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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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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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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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Hendarto S, Doewes RI, Purnama SK, Nuryadin I, Manshuralhudlori M. The effects of aerator masks and medical masks on oxygen saturation (SO2) on mentally retarded athletes. J Public Health Afr 2022. [PMID: 37497144 PMCID: PMC10367026 DOI: 10.4081/jphia.2022.2416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The study purpose was investigated the effect of aerator masks on the oxygen saturation (SO2) of mentally retarded athletes compared to medical masks. The researcher used a comparative study. Parametric test was used to test the difference in SO2 percent and evaluate the questionnaire in the two groups. The results showed after undergoing exercise, SO2 percent in participants was 94.60±0.55 for aerator masks and 96.60±0.55 for medical masks. The study also showed that there was no significant difference in SO2 percent of participants wearing aerator masks and medical masks. However, the decrease in oxygen saturation percent of participants wearing aerator masks experienced a lower decrease, 1.60±0.55 compared to medical masks of 2.00±1.00. On the other hand, wearing an aerator mask is better because it does not prevent maximum performance, better comfort, the mask material feels better on the skin, does not experience difficulties breathable, and suitable for exercise. An aerator mask is a mask with an adequate supply of oxygen so that every breath is maintained even when used during sports activities.
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Abe M, Ushio K, Ishii Y, Nakashima Y, Iwaki D, Fukuhara K, Takahashi M, Mikami Y. A method of determining anaerobic threshold from percutaneous oxygen saturation. Sci Rep 2022; 12:20081. [PMID: 36418407 PMCID: PMC9684533 DOI: 10.1038/s41598-022-24271-w] [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: 07/20/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
The anaerobic threshold (AT) is the point of the aerobic-to-anaerobic metabolic switch. Despite the many clinical applications of AT, this measurement requires sophisticated equipment and skills. Here, we investigated a simple measurement method for AT using percutaneous oxygen saturation (SpO2) and pulse rate (PR) with a pulse oximeter in a study of exercise stress on healthy volunteers. Twenty individuals (ten men and ten women) were included in the study. Various respiratory parameters, including AT, were measured using conventional analytical methods. The SpO2 threshold (ST) was calculated using the SpO2-Slope method. The mean ± standard deviations SpO2 at ST was 97.8% ± 0.3% in men and 99.0 ± 0.3% in women. The concordance and interchangeability between ST and various five different types of AT, the ventilatory equivalent for oxygen (VE/VO2_AT), V-Slope (V-Slope_AT), ventilatory equivalent (VE_AT), respiratory exchange ratio (R_AT), and partial pressure of end-tidal oxygen (PETO2_AT) were generally high, with positive correlation coefficients in the range of [0.68-0.80]. These findings suggest that the SpO2-Slope method with a pulse oximeter may be a useful and simple method to determine AT compared to conventional methods.
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Affiliation(s)
- Masatsugu Abe
- FANCL Corporation Research Institute, 2-13 Kamishinano, Totsuka-ku, Yokohama, Kanagawa 244-0806 Japan
| | - Kai Ushio
- grid.470097.d0000 0004 0618 7953Department of Rehabilitation Medicine, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Yuri Ishii
- FANCL Corporation Research Institute, 2-13 Kamishinano, Totsuka-ku, Yokohama, Kanagawa 244-0806 Japan
| | - Yuki Nakashima
- grid.470097.d0000 0004 0618 7953Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Daisuke Iwaki
- grid.470097.d0000 0004 0618 7953Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Kouki Fukuhara
- grid.470097.d0000 0004 0618 7953Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Makoto Takahashi
- grid.257022.00000 0000 8711 3200Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Mikami
- grid.470097.d0000 0004 0618 7953Department of Rehabilitation Medicine, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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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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Aerosol particle emission increases exponentially above moderate exercise intensity resulting in superemission during maximal exercise. Proc Natl Acad Sci U S A 2022; 119:e2202521119. [PMID: 35605123 PMCID: PMC9295808 DOI: 10.1073/pnas.2202521119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other pathogens is probably increased during indoor exercise, but data on the emission of aerosol particles by an exercising individual are lacking. Here, we report that aerosol particle emission increases on average 132-fold from 580 ± 489 particles/min at rest to 76,200 ± 48,000 particles/min during maximal exercise. Aerosol particle emission increases moderately up to an exercise intensity of ≈2 W/kg and exponentially at higher exercise intensities. These data not only explain SARS-CoV-2 transmissions during indoor group exercise but also can be used to design better targeted mitigation measures for physical activity indoors such as physical education in school, dance events during weddings, or high-intensity gym classes such as spinning. Many airborne pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are transmitted indoors via aerosol particles. During exercise, pulmonary ventilation can increase over 10-fold, and therefore, exercisers will exhale a greater volume of aerosol-containing air. However, we currently do not know how exercise affects the concentration of aerosol particles in exhaled air and the overall emission of aerosol particles. Consequently, we developed a method to measure in parallel the concentration of aerosol particles in expired air, pulmonary ventilation, and aerosol particle emission at rest and during a graded exercise test to exhaustion. We used this method to test eight women and eight men in a descriptive study. We found that the aerosol particle concentration in expired air increased significantly from 56 ± 53 particles/liter at rest to 633 ± 422 particles/liter at maximal intensity. Aerosol particle emission per subject increased significantly by a factor of 132 from 580 ± 489 particles/min at rest to a super emission of 76,200 ± 48,000 particles/min during maximal exercise. There were no sex differences in aerosol particle emission, but endurance-training subjects emitted significantly more aerosol particles during maximal exercise than untrained subjects. Overall, aerosol particle emission increased moderately up to an exercise intensity of ∼2 W/kg and exponentially thereafter. Together, these data might partly explain superspreader events especially during high-intensity group exercise indoors and suggest that strong infection prevention measures are needed especially during exercise at an intensity that exceeds ∼2 W/kg. Investigations of influencing factors like airway and whole-body hydration status during exercise on aerosol particle generation are needed.
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