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

Florian Egger, Dominic Blumenauer, Patrick Fischer, Andreas Venhorst, Saarraaken Kulenthiran, Yvonne Bewarder, Angela Zimmer, Michael Böhm, Tim Meyer, Felix Mahfoud, Florian Egger, Dominic Blumenauer, Patrick Fischer, Andreas Venhorst, Saarraaken Kulenthiran, Yvonne Bewarder, Angela Zimmer, Michael Böhm, Tim Meyer, Felix Mahfoud

Abstract

Background: During the COVID-19 pandemic, compulsory masks became an integral part of outdoor sports such as jogging in crowded areas (e.g. city parks) as well as indoor sports in gyms and sports centers. This study, therefore, aimed to investigate the effects of medical face masks on performance and cardiorespiratory parameters in athletes.

Methods: In a randomized, cross-over design, 16 well-trained athletes (age 27 ± 7 years, peak oxygen consumption 56.2 ± 5.6 ml kg-1 min-1, maximum performance 5.1 ± 0.5 Watt kg-1) underwent three stepwise incremental exercise tests to exhaustion without mask (NM), with surgical mask (SM) and FFP2 mask (FFP2). Cardiorespiratory and metabolic responses were monitored by spiroergometry and blood lactate (BLa) testing throughout the tests.

Results: There was a large effect of masks on performance with a significant reduction of maximum performance with SM (355 ± 41 Watt) and FFP2 (364 ± 43 Watt) compared to NM (377 ± 40 Watt), respectively (p < 0.001; ηp2 = 0.50). A large interaction effect with a reduction of both oxygen consumption (p < 0.001; ηp2 = 0.34) and minute ventilation (p < 0.001; ηp2 = 0.39) was observed. At the termination of the test with SM 11 of 16 subjects reported acute dyspnea from the suction of the wet and deformed mask. No difference in performance was observed at the individual anaerobic threshold (p = 0.90).

Conclusion: Both SM and to a lesser extent FFP2 were associated with reduced maximum performance, minute ventilation, and oxygen consumption. For strenuous anaerobic exercise, an FFP2 mask may be preferred over an SM.

Keywords: Athletes; Cardiopulmonary exercise test; Masks.

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Interindividual differences at exhaustion during the incremental exercise test (n = 16) without a mask (NM), with a surgical mask (SM), and with FFP2-mask (FFP2). A maximum performance (Pmax). B peak oxygen consumption (VO2peak). C peak minute ventilation (VEpeak), D maximum blood lactate concentration (BLamax). W Watt
Fig. 2
Fig. 2
Mean changes in physiological parameters throughout the incremental exercise test (n = 16) without a mask (NM), with a surgical mask (SM), and with FFP2-mask (FFP2). A Heart rate (HR) in beats*min−1 (bpm). B oxygen consumption (VO2) in ml kg−1 min−1. C minute ventilation (VE) in l min−1. D blood lactate concentration (BLa) in mmol l−1. Error bars represent standard deviation. *p < 0.05, NM vs. SM. **p < 0.01, NM vs. SM. §p < 0.05, NM vs. FFP2. §§p < 0.01, NM vs. FFP2. % = time effect. $ = interaction effect

References

    1. Brooks JT, Butler JC, Redfield RR. Universal masking to prevent SARS-CoV-2 transmission-the time is now. JAMA. 2020 doi: 10.1001/jama.2020.13107.
    1. Ueki H, Furusawa Y, Iwatsuki-Horimoto K, et al. Effectiveness of face masks in preventing airborne transmission of SARS-CoV-2. mSphere. 2020 doi: 10.1128/mSphere.00637-20.
    1. Rader B, White LF, Burns MR, et al. Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. Lancet Digit Health. 2021 doi: 10.1016/s2589-7500(20)30293-4.
    1. Centers for Disease Control and Prevention (2021) Public Health Guidance for Community-Related Exposure.
    1. World Health Organization (2020) Mask use in the context of COVID-19. Interim guidance.
    1. Tcharkhtchi A, Abbasnezhad N, Zarbini Seydani M, Zirak N, Farzaneh S, Shirinbayan M. An overview of filtration efficiency through the masks: mechanisms of the aerosols penetration. Bioact Mater. 2021;6(1):106–122. doi: 10.1016/j.bioactmat.2020.08.002.
    1. Epstein D, Korytny A, Isenberg Y, Marcusohn E, Zukermann R, Bishop B, Minha S, Raz A, Miller A. Return to training in the COVID-19 era: the physiological effects of face masks during exercise. Scand J Med Sci Sports. 2021;31(1):70–75. doi: 10.1111/sms.13832.
    1. Shaw K, Butcher S, Ko J, Zello GA, Chilibeck PD. Wearing of cloth or disposable surgical face masks has no effect on vigorous exercise performance in healthy individuals. Int J Environ Res Public Health. 2020 doi: 10.3390/ijerph17218110.
    1. Fikenzer S, Uhe T, Lavall D, Rudolph U, Falz R, Busse M, Hepp P, Laufs U. Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clin Res Cardiol. 2020;109(12):1522–1530. doi: 10.1007/s00392-020-01704-y.
    1. Lässing J, Falz R, Pökel C, Fikenzer S, Laufs U, Schulze A, Hölldobler N, Rüdrich P, Busse M. Effects of surgical face masks on cardiopulmonary parameters during steady state exercise. Sci Rep. 2020;10(1):22363. doi: 10.1038/s41598-020-78643-1.
    1. Faude O, Kindermann W, Meyer T. Lactate threshold concepts: how valid are they? Sports Med. 2009;39(6):469–490. doi: 10.2165/00007256-200939060-00003.
    1. Mann T, Lamberts RP, Lambert MI. Methods of prescribing relative exercise intensity: physiological and practical considerations. Sports Med. 2013;43(7):613–625. doi: 10.1007/s40279-013-0045-x.
    1. De Pauw K, Roelands B, Cheung SS, de Geus B, Rietjens G, Meeusen R. Guidelines to classify subject groups in sport-science research. Int J Sports Physiol Perform. 2013;8(2):111–122. doi: 10.1123/ijspp.8.2.111.
    1. Borg G (1998) Borg’s perceived exertion and pain scales. Human kinetics
    1. Stegmann H, Kindermann W, Schnabel A. Lactate kinetics and individual anaerobic threshold. Int J Sports Med. 1981;2(3):160–165. doi: 10.1055/s-2008-1034604.
    1. Löllgen H, Leyk D. Exercise testing in sports medicine. Dtsch Arztebl Int. 2018;115(24):409–416. doi: 10.3238/arztebl.2018.0409.
    1. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153–156. doi: 10.1016/s0735-1097(00)01054-8.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale: Lawrence Erlbaum Associates; 1988. p. 567.
    1. Louhevaara VA. Physiological effects associated with the use of respiratory protective devices. A review. Scand J Work Environ Health. 1984;10(5):275–281. doi: 10.5271/sjweh.2327.
    1. Melissant CF, Lammers JW, Demedts M. Relationship between external resistances, lung function changes and maximal exercise capacity. Eur Respir J. 1998;11(6):1369–1375. doi: 10.1183/09031936.98.11061369.
    1. Lee HP, de Wang Y. Objective assessment of increase in breathing resistance of N95 respirators on human subjects. Ann Occup Hyg. 2011;55(8):917–921. doi: 10.1093/annhyg/mer065.
    1. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873–934. doi: 10.1161/CIR.0b013e31829b5b44.
    1. Smirmaul BP, Dantas JL, Fontes EB, Altimari LR, Okano AH, Moraes AC. Comparison of electromyography fatigue threshold in lower limb muscles in trained cyclists and untrained non-cyclists. Electromyogr Clin Neurophysiol. 2010;50(3–4):149–154.
    1. Roberge RJ, Kim JH, Coca A. Protective facemask impact on human thermoregulation: an overview. Ann Occup Hyg. 2012;56(1):102–112. doi: 10.1093/annhyg/mer069.
    1. Purushothaman PK, Priyangha E, Vaidhyswaran R. Effects of prolonged use of facemask on healthcare workers in tertiary care hospital during COVID-19 pandemic. Indian J Otolaryngol Head Neck Surg. 2020 doi: 10.1007/s12070-020-02124-0.
    1. Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control. 2013;41(12):1218–1223. doi: 10.1016/j.ajic.2013.02.017.
    1. Wong AY, Ling SK, Louie LH, Law GY, So RC, Lee DC, Yau FC, Yung PS. Impact of the COVID-19 pandemic on sports and exercise. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020;22:39–44. doi: 10.1016/j.asmart.2020.07.006.
    1. Langrish JP, Li X, Wang S, Lee MM, Barnes GD, Miller MR, Cassee FR, Boon NA, Donaldson K, Li J, Li L, Mills NL, Newby DE, Jiang L. Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease. Environ Health Perspect. 2012;120(3):367–372. doi: 10.1289/ehp.1103898.
    1. Kyung SY, Kim Y, Hwang H, Park JW, Jeong SH. Risks of N95 face mask use in subjects with COPD. Respir Care. 2020;65(5):658–664. doi: 10.4187/respcare.06713.
    1. Sydó N, Sydó T, Gonzalez Carta KA, Hussain N, Merkely B, Murphy JG, Squires RW, Lopez-Jimenez F, Allison TG. Significance of an increase in diastolic blood pressure during a stress test in terms of comorbidities and long-term total and CV mortality. Am J Hypertens. 2018;31(9):976–980. doi: 10.1093/ajh/hpy080.
    1. Wolthuis RA, Froelicher VF, Jr, Fischer J, Triebwasser JH. The response of healthy men to treadmill exercise. Circulation. 1977;55(1):153–157. doi: 10.1161/01.cir.55.1.153.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa