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

Abstract

Background Due to the SARS-CoV2 pandemic, medical face masks are widely recommended for a large number of individuals and long durations. The effect of wearing a surgical and a FFP2/N95 face mask on cardiopulmonary exercise capacity has not been systematically reported. Methods This prospective cross-over study quantitated the effects of wearing no mask (nm), a surgical mask (sm) and a FFP2/N95 mask (ffpm) in 12 healthy males (age 38.1 ± 6.2 years, BMI 24.5 ± 2.0 kg/m2). The 36 tests were performed in randomized order. The cardiopulmonary and metabolic responses were monitored by ergo-spirometry and impedance cardiography. Ten domains of comfort/discomfort of wearing a mask were assessed by questionnaire. Results The pulmonary function parameters were significantly lower with mask (forced expiratory volume: 5.6 ± 1.0 vs 5.3 ± 0.8 vs 6.1 ± 1.0 l/s with sm, ffpm and nm, respectively; p = 0.001; peak expiratory flow: 8.7 ± 1.4 vs 7.5 ± 1.1 vs 9.7 ± 1.6 l/s; p < 0.001). The maximum power was 269 ± 45, 263 ± 42 and 277 ± 46 W with sm, ffpm and nm, respectively; p = 0.002; the ventilation was significantly reduced with both face masks (131 ± 28 vs 114 ± 23 vs 99 ± 19 l/m; p < 0.001). Peak blood lactate response was reduced with mask. Cardiac output was similar with and without mask. Participants reported consistent and marked discomfort wearing the masks, especially ffpm. Conclusion Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals. These data are important for recommendations on wearing face masks at work or during physical exercise.

Impact of wearing a facial covering on aerobic exercise capacity in the COVID-19 era: is it more than a feeling?

“…The authors conclude with the bold recommendation for readers regarding the wearing of ffpm or sm coverings during exercise participation, "These effects have to be considered versus the potential protective effects of face masks on viral transmissions. The quantitative data of this study may, therefore, inform medical recommendations and policy makers [1]." Thus, because there are clear clinical implications associated with implementing and closely adhering to expert-guided safety precautions aimed at helping to minimize public transmission of the novel coronavirus disease 2019 (COVID-19) [2], we felt that it would be instructive and responsible to communicate our concerns over the interpretation of quantitative and qualitative data acquired during CPET performed while wearing nm as compared to CPET performed with an ffpm or sm as discussed by Fikenzer et al [1].…”

“…In this issue of Clinical Research in Cardiology, Drs. Fikenzer and colleagues [1] should be acknowledged for their timely study focused on examining how 'cardiopulmonary exercise capacity' may be impacted by wearing a nose and mouth facial covering during cardiopulmonary exercise testing (CPET). They are the first to report in a randomized-controlled cross-over study design that when CPET is performed by healthy young-to-middle aged adult men while wearing an FFP2/N95 mask (ffpm), and to a lesser extent with a surgical mask (sm), key exercise measurements, including peak oxygen uptake (VȮ 2peak ), maximum Power (Pmax), and peak minute ventilation (V̇E) do not increase to levels demonstrated during CPET with no mask (nm) [1].…”

“…Fikenzer and colleagues [1] should be acknowledged for their timely study focused on examining how 'cardiopulmonary exercise capacity' may be impacted by wearing a nose and mouth facial covering during cardiopulmonary exercise testing (CPET). They are the first to report in a randomized-controlled cross-over study design that when CPET is performed by healthy young-to-middle aged adult men while wearing an FFP2/N95 mask (ffpm), and to a lesser extent with a surgical mask (sm), key exercise measurements, including peak oxygen uptake (VȮ 2peak ), maximum Power (Pmax), and peak minute ventilation (V̇E) do not increase to levels demonstrated during CPET with no mask (nm) [1]. When such differences are taken together with additional data acquired at rest suggesting pulmonary function testing while wearing an ffpm also yields significantly decreased lung function as compared with the condition of nm, the authors emphasize that wearing an ffpm (or even an sm) during CPET imposes appreciable limitations on cardiopulmonary function when exercise is performed at high intensity.…”

“…An initial focus of our concern is that Fikenzer et al [1] offer support for their interpretation of quantitative data based on the physiological concept [3] that wearing an ffpm/ sm during CPET markedly increases breathing resistance to yield exercise limiting elevations in work of breathing, altered ventilatory mechanics, cardiac hemodynamic compensation, and disproportionately increased cardiac output redistributed to respiratory muscles. While this is a plausible cascade of events provoked by wearing an ffpm/sm during CPET, it is unclear on what physiological basis they arrived at such a causal pathway for their study, since (1) they did not perform measurements of pulmonary function, work of breathing, and ventilatory mechanics during CPET, (2) actual data reported are incompletely listed, and (3) the fundamental model of blood flow redistribution at peak exercise described by Harms et al [3] is not properly translated and applied.…”

Gesichtsmasken im Unterricht

“…Insbesondere führte die N95-Maske (entspricht einer FFP-2-Maske) im Vergleich zur chirurgischen Maske zu einer höheren Feuchtigkeit und Hauttemperatur im Bereich zwischen Gesichtsmaske und Haut, zu einer höheren Herzfrequenz und zu einer Zunahme negativer "Empfindungen, einschließlich des Gefühls der Abgeschlagenheit, Enge, Juckreiz, [und] Müdigkeit" [46]. Eine Studie zu den kardiovaskulären Auswirkungen von Gesichtsmasken (chirurgisch oder FFP-2) auf die Leistungsfähigkeit gesunder junger männlicher Probanden auf dem Fahrradergometer ergab, dass die körperliche Leistungsfähigkeit durch chirurgische Masken um gut 2 % (nicht signifikant) und durch FFP-2-Masken um etwa 5 % (p < 0,01) reduziert war [32]. Insgesamt bevorzugten in beiden Studien die Probanden die chirurgische Gesichtsmaske.…”