during exercise while recognising the limited evidence base.
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Affiliation(s)
- Andy Hung
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Koch
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Valerie Bougault
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Cameron Marshall Gee
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Athletics Canada, Ottawa, Ontario, Canada
| | - Romulo Bertuzzi
- Endurance Performance Research Group, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Paddy McCluskey
- Athletics Canada, Ottawa, Ontario, Canada.,Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada
| | - Laura Hidalgo
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Michael Stephen Koehle
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada .,Division of Sport & Exercise Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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25
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Wells AD, Mermier CM, Bellovary BN, Deyhle MR, Hsiao YY, Amorim FT. The physiological, perceptual, and thermoregulatory responses to facemask use during exercise. J Sports Med Phys Fitness 2023; 63:264-272. [PMID: 35912891 DOI: 10.23736/s0022-4707.22.14032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of masks in public settings and when around people has been recommended to limit the spread of Coronavirus disease 2019 (COVID-19) by major public health agencies. Several different types of masks classified as either medical- or non-medical grade are commonly used among the public. However, concerns with difficulty breathing, re-breathing exhaled carbon dioxide, a decrease in arterial oxygen saturation, and a decrease in exercise performance have been raised regarding the use of mask during exercise. We review the current knowledge related to the effect of different masks during exercise on cardiorespiratory, metabolic, thermoregulatory, and perceptual responses. As such, the current literature seems to suggest that there are minimal changes to cardiovascular, metabolic, and no changes to thermoregulatory parameters with facemask use. However, differences in ventilatory parameters have been reported with submaximal and maximal intensity exercise to volitional fatigue. Literature on perceptual responses to exercise indicate an impact on ratings of perceived exertion, dyspnea, and overall discomfort dependent on mask use as well as exercise intensity. In conclusion, data from the current literature suggests a minimal impact on physiological, perceptual, and thermoregulatory responses dependent on the type of mask used during exercise.
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Affiliation(s)
- Andrew D Wells
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA - .,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA -
| | - Christine M Mermier
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | | | - Michael R Deyhle
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Yu-Yu Hsiao
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, USA
| | - Fabiano T Amorim
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
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26
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Reeder EL, O'Connell CJ, Collins SM, Traubert OD, Norman SV, Cáceres RA, Sah R, Smith DW, Robson MJ. Increased Carbon Dioxide Respiration Prevents the Effects of Acceleration/Deceleration Elicited Mild Traumatic Brain Injury. Neuroscience 2023; 509:20-35. [PMID: 36332692 DOI: 10.1016/j.neuroscience.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
Acceleration/deceleration forces are a common component of various causes of mild traumatic brain injury (mTBI) and result in strain and shear forces on brain tissue. A small quantifiable volume dubbed the compensatory reserve volume (CRV) permits energy transmission to brain tissue during acceleration/deceleration events. The CRV is principally regulated by cerebral blood flow (CBF) and CBF is primarily determined by the concentration of inspired carbon dioxide (CO2). We hypothesized that experimental hypercapnia (i.e. increased inspired concentration of CO2) may act to prevent and mitigate the actions of acceleration/deceleration-induced TBI. To determine these effects C57Bl/6 mice underwent experimental hypercapnia whereby they were exposed to medical-grade atmospheric air or 5% CO2 immediately prior to an acceleration/deceleration-induced mTBI paradigm. mTBI results in significant increases in righting reflex time (RRT), reductions in core body temperature, and reductions in general locomotor activity-three hours post injury (hpi). Experimental hypercapnia immediately preceding mTBI was found to prevent mTBI-induced increases in RRT and reductions in core body temperature and general locomotor activity. Ribonucleic acid (RNA) sequencing conducted four hpi revealed that CO2 exposure prevented mTBI-induced transcriptional alterations of several targets related to oxidative stress, immune, and inflammatory signaling. Quantitative real-time PCR analysis confirmed the prevention of mTBI-induced increases in mitogen-activated protein kinase kinase kinase 6 and metallothionein-2. These initial proof of concept studies reveal that increases in inspired CO2 mitigate the detrimental contributions of acceleration/deceleration events in mTBI and may feasibly be translated in the future to humans using a medical device seeking to prevent mTBI among high-risk groups.
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Affiliation(s)
- Evan L Reeder
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Christopher J O'Connell
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Sean M Collins
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA
| | - Owen D Traubert
- University of Cincinnati College of Arts and Sciences, Department of Biological Sciences, Cincinnati, OH 45221, USA
| | - Sophia V Norman
- University of Cincinnati College of Arts and Sciences, Department of Biological Sciences, Cincinnati, OH 45221, USA
| | - Román A Cáceres
- University of Cincinnati College of Medicine, Department of Cancer and Cell Biology Cincinnati, OH 45267, USA
| | - Renu Sah
- University of Cincinnati College of Medicine, Department of Pharmacology and Systems Physiology, Cincinnati, OH 45267, USA
| | | | - Matthew J Robson
- University of Cincinnati James L. Winkle College of Pharmacy, Division of Pharmaceutical Sciences, Cincinnati, OH 45267, USA.
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27
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Seibt R, Bär M, Rieger MA, Steinhilber B. Limitations in evaluating COVID-19 protective face masks using open circuit spirometry systems: respiratory measurement mask introduces bias in breathing pressure and perceived respiratory effort. Physiol Meas 2023; 44. [PMID: 36595319 DOI: 10.1088/1361-6579/aca7ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022]
Abstract
Objective.In response to the COVID-19 pandemic and the resulting widespread use of protective face masks, studies have been and are being conducted to investigate potential side effects of wearing masks on the performance and physiological parameters of wearers. The purpose of the present study is to determine whether and to what extent the use of a respiratory measurement (RM) mask-which is normally used during open-circuit spirometry-influences the results of these types of studies.Approach.34 subjects were involved in this intra-subject study with a cross-over design. Four different protective face masks, Community Mask, medical Mouth-Nose-Protection Mask, Filtering Face Piece Mask Class 2 (FFP2), and FFP2 with exhalation valve (FFP2ex), were tested at rest and during deep breathing by using or not using a RM mask (RM versus noRM). Breathing pressure inside the protective face masks was measured during inhalation and exhalation, and subjects rated breathing effort using an 11-stage Borg scale.Main results.The use of an additional RM mask-worn over the protective face masks-significantly increased inspiratory pressures under all mask conditions. The respiratory pressure rises to a level that substantially distorts the results. Expiratory pressure was also significantly increased except for the FFP2ex mask condition. The perceived respiratory effort was significantly increased by 1.0 to 2.8 steps on the Borgs scale for all mask conditions compared with noRM.Significance.We strongly recommend avoiding the use of RM masks for evaluating the effects of protective face masks on human physiology and subjective perception.
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Affiliation(s)
- Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, D-72074 Tuebingen, Germany
| | - Mona Bär
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, D-72074 Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, D-72074 Tuebingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Medical Faculty, University Hospital Tuebingen, D-72074 Tuebingen, Germany
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Harber P, Beckett WS. Health effects of filtering facepiece respirators: Systematic review of pulmonary and cardiovascular effects. Am J Ind Med 2023; 66:181-198. [PMID: 36464991 PMCID: PMC9878161 DOI: 10.1002/ajim.23450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022]
Abstract
Filtering facepiece respirators (FFRs) were introduced to protect the wearer by removing small particles from inspired air. FFRs are now also used to reduce the spread of transmissible agents from the wearer and are worn outside traditional healthcare and other workplaces. The COVID-19 pandemic increased concerns about potential adverse effects on wearers. A PUBMED query retrieved articles through June 2022. Abstracts and selected full-text articles were systematically reviewed by the authors. This article focuses upon cardiopulmonary physiologic effects (e.g., ventilation, CO2 elimination, oxygen uptake, and respiratory control) with emphasis upon current and potential research methods as well as summarizing results. 1985 records were identified, of which only 26% were published before 2020. FFR effects on CO2 elimination appear more likely to be significant than effects on oxygenation or cardiovascular function. While FFRs appear well tolerated by healthy persons, more research is needed for those with pulmonary or cardiac disorders, and for children. Many traditional pulmonary exercise study methods require special care when applied to filtering facepiece respirators. Studying additional parameters may explain the paradox of many subjective discomfort reports despite very limited physiologic effects.
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Affiliation(s)
- Philip Harber
- University of Arizona‐Mel and Enid Zuckerman College of Public HealthTucsonArizonaUSA
| | - William S. Beckett
- Harvard Medical School and Mount Auburn HospitalCambridgeMassachusettsUSA
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Jones N, Oke J, Marsh S, Nikbin K, Bowley J, Dijkstra HP, Hobbs FR, Greenhalgh T. Face masks while exercising trial (MERIT): a cross-over randomised controlled study. BMJ Open 2023; 13:e063014. [PMID: 36604128 PMCID: PMC9827243 DOI: 10.1136/bmjopen-2022-063014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Physical exertion is a high-risk activity for aerosol emission of respiratory pathogens. We aimed to determine the safety and tolerability of healthy young adults wearing different types of face mask during moderate-to-high intensity exercise. DESIGN Cross-over randomised controlled study, completed between June 2021 and January 2022. PARTICIPANTS Volunteers aged 18-35 years, who exercised regularly and had no significant pre-existing health conditions. INTERVENTIONS Comparison of wearing a surgical, cloth and filtering face piece (FFP3) mask to no mask during 4×15 min bouts of exercise. Exercise was running outdoors or indoor rowing at moderate-to-high intensity, with consistency of distance travelled between bouts confirmed using a smartphone application (Strava). Each participant completed each bout in random order. OUTCOMES The primary outcome was change in oxygen saturations. Secondary outcomes were change in heart rate, perceived impact of face mask wearing during exercise and willingness to wear a face mask for future exercise. RESULTS All 72 volunteers (mean age 23.9) completed the study. Changes in oxygen saturations did not exceed the prespecified non-inferiority margin (2% difference) with any mask type compared with no mask. At the end of exercise, the estimated average difference in oxygen saturations for cloth mask was -0.07% (95% CI -0.39% to 0.25%), for surgical 0.28% (-0.04% to 0.60%) and for FFP3 -0.21% (-0.53% to 0.11%). The corresponding estimated average difference in heart rate for cloth mask was -1.20 bpm (95% CI -4.56 to 2.15), for surgical 0.36 bpm (95% CI -3.01 to 3.73) and for FFP3 0.52 bpm (95% CI -2.85 to 3.89). Wearing a face mask caused additional symptoms such as breathlessness (n=13, 18%) and dizziness (n=7, 10%). 33 participants broadly supported face mask wearing during exercise, particularly indoors, but 22 were opposed. CONCLUSION This study adds to previous findings (mostly from non-randomised studies) that exercising at moderate-to-high intensity wearing a face mask appears to be safe in healthy, young adults. TRIAL REGISTRATION NUMBER NCT04932226.
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Affiliation(s)
- Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seren Marsh
- University of Oxford Medical School, University of Oxford, Oxford, UK
| | - Kurosh Nikbin
- GKT School of Medical Education, King's College London, London, UK
| | - Jonathan Bowley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - H Paul Dijkstra
- Department of Continuing Education, University of Oxford, Oxford, UK
- Medical Education Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Zheng C, Poon ETC, Wan K, Dai Z, Wong SHS. Effects of Wearing a Mask During Exercise on Physiological and Psychological Outcomes in Healthy Individuals: A Systematic Review and Meta-Analysis. Sports Med 2023; 53:125-150. [PMID: 36001290 PMCID: PMC9400006 DOI: 10.1007/s40279-022-01746-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Wearing face masks in public is an effective strategy for preventing the spread of viruses; however, it may negatively affect exercise responses. Therefore, this review aimed to explore the effects of wearing different types of face masks during exercise on various physiological and psychological outcomes in healthy individuals. METHODS A literature search was conducted using relevant electronic databases, including Medline, PubMed, Embase, SPORTDiscus, Web of Science, and Cochrane Central Register of Controlled Trials on April 05, 2022. Studies examining the effect of mask wearing (surgical mask, cloth mask, and FFP2/N95 respirator) during exercise on various physiological and psychological parameters in apparently healthy individuals were included. For meta-analysis, a random effects model was used. Mean difference (MD) or standardized MD (SMD) with 95% confidence intervals (CI) were calculated to analyze the total effect and the effect in subgroups classified based on face mask and exercise types. The quality of included studies was examined using the revised Cochrane risk-of-bias tool. RESULTS Forty-five studies with 1264 participants (708 men) were included in the systematic review. Face masks had significant effects on gas exchange when worn during exercise; this included differences in oxygen uptake (SMD - 0.66, 95% CI - 0.87 to - 0.45), end-tidal partial pressure of oxygen (MD - 3.79 mmHg, 95% CI - 5.46 to - 2.12), carbon dioxide production (SMD - 0.77, 95% CI - 1.15 to - 0.39), and end-tidal partial pressure of carbon dioxide (MD 2.93 mmHg, 95% CI 2.01-3.86). While oxygen saturation (MD - 0.48%, 95% CI - 0.71 to - 0.26) decreased slightly, heart rate was not affected. Mask wearing led to higher degrees of rating of perceived exertion, dyspnea, fatigue, and thermal sensation. Moreover, a small effect on exercise performance was observed in individuals wearing FFP2/N95 respirators (SMD - 0.42, 95% CI - 0.76 to - 0.08) and total effect (SMD - 0.23, 95% CI - 0.41 to - 0.04). CONCLUSION Wearing face masks during exercise modestly affected both physiological and psychological parameters, including gas exchange, pulmonary function, and subjective discomfort in healthy individuals, although the overall effect on exercise performance appeared to be small. This review provides updated information on optimizing exercise recommendations for the public during the COVID-19 pandemic. SYSTEMATIC REVIEW REGISTRATION NUMBER This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42021287278).
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Affiliation(s)
- Chen Zheng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric Tsz-Chun Poon
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Kewen Wan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zihan Dai
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China.
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A Cloth Facemask Causes No Major Respiratory or Cardiovascular Perturbations During Moderate to Heavy Exercise. J Phys Act Health 2023; 20:35-44. [PMID: 36476970 DOI: 10.1123/jpah.2022-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/25/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Investigate whether a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in untrained individuals. METHODS Healthy participants (n = 35; 17 men, age 30 [4] y, and 18 women, age 28 [5] y) underwent a progressive square wave test at 4 intensities: (1) 80% of ventilatory anaerobic threshold; (2) ventilatory anaerobic threshold; (3) respiratory compensation point; and (4) exercise peak (Peak) to exhaustion, 5-minute stages, with or without a triple-layered cloth facemask (Mask or No-Mask). Several physiological and perceptual measures were analyzed. RESULTS Mask reduced inspiratory capacity at all exercise intensities (P < .0001). Mask reduced respiratory frequency (P = .001) at Peak (-8.3 breaths·min-1; 95% confidence interval [CI], -5.8 to -10.8), respiratory compensation point (-6.9 breaths·min-1; 95% CI, -4.6 to -9.2), and ventilatory anaerobic threshold (-6.5 breaths·min-1; 95% CI, -4.1 to -8.8), but not at Baseline or 80% of ventilatory anaerobic threshold. Mask reduced tidal volume (P < .0001) only at respiratory compensation point (-0.5 L; 95% CI, -0.3 to -0.6) and Peak (-0.8 L; 95% CI, -0.6 to -0.9). Shallow breathing index was increased with Mask only at Peak (11.3; 95% CI, 7.5 to 15.1). Mask did not change HR, lactate, ratings of perceived exertion, blood pressure, or oxygen saturation. CONCLUSIONS A cloth facemask reduced time to exhaustion but had no major impact on cardiorespiratory parameters and had a slight but clinically meaningless impact on respiratory variables at higher intensities. Moderate to heavy activity is safe and tolerable for healthy individuals while wearing a cloth facemask. CLINICALTRIALS gov: NCT04887714.
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The Influence of Surgical Mask on Heart Rate, Muscle Saturation of Oxygen, and Hemoglobin during Whole-Body Vibration Exercise. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3958554. [DOI: 10.1155/2022/3958554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Background. Whole-body vibration (WBV) is a safe and effective exercise system that affects muscle oxygen through several physiological processes, although its effects on different protocols are still unclear. Unfortunately, the COVID-19 pandemic has generated various health problems and controversy or confusion on its possible adverse consequences and impact on performance when wearing a mask during the practice of physical exercise. Aim. To analyze the acute effects of WBV exercise in muscle oxygen variables during different intervention phases with or without a surgical mask and compare protocols that differ in the order of vibration frequencies. Methods. Forty-seven healthy students participated in WBV training. They were randomly assigned to use or not use a mask between the three intervention groups: group A (8, 12.6, and 20 Hz), group B (12.6, 20, and 8 Hz), and group C (20, 8, and 12.6 Hz). Besides the 3 WBV moments, the intervention had a baseline moment, two rest time and a recovery moment. During the whole intervention, the heart rate (HR), muscle oxygen saturation (SatO2), oxyhemoglobin (O2Hb), and deoxyhemoglobin (HHb) were registered. Results. There were no significant differences between the mask use and not use groups. Significant differences were found between the variables during the seven intervention moments and between intervention groups (A, B, or C). Conclusion. HR, SatO2, and Hb were not influenced by the use of a surgical mask, but they reacted differently through the different moments and were sensitive to vibration frequencies and respective order.
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Shuval K, Leonard D, DeFina LF, Barlow CE, Drope J, Amir O, Gneezy A, Tzafrir S, Chartier KG, Qadan M. Cardiorespiratory Fitness and Depression Symptoms among Adults During the COVID-19 Pandemic: Cooper Center Longitudinal Study. Prev Med Rep 2022; 30:102065. [PMCID: PMC9677558 DOI: 10.1016/j.pmedr.2022.102065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
This study examined the relation between cardiorespiratory fitness (fitness) and depression symptoms prior to and during COVID-19 among adults seeking preventive medical care. Participants consisted of 967 patients attending the Cooper Clinic (Dallas, TX) pre-pandemic (March 2018-December 2019) and during the pandemic (March-December 2020). The outcome, depression symptoms, was based on the Center for Epidemiological Studies-Depression (CES-D). Maximal metabolic equivalents task (MET) levels for fitness were determined from the final treadmill speed and grade. Multiple linear regression models were computed by sex. Analysis revealed that mean fitness decreased from 11.4 METs (SD=2.1) prior to the pandemic to 10.9 METs (SD=2.3) during the pandemic (p-value<0.001). The mean CES-D score increased from 2.8 (SD= 3.1) before to pandemic to 3.1 (SD=3.2) during the pandemic (p-value=0.003). Results from multiple linear regression indicate that increased fitness was associated with a statistically significant decrease in depression scores in men (-0.17 per MET; 95%CI -0.33, -0.02) but not women. This modest decrease may have been tempered by high fitness levels and low depression scores at baseline in this well-educated sample.
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Affiliation(s)
- Kerem Shuval
- The Cooper Institute, Dallas, Texas 75230, USA,School of Business Administration, University of Haifa, Haifa 3498838, Israel,School of Public Health, University of Haifa, Haifa 3498838, Israel,Corresponding author
| | | | | | | | - Jeffrey Drope
- Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Illinois, USA
| | - On Amir
- Rady School of Management, University of California San Diego, CA, USA
| | - Ayelet Gneezy
- Rady School of Management, University of California San Diego, CA, USA
| | - Shay Tzafrir
- School of Business Administration, University of Haifa, Haifa 3498838, Israel
| | - Karen G. Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Mahmoud Qadan
- School of Business Administration, University of Haifa, Haifa 3498838, Israel
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Glänzel MH, Barbosa IM, Machado E, Prusch SK, Barbosa AR, Lemos LFC, Schuch FB, Lanferdini FJ. Facial mask acute effects on affective/psychological and exercise performance responses during exercise: A meta-analytical review. Front Physiol 2022; 13:994454. [PMID: 36406998 PMCID: PMC9667098 DOI: 10.3389/fphys.2022.994454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Face masks are widely used during the COVID-19 pandemic as one of the protective measures against the viral infection risk. Some evidence suggests that face mask prolonged use can be uncomfortable, and discomfort can be exacerbated during exercise. However, the acute responses of mask-wearing during exercise on affective/psychological and exercise performance responses is still a topic of debate. Purpose: To perform a systematic review with meta-analysis of the acute effects of mask-wearing during exercise on affective/psychological and exercise performance responses in healthy adults of different/diverse training status. Methods: This review (CRD42021249569) was performed according to Cochrane's recommendations, with searches performed in electronic (PubMed, Web of Science, Embase, SportDiscus, and PsychInfo) and pre-print databases (MedRxiv, SportRxiv, PsyArXiv, and Preprint.Org). Syntheses of included studies' data were performed, and the RoB-2 tool was used to assess the studies' methodological quality. Assessed outcomes were affective/psychological (discomfort, stress and affective responses, fatigue, anxiety, dyspnea, and perceived exertion) and exercise performance time-to-exhaustion (TTE), maximal power output (POMAX), and muscle force production] parameters. Available data were pooled through meta-analyses. Results: Initially 4,587 studies were identified, 36 clinical trials (all crossover designs) were included. A total of 749 (39% women) healthy adults were evaluated across all studies. The face mask types found were clothing (CM), surgical (SM), FFP2/N95, and exhalation valved FFP2/N95, while the most common exercises were treadmill and cycle ergometer incremental tests, beyond outdoor running, resistance exercises and functional tests. Mask-wearing during exercise lead to increased overall discomfort (SMD: 0.87; 95% CI 0.25-1.5; p = 0.01; I2 = 0%), dyspnea (SMD: 0.40; 95% CI 0.09-0.71; p = 0.01; I2 = 68%), and perceived exertion (SMD: 0.38; 95% CI 0.18-0.58; p < 0.001; I2 = 46%); decreases on the TTE (SMD: -0.29; 95% CI -0.10 to -0.48; p < 0.001; I2 = 0%); without effects on POMAX and walking/running distance traveled (p > 0.05). Conclusion: Face mask wearing during exercise increases discomfort (large effect), dyspnea (moderate effect), and perceived exertion (small effect), and reduces the TTE (small effect), without effects on cycle ergometer POMAX and distance traveled in walking and running functional tests. However, some aspects may be dependent on the face mask type, such as dyspnea and perceived exertion. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249569], identifier [CRD42021249569].
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Affiliation(s)
- Marcelo Henrique Glänzel
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, RS, Brazil,Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,*Correspondence: Marcelo Henrique Glänzel, ; Fábio Juner Lanferdini,
| | - Igor Martins Barbosa
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Esthevan Machado
- Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Samuel Klippel Prusch
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, RS, Brazil,Graduate Program in Gerontology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Luiz Fernando Cuozzo Lemos
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, RS, Brazil,Graduate Program in Gerontology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Fábio Juner Lanferdini
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, RS, Brazil,*Correspondence: Marcelo Henrique Glänzel, ; Fábio Juner Lanferdini,
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Hong J, Byun J, Choi JO, Shim D, Rha DW. The Effects of Wearing Facemasks during Vigorous Exercise in the Aspect of Cardiopulmonary Response, In-Mask Environment, and Subject Discomfort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114106. [PMID: 36360983 PMCID: PMC9656209 DOI: 10.3390/ijerph192114106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 06/01/2023]
Abstract
Non-pharmaceutical intervention such as wearing a mask during the pandemic of SARS-CoV-2 is one of the most important ways to prevent the spread of the virus. However, despite high effectiveness and easy to access, the biggest problem is 'discomfort'. The purpose of this study was to measure the changes of cardiopulmonary response and related factors affecting breathing discomfort when wearing a mask during vigorous exercise. Fifteen healthy male adults participated in this study. The experimental protocol consisted of three conditions: no mask; KF-94 mask; and sports mask. Each condition consisted of three stages: stage I, 2 m/s on even level; stage II, 2 m/s with 5° inclination; and stage III, 3 m/s on even level. Oxygen saturation (SaO2) and heart rate (HR), partial pressure of carbon dioxide (pCO2), energy expenditure index (EEI), in-mask temperature, humidity, and a five-point scale questionnaire to evaluate subjective discomfort were measured. The results show that there was a significantly higher discomfort score in mask conditions compared with no mask (p < 0.05) and only pCO2 change significantly related to subjective discomfort during exercise (p < 0.05). Moreover, the pCO2 washout was significantly disturbed when wearing a sports mask in stages 2 and 3, which was related to wearer subjective discomfort.
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Vogt G, Radtke K, Jagim A, Peckumn D, Lee T, Mikat R, Foster C. Effect of Face Masks on Physiological and Perceptual Responses during 30 Minutes of Self-Paced Exercise in Older Community Dwelling Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12877. [PMID: 36232176 PMCID: PMC9564912 DOI: 10.3390/ijerph191912877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
This study examined the effects of different types of masks (no mask, surgical mask (SM), and N95-mask) on physiological and perceptual responses during 30-min of self-paced cycle ergometer exercise. This study was a prospective randomly assigned experimental design. Outcomes included workload (Watts), oxygen saturation (SpO2), end-tidal carbon dioxide (PetCO2), heart rate (HR), respiratory rate (RR), rating of perceived exertion (RPE), and rating of perceived dyspnea (RPD). Volunteers (54-83 years (n = 19)) completed two familiarization sessions and three testing sessions on an air braked cycle ergometer. No significant difference was found for condition x time for any of the dependent variables. RPE, RPD, and PetCO2 were significantly higher with an N95-mask vs. no mask (NM) ((p = 0.012), (p = 0.002), (p < 0.001)). HR was significantly higher with the SM compared to the NM condition (p = 0.027) (NM 107.18 ± 9.96) (SM 112.34 ± 10.28), but no significant difference was found when comparing the SM to the N95 condition or when comparing the N95condition to the NM condition. Watts increased across time in each condition (p = 0.003). Initially RR increased during the first 3 min of exercise (p < 0.001) with an overall gradual increase noted across time regardless of mask condition (p < 0.001). SpO2 significantly decreased across time but remained within normal limits (>95%). No significant difference was found in Watts, RR, or SpO2 regardless of mask condition. Overall, the N95mask was associated with increased RPE, RPD, and PetCO2 levels. This suggests trapping of CO2 inside the mask leading to increased RPE and RPD.
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Affiliation(s)
- Grace Vogt
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Kimberley Radtke
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Andrew Jagim
- Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA
| | - Dominique Peckumn
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Teresa Lee
- Department of Health, Exercise & Rehabilitative Sciences, Winona State University, Winona, MN 55987, USA
| | - Richard Mikat
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Carl Foster
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
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Slimani M, Paravlic A, Abazovic E, Znazen H, Bragazzi NL. Effect of facemask use on cognitive function during a maximal running aerobic fitness test. Front Physiol 2022; 13:912740. [PMID: 36246122 PMCID: PMC9557100 DOI: 10.3389/fphys.2022.912740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of the present randomized, crossover study was to determine the physiological and cognitive function responses while wearing a facemask during a maximal running aerobic fitness test. Methods: Fourteen healthy, nonsmoking physical education students (age = 17.5 years, height = 1.72 m, body mass = 70.4 kg) volunteered to participate in this study. They carried out a 20 m multistage fitness test (MSFT) while wearing or not a cloth facemask on two separate occasions performed in random order. The “Rating of Perceived Exertion” (RPE) and the d2 test for visual attention were administered and assessed before and immediately after the MSFT for both conditions (with or without a facemask). Results: When wearing the facemask, the participants exhibited lower maximal aerobic speed (p = 0.039), VO2max (p = 0.039), distance covered during the MSFT (p = 0.057), and concentration performance (p < 0.001), when compared with the control situation (without facemask). Moreover, they made more errors compared with the control condition (p = 0.021). The use of a cloth facemask during maximal endurance running tests (such as the MSFT) reduced VO2max, and measures of cognitive performance as assessed by the test of focused visual attention (the d2 test). This data suggests avoiding using a cloth facemask during maximal aerobic fitness tests, and before any tasks that require a high level of visual attention.
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Affiliation(s)
- Maamer Slimani
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), Genoa University, Genoa, Italy
- Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Tunisia, North Africa
- *Correspondence: Maamer Slimani,
| | - Armin Paravlic
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Ensar Abazovic
- Faculty of Sports and Physical Education, Sarajevo, Bosnia and Herzegovina
| | - Hela Znazen
- Department of Physical Education and Sport, College of Education, Taif University, Taif, Saudi Arabia
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Acuti Martellucci C, Flacco ME, Martellucci M, Violante FS, Manzoli L. Inhaled CO 2 Concentration While Wearing Face Masks: A Pilot Study Using Capnography. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221123573. [PMID: 36133777 PMCID: PMC9483963 DOI: 10.1177/11786302221123573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/10/2022] [Indexed: 05/21/2023]
Abstract
Background Face masks are recommended based on the assumption that they protect against SARS-CoV-2 transmission, however studies on their potential side effects are still lacking. We aimed to evaluate the inhaled air carbon dioxide (CO2) concentration, when wearing masks. Methods We measured end-tidal CO2 using professional side-stream capnography, with water-removing tubing, (1) without masks, (2) wearing a surgical mask, and (3) wearing a FFP2 respirator (for 5 minutes each while seated after 10 minutes of rest), in 146 healthy volunteers aged 10 to 90 years, from the general population of Ferrara, Italy. The inhaled air CO2 concentration was computed as: ([mask volume × end-tidal CO2] + [tidal volume - mask volume] × ambient air CO2)/tidal volume. Results With surgical masks, the mean CO2 concentration was 7091 ± 2491 ppm in children, 4835 ± 869 in adults, and 4379 ± 978 in the elderly. With FFP2 respirators, this concentration was 13 665 ± 3655 in children, 8502 ± 1859 in adults, and 9027 ± 1882 in the elderly. The proportion showing a CO2 concentration higher than the 5000 ppm (8-hour average) acceptable threshold for workers was 41.1% with surgical masks, and 99.3% with FFP2 respirators. Adjusting for age, gender, BMI, and smoking, the inhaled air CO2 concentration significantly increased with increasing respiratory rate (mean 10 837 ±3712 ppm among participants ⩾18 breaths/minute, with FFP2 respirators), and among the minors. Conclusion If these results are confirmed, the current guidelines on mask-wearing should be reevaluated.
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Affiliation(s)
| | - Maria Elena Flacco
- Department of Environmental and
Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Mosè Martellucci
- Department of Medicine and Surgery,
University of Perugia, Perugia, Italy
| | - Francesco Saverio Violante
- Occupational Health Unit, Sant’Orsola
Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical
Sciences, University of Bologna, Bologna, Italy
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Kogel A, Hepp P, Stegmann T, Tünnemann-Tarr A, Falz R, Fischer P, Mahfoud F, Laufs U, Fikenzer S. Effects of surgical and FFP2 masks on cardiopulmonary exercise capacity in patients with heart failure. PLoS One 2022; 17:e0269470. [PMID: 35998172 PMCID: PMC9397906 DOI: 10.1371/journal.pone.0269470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/22/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in patients with stable heart failure. Methods 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11%, NTProBNP 573±567 pg/ml) underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire. Results Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p = 0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p = 0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p = 0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05). Conclusion Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation. This reduction in cardiopulmonary performance should be considered in heart failure patients whose daily life activities are often just as challenging as exercise is for healthy adults.
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Affiliation(s)
- Alexander Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
- * E-mail:
| | - Pierre Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Tina Stegmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Roberto Falz
- Institute of Sport Medicine and Prevention, University of Leipzig, Leipzig, Germany
| | - Patrick Fischer
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sven Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Conners RT, Whitehead PN, Skarp T, Waller B, Richard M, Bain C, Monks M, Faghy MA. Acute Effects of Facial Coverings on Anaerobic Exercise Performance in College-Aged Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10500. [PMID: 36078215 PMCID: PMC9517774 DOI: 10.3390/ijerph191710500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
The use of facial coverings has been amplified during the COVID-19 pandemic as a means to minimize the spread of disease. However, facial coverings may impede ventilation during high-intensity activity, leading to a reduction in cardiopulmonary exercise capacity. Thus, the purpose of this study was to determine the acute impact of different facial coverings on exercise performance in college-aged individuals during a 300-yard shuttle. It was hypothesized that the lowest heart rate (HR), completion time (CT), and rate of perceived exertion (RPE) would occur with no mask. Furthermore, it was hypothesized the SHEMA97 mask would have lower HR, CT, and RPE compared to surgical and fabric masks. Results showed the use of the fabric mask resulted in significantly higher HR compared to no mask (p = 0.006). The SHEMA97 mask resulted in faster CT and lower RPE compared to both the fabric and surgical masks (p < 0.001). All mask conditions yielded significantly higher levels of perceived discomfort than wearing no mask (p < 0.05). While the use of facial coverings can help prevent the spread of disease, their use during exercise may pose limitations to performance; however, the ability of the SHEMA97 to provide minimal changes to CT and RPE provides a promising option.
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Affiliation(s)
- Ryan T. Conners
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Paul N. Whitehead
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Thomas Skarp
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Briana Waller
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Mark Richard
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Carrington Bain
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Megan Monks
- Department of Kinesiology, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Mark A. Faghy
- School of Human Sciences, University of Derby, Derby DE22 1GB, UK
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Wangsan K, Sapbamrer R, Sirikul W, Panumasvivat J, Surawattanasakul V, Assavanopakun P. Effect of N95 Respirator on Oxygen and Carbon Dioxide Physiologic Response: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8646. [PMID: 35886496 PMCID: PMC9316293 DOI: 10.3390/ijerph19148646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
During the COVID-19 pandemic, N95 respirators were commonly used in many situations. Respiratory problems from prolonged use of respirators were discussed in many studies, which show varied results. From the inconclusive results, the current systematic review and meta-analysis discerned the effects of the N95 respirator by assessing the oxygen and carbon dioxide changes in both high- and low-to-moderate-intensity physical activities in a healthy population. Thirteen studies were identified for inclusion in the study. In high-intensity physical activities, our meta-analysis showed borderline lower oxygen saturation and higher carbon dioxide partial pressure, but oxygen saturation did not change in low-to-moderate physical activity. The use of N95 respirators could statistically affect the physiologic changes of carbon dioxide and oxygen in high-intensity physical activity among healthy participants, but this may not be clinically significant. Some users who have certain health conditions, such as respiratory problems, should be informed of the clinical symptoms related to hypercarbia and hypoxia for the early detection of adverse effects of N95 respirators.
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Affiliation(s)
| | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine Chiang Mai University, Chiang Mai 50200, Thailand; (K.W.); (J.P.); (V.S.); (P.A.)
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine Chiang Mai University, Chiang Mai 50200, Thailand; (K.W.); (J.P.); (V.S.); (P.A.)
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Blood gas levels, cardiovascular strain and cognitive performance during surgical mask and filtering face piece application. Sci Rep 2022; 12:9708. [PMID: 35690655 PMCID: PMC9188275 DOI: 10.1038/s41598-022-13711-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/26/2022] [Indexed: 12/12/2022] Open
Abstract
Mask induced airway resistance and carbon dioxide rebreathing is discussed to impact gas exchange and to induce discomfort and impairments in cognitive performance. N = 23 healthy humans (13 females, 10 males; 23.5 ± 2.1 years) participated in this randomized crossover trial (3 arms, 48-h washout periods). During interventions participants wore either a surgical face mask (SM), a filtering face piece (FFP2) or no mask (NM). Interventions included a 20-min siting period and 20 min steady state cycling on an ergometer at 77% of the maximal heart rate (HR). Hemodynamic data (HR, blood pressure), metabolic outcomes (pulse derived oxygen saturation, capillary carbon dioxide (pCO2), and oxygen partial pressure (pO2), lactate, pH, base excess), subjective response (ability to concentrate, arousal, perceived exertion) and cognitive performance (Stroop Test) were assessed. Compared to NM, both masks increased pCO2 (NM 31.9 ± 3.3 mmHg, SM = 35.2 ± 4.0 mmHg, FFP2 = 34.5 ± 3.8 mmHg, F = 12.670, p < 0.001) and decreased pH (NM = 7.42 ± 0.03, SM = 7.39 ± 0.03, FFP2 = 7.39 ± 0.04, F = 11.4, p < 0.001) during exercise. The FFP2 increased blood pressure during exercise (NM = 158 ± 15 mmHg, SM = 159 ± 16 mmHg, FFP2 = 162 ± 17 mmHg, F = 3.21, p = 0.050), the SM increased HR during sitting (NM = 70 ± 8 bpm, SM = 74 ± 8 bpm, FFP2 = 73 ± 8 bpm, F = 4.70, p = 0.014). No mask showed any comparative effect on other hemodynamic, metabolic, subjective, or cognitive outcomes. Mask wearing leads to slightly increased cardiovascular stress and elevated carbon dioxide levels during exercise but did not affect cognitive performance or wellbeing.
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43
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Khan J, E N, Mariatti M, Vilay V, Todo M. A comprehensive review on facemask manufacturing, testing, and its environmental impacts. JOURNAL OF INDUSTRIAL TEXTILES 2022; 52:15280837221111175. [PMID: 36249720 PMCID: PMC9548449 DOI: 10.1177/15280837221111175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The coronavirus pandemic (COVID-19) is currently the biggest threat to human lives due to its rapid transmission rate causing severe damage to human health and economy. The transmission of viral diseases can be minimized at its early stages with proper planning and preventive practices. The use of facemask has proved to be most effective measure to curb the spread of virus along with social distancing and good hygiene practices. This necessitates more research on facemask technology to increase its filtration efficiencies and proper disposal, which can be accelerated with knowledge of the current manufacturing process and recent research in this field. This review article provides an overview of the importance of facemask, fundamentals of nonwoven fabrics, and its manufacturing process. It also covers topics related to recent research reported for improved facemask efficiencies and testing methods to evaluate the performance of facemask. The plastic waste associated with the facemask and measures to minimize its effect are also briefly described. A systematic understanding is given in order to trigger future research in this field to ensure that we are well equipped for any future pandemic.
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Affiliation(s)
- Junaid Khan
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal Penang, Malaysia
| | - Netnapa E
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal Penang, Malaysia
| | - M Mariatti
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal Penang, Malaysia
| | - V Vilay
- Department of Mechanical Engineering, Faculty of Engineering, Sokpaluang Campus, National University of Laos, Vientiane, Laos
| | - M Todo
- Renewable Energy Center, Research Institute for Applied Mechanics, Kyushu University, Fukuoka, Japan
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Sanchez-Migallón V, Calvo-Lobo C, Sanchez-Jorge S, Arce M, Vicente A, Bello E, Rodriguez-Sanz D, Becerro-de-Bengoa-Vallejo R, Chicharro JL, Vicente-Campos D. Exercise Physiology at "Conversational Level" Is Not Impaired in Healthy Young Subjects Wearing Masks or Respirators. Respiration 2022; 101:728-737. [PMID: 35512663 DOI: 10.1159/000524490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of the use of both surgical masks and FFP2 respirators on the inspiratory muscle strength, metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception, before and during 30 min stable load exercise at "conversational level". METHODS A randomized cross-over study was carried out. Nineteen healthy adults completed 3 conditions (without a mask, with a surgical mask or an FFP2 respirator) during a 30-min steady-state test at the lactate threshold intensity. Inspiratory muscle strength was measured before and after the test, and metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception were collected at baseline, during, and after the test. RESULTS There was a significant reduction in inspiratory muscle strength after the 30-min test in all conditions (control: 6.26 mm Hg, p < 0.5; surgical mask: 8.55 mm Hg, p < 0.01; FFP2 respirator: 12.42 mm Hg, p < 0.001), but without significant differences between them (p = 0.283). Data showed a statistically significant effect for time, but did not show a statistically significant interaction between condition and time for heart rate (p = 0.674), oxygen saturation (p = 0.297), blood lactate level (p = 0.991), rating perceived exertion (p = 0.734) and dyspnea (p = 0.532) comparisons. CONCLUSIONS The present study findings suggested that inspiratory muscle strength and physiological parameters during "conversational level" exercise were not impaired under wearing masks in healthy, nonsmoking young adults.
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Affiliation(s)
| | - César Calvo-Lobo
- Faculty of Nursing, Physical Therapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Mónica Arce
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Alejandra Vicente
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Elena Bello
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - David Rodriguez-Sanz
- Faculty of Nursing, Physical Therapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - J L Chicharro
- Faculty of Nursing, Physical Therapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
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Sanri E, Karacabey S, Unal E, Kudu E, Cetin M, Ozpolat C, Denizbasi A. The Cardiopulmonary Effects of Medical Masks and Filtering Facepiece Respirators on Healthy Health Care Workers in the Emergency Department: A Prospective Cohort Study. J Emerg Med 2022; 62:600-606. [PMID: 35058098 PMCID: PMC8767914 DOI: 10.1016/j.jemermed.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/31/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Background International COVID-19 guidelines recommend that health care workers (HCWs) wear filtering facepiece (FFP) respirators to reduce exposure risk. However, there are concerns about FFP respirators causing hypercapnia via rebreathing carbon dioxide (CO2). Most previous studies measured the physiological effects of FFP respirators on treadmills or while resting, and such measurements may not reflect the physiological changes of HCWs working in the emergency department (ED). Objective Our aim was to evaluate the physiological and clinical impacts of FFP type II (FFP2) respirators on HCWs during 2 h of their day shift in the ED. Methods We included emergency HCWs in this prospective cohort study. We measured end-tidal CO2 (ETCO2), mean arterial pressure (MAP), respiratory rate (RR), and heart rate values and dyspnea scores of subjects at two time points. The first measurements were carried out with medical masks while resting. Subjects then began their day shift in the ED with medical mask plus FFP2 respirator. We called subjects after 2 h for the second measurement. Results The median age of 153 healthy volunteers was 24.0 years (interquartile range 24.0–25.0 years). Subjects’ MAP, RR, and ETCO2 values and dyspnea scores were significantly higher after 2 h. Median ETCO2 values increased from 36.4 to 38.8 mm Hg. None of the subjects had hypercapnia symptoms, hypoxia, or other adverse effects. Conclusion We did not observe any clinical reflection of these changes in physiological values. Thus, we evaluated these changes to be clinically insignificant. We found that it is safe for healthy HCWs to wear medical masks plus FFP2 respirators during a 2-h working shift in the ED.
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Affiliation(s)
- Erkman Sanri
- Faculty of Medicine, Department of Emergency Medicine, Marmara University, Istanbul, Turkey
| | - Sinan Karacabey
- Faculty of Medicine, Department of Emergency Medicine, Marmara University, Istanbul, Turkey
| | - Emir Unal
- Faculty of Medicine, Department of Emergency Medicine, Marmara University, Istanbul, Turkey
| | - Emre Kudu
- Faculty of Medicine, Department of Emergency Medicine, Marmara University, Istanbul, Turkey
| | - Murat Cetin
- Izmir Tinaztepe University, Vocational School of Health Services, Department of First Aid and Emergency Care, Izmir, Turkey
| | - Cigdem Ozpolat
- Faculty of Medicine, Department of Emergency Medicine, Marmara University, Istanbul, Turkey
| | - Arzu Denizbasi
- Faculty of Medicine, Department of Emergency Medicine, Marmara University, Istanbul, Turkey
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46
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Facemask Use During High Intensity Interval Exercise in Temperate and Hot Environments. J Occup Environ Med 2022; 64:421-428. [DOI: 10.1097/jom.0000000000002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Poncin W, Schalkwijk A, Vander Straeten C, Braem F, Latiers F, Reychler G. Impact of surgical mask on performance and cardiorespiratory responses to submaximal exercise in COVID-19 patients near hospital discharge: A randomized crossover trial. Clin Rehabil 2022; 36:1032-1041. [PMID: 35473371 PMCID: PMC9047665 DOI: 10.1177/02692155221097214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Wearing a surgical mask in hospitalized patients has become recommended during care, including rehabilitation, to mitigate coronavirus disease 2019 (COVID-19) transmission. However, the mask may increase dyspnoea and raise concerns in promoting rehabilitation activities in post-acute COVID-19 patients. Objective To evaluate the impact of the surgical mask on dyspnoea, exercise performance and cardiorespiratory response during a 1-min sit-to-stand test in hospitalized COVID-19 patients close to discharge. Methods COVID-19 patients whose hospital discharge has been planned the following day performed in randomized order two sit-to-stand tests with or without a surgical mask. Outcome measures were recorded before, at the end, and after two minutes of recovery of each test. Dyspnoea (modified Borg scale), cardiorespiratory parameters and sit-to-stand repetitions were measured. Results Twenty-eight patients aged 52 ± 10 years were recruited. Compared to unmasked condition, dyspnoea was significantly higher with the mask before and at the end of the sit-to-stand test (mean difference[95%CI]: 1.0 [0.6, 1.4] and 1.7 [0.8, 2.6], respectively). The difference was not significant after the recovery period. The mask had no impact on cardiorespiratory parameters nor the number of sit-to-stand repetitions. Conclusion In post-acute COVID-19 patients near hospital discharge, the surgical mask increased dyspnoea at rest and during a submaximal exercise test but had no impact on cardiorespiratory response or exercise performance. Patients recovering from COVID-19 should be reassured that wearing a surgical facemask during physical or rehabilitation activities is safe. These data may also mitigate fears to refer these patients in rehabilitation centres where mask-wearing has become mandatory.
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Affiliation(s)
- William Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, 70492Cliniques universitaires Saint-Luc, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, 70492Cliniques universitaires Saint-Luc, Brussels, Belgium.,Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Adrien Schalkwijk
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Charlie Vander Straeten
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Frédéric Braem
- Secteur de Kinésithérapie et Ergothérapie, 70492Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Fabien Latiers
- Secteur de Kinésithérapie et Ergothérapie, 70492Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, 70492Cliniques universitaires Saint-Luc, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, 70492Cliniques universitaires Saint-Luc, Brussels, Belgium.,Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
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Braga F, Espinosa G, Monteiro A, Marinho B, Drummond E. Physiological Effects of Exercising at Different Intensities Wearing Surgical or Double-layer Cotton Facemasks Compared to Not Wearing a Mask. Eur J Sport Sci 2022; 23:925-935. [PMID: 35418276 DOI: 10.1080/17461391.2022.2065928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since the beginning of the SARS-CoV-2 pandemic, the community use of facemasks has been widely recommended. However, their use during exercise has raised safety concerns. Thus, we compared the physiological differences between exercising wearing a surgical (SM) or a double-layer-cotton (DLC) facemask and not wearing a mask (NM). Sixteen volunteers underwent 4 bouts of cycling-based exercise, which consisted of two different intensities: light-to-moderate and moderate-to-high. Facemasks were used as follows: bout-1 and 4: NM; bout-2: SM or DLC and bout-3: DLC or SM. Ventilatory, metabolic, pulmonary gas exchange (PGE) and perceptual variables were collected. At both exercise intensities compared to NM, both facemasks induced similar ventilatory adaptations, increasing inspiratory time and tidal volume and decreasing breathing frequency. Effect sizes (ES) were larger for DLC than for SM. At moderate-to-high, both facemasks reduced the minute ventilation, whereas at light-to-moderate, it was only seen with DLC. End tidal and mixed CO2 pressures, as well as the difference between them, increased with both facemasks. Again, ES was larger for DLC than SM. No relevant oxygen saturation drop was observed with both facemaks and exercise intensities. A small ES increament in VO2 and VCO2 were seen with both facemasks. Effort perception increased at moderate-to-high for both exercise intensities, buth larger EF were with DLC than SM . DLC increased facial temperature during both exercise intensities. In conclusion, ventilatory adjustments imposed during facemask exercise influenced PGE and metabolic and perceptual changes. Larger ES were mostly seen for DLC than SM.Novelty Bullets Facemasks affect the breathing pattern by changing the frequency and amplitude of pulmonary ventilation.The augmented ventilatory work increases VO2, VCO2, and RPE and promotes nonconcerning drops in SpO2 and CO2 retention.Increased inspiratory and expiratory pressure can account for the reduction in pulmonary physiological dead space.
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Affiliation(s)
- Fabrício Braga
- Human Performance Laboratory; Rio de Janeiro; Brazil.,Casa de Saúde São José; Rio de Janeiro; Brazil
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Litwinowicz K, Choroszy M, Ornat M, Wróbel A, Waszczuk E. Bayesian network meta-analysis of face masks' impact on human physiology. Sci Rep 2022; 12:5823. [PMID: 35388100 PMCID: PMC8985742 DOI: 10.1038/s41598-022-09747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
Several concerns regarding the safety of face masks use have been propounded in public opinion. The objective of this review is to examine if these concerns find support in the literature by providing a comprehensive overview of physiological responses to the use of face masks. We have performed a systematic review, pairwise and network meta-analyses to investigate physiological responses to the use of face masks. The study has been registered with PROSPERO (C RD42020224791). Obtained results were screened using our exclusion and inclusion criteria. Meta-analyses were performed using the GeMTC and meta R packages. We have identified 26 studies meeting our inclusion and exclusion criteria, encompassing 751 participants. The use of face masks was not associated with significant changes in pulsoxymetrically measured oxygen saturation, even during maximal-effort exercises. The only significant physiological responses to the use of face masks during low-intensity activities were a slight increase in heart rate, mildly elevated partial pressure of carbon dioxide (not meeting criteria for hypercarbia), increased temperature of facial skin covered by the mask, and subsequent increase of the score in the rating of heat perception, with N95 filtering facepiece respirators having a greater effect than surgical masks. In high-intensity conditions, the use of face masks was associated with decreased oxygen uptake, ventilation, and RR. Face masks are safe to use and do not cause significant alterations in human physiology. The increase in heart rate stems most likely from increased respiratory work required to overcome breathing resistance. The increase in carbon dioxide is too small to be clinically relevant. An increased rating of heat perception when using face masks results from higher temperature of facial skin covered by the mask.
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Affiliation(s)
- Kamil Litwinowicz
- Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Wrocław, Poland.
| | - Marcin Choroszy
- Department of Microbiology, Wroclaw Medical University, Wrocław, Poland
| | - Maciej Ornat
- Department of Human Morphology and Embryology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Wróbel
- Department of Psychotherapy and Psychosomatic Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Ewa Waszczuk
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wrocław, Poland
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Motivation and Eco-Attitudes among Night Runners during the COVID-19 Pandemic. SUSTAINABILITY 2022. [DOI: 10.3390/su14031512] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Running surrounded by nature at night, often with limited contact with other people, is one of the safest physical activities during the COVID-19 pandemic. The aim of this article is to determine what motivates night recreational runners and to analyse the differences between men and women according to age, and also to see whether the fact of having had COVID-19 or not matters when it comes to athletes’ motivation behind participating in runs. Runners were also asked about participating in cities or out-of-town events in terms of verifying the cleanliness of the air before running, using masks or running in green areas. 233 individuals in total participated in this descriptive, quantitative, cross-sectional study. The questionnaire uses the division of motives used in the Marathon Motivation Scale (MOMS) and a number of additional questions on environmental factors. Overall, the main motivation that drives night-time runners is health orientation, weight concern, personal goal achievement, psychological coping, life meaning and self-esteem. The research also showed higher scores for health orientation, recognition, psychological coping, life meaning and self-esteem among runners who had had COVID-19 than runners who had not had the virus. In addition, respondents clearly indicated that night running makes it easier to fall asleep and improves the quality of sleep. Most runners rated their mental health as being good, did not run in the morning despite better air levels, did not choose running events outside the urban area and did not check the air quality index before running. Therefore, it will be important for coaches, event organisers and other professionals to consider athletes’ age, gender, whether they have had COVID-19 and runners’ approaches to eco-attitudes when trying to understand their reasons for participating in different sports or leisure events, especially those that focus on a priority in shaping environmental attitudes.
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