Document Type : Original Article
Authors
1 Ph.D student in Exercise Physiology, University of Mazandaran, Babolsar, Iran.
2 Assistant Professor, Department of Exercise Physiology, Sport Sciences Faculty, University of Mazandaran, Babolsar, Iran.
3 Full Professor, Department of Exercise Physiology, Sport Sciences Faculty, University of Mazandaran, Babolsar, Iran. Athletic Performance and Health Research Center, University of Mazandaran, Babolsar, Iran.
Abstract
Background and Aim: COVID-19 prevalence has a tremendous effect on almost all aspect of human life and wearing respiratory facemasks are recommended as a means of virus control. The aim of the current study was to examine the effect of using medical masks on cardiovascular responses and rating of perceived exertion (RPE) in healthy women during a submaximal exercise (SE) protocol. Materials and Methods: This randomized study conducted to evaluate the effects of respiratory facemasks (N95 versus surgical), or no mask status, following a submaximal exercise (with 60 to 70% intensity of maximal heart rate) in three groups of healthy volunteers females (mean age and body mass index of 28.3±6 years and 23±3 kg/m2, respectively). Participants divided into submaximal exercise+N95 mask, submaximal exercise+surgical mask, and submaximal exercise+Nomask groups. Cardiovascular parameters including QRS duration, QT interval, ST segment, and P wave duration were assessed by an electrocardiogram system; then data were analyzed using one-way analysis of variance and Tukey tests at the significant level of p≤0.05. Result: Wearing face masks had no effect on SPO2% (p=0.77), heart rate (p=0.34), QT distance (p=0.64), ST segment (p=0.58), QRS wavelength (p=0.67), and P wavelength (p=0.45)) following SE on treadmill. Values of RPE in the N95 mask group increased significantly as compared to the NoMask (p=0.006) group; while it increased insignificantly when compared to the surgical mask (p=0.06) group. Conclusion: Wearing a surgical facemask, specifically surgical facemask, during a submaximal exercise protocol does not have a detrimental effects on cardiovascular markers and performance of healthy women.
Keywords
Albesa-Albiol, L., Serra-Payá, N., Garnacho-Castaño, M. A., Guirao Cano, L., Pleguezuelos Cobo, E. & Maté-Muñoz, J. L. (2019). Ventilatory efficiency during constant-load test at lactate threshold intensity: Endurance versus resistance exercises. PloS One, 14(5), e0216824.
Andre, T. L., Gann, J. J., Hwang, P. S., Ziperman, E., Magnussen, M. J., & Willoughby, D. S. (2018). Restrictive breathing mask reduces repetitions to failure during a session of lower-body resistance Exercise. Journal of Strength and Conditioning Research, 32(8), 2103–2108.
Atangana, E., & Atangana, A. (2020). Facemasks simple but powerful weapons to protect against COVID-19 spread: Can they have sides effects? Results in Physics, 19, 103425.
Bradford Smith, P., Agostini, G., & Mitchell, J.C. (2020). A scoping review of surgical masks and N95 filtering facepiece respirators: Learning from the past to guide the future of dentistry. Safety Science, 131, 104920.
Buekers, J., Theunis, J., De Boever, P., Vaes, A. W., Koopman, M., Janssen, E. V., ... & Aerts, J. M. (2019). Wearable finger pulse oximetry for continuous oxygen saturation measurements during daily home routines of patients with chronic obstructive pulmonary disease (COPD) over one week: observational study. Journal of Medical Internet Research mHealth and uHealth, 7(6), e12866.
Busch, S. A., van Diepen, S., Roberts, R., Steele, A. R., Berthelsen, L. F., & Smorschok, M. P. (2021). Short-term hypoxia does not promote arrhythmia during voluntary apnea. Physiological Reports, 9(1), e14703.
Carriedo, A., Cecchini, J.A., Fernandez-Rio, J., & Méndez-Giménez, A. (2020). COVID-19, psychological well-being and physical activity levels in older adults during the nationwide lockdown in Spain. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 28(11), 1146–1155.
Chandrasekaran, B., & Fernandes, S. (2020). Exercise with facemask; Are we handling a devil’s sword?” - A physiological hypothesis. Medical Hypotheses, 144, 110002.
Egger, F., Blumenauer, D., Fischer, P., Venhorst, A., Kulenthiran, S., Bewarder, Y., … & Mahfoud, F. (2021). Effects of face masks on performance and cardiorespiratory response in well-trained athletes. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 1–8.
Epstein, D., Korytny, A., Isenberg, Y., Marcusohn, E., Zukermann, R., & Bishop, B., … & Miller, A. (2021). Return to training in the COVID-19 era: The physiological effects of face masks during exercise. Scandinavian Journal of Medicine & Science in Sports, 31(1), 70–75.
Fikenzer, S., Uhe, T., Lavall, D., Rudolph, U., Falz, R., & Busse, M., … & Laufs, U. (2020). Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 109(12), 1522–1530.
Garnacho-Castaño, M. V., Albesa-Albiol, L., Serra-Payá, N., Gomis Bataller, M., Felíu-Ruano, R., & Guirao Cano, L., … & Mate-Munos, J. L. (2019). The slow component of oxygen uptake and efficiency in resistance exercises: A comparison with endurance exercises. Frontiers in Physiology, 10, 357.
Gentil, P., Barbosa de Lira, C. A., Souza, D., Jimenez, A., Mayo, X., & de Fátima Pinho Lins Gryschek, A. L., … & Carnevali Junior, L. C. (2020). Resistance training safety during and after the SARS-Cov-2 Outbreak: Practical recommendations. BioMed Research International, 2020, 3292916.
Hopkins, S. R., Dominelli, P. B., Davis, C. K., Guenette, J. A., Luks, A. M., & Molgat-Seon, Y., … & Stickland, M.K. (2021). Face masks and the cardiorespiratory response to physical activity in health and disease. Annals of the American Thoracic Society, 18(3), 399–407.
Jagim, A. R., Dominy, T. A., Camic, C. L., Wright, G., Doberstein, S., & Jones, M. T., Oliver, J. M. (2018). Acute effects of the elevation training mask on strength performance in recreational weight lifters. Journal of Strength and Conditioning Research, 32(2), 482–489.
Khodarahmi, B., Dehghan, H., Motamedzadeh, M., Zeinodini, M., & Hosseini, S. M. (2013). Effect of respiratory protection equipments wear on heart rate in different workload. International Journal of Environmental Health Engineering, 2(1), 26.
Kim, K. H., Jeon, K. N., Kang, M. G., Ahn, J. H., Koh, J. S., & Park, Y., … & Rang Park, J. (2016). Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular events. The Korean Journal of Internal Medicine, 31(5), 880–890.
Kisielinski, K., Giboni, P., Prescher, A., Klosterhalfen, B., Graessel, D., & Funken, S., … & Hirsch, O. (2021). Is a mask that covers the mouth and nose free from undesirable side effects in everyday use and free of potential hazards?. International Journal of Environmental Research and Public Health, 18(8), 4344.
Kyung, S.Y., Kim, Y., Hwang, H., Park, J. W., & Jeong, S. H. (2020). Risks of N95 face mask use in subjects with COPD. Respiratory Care, 65(5), 658–664.
Lässing, J., Falz, R., Pökel, C., Fikenzer, S., Laufs, U., & Schulze, A., … & Busse, M. (2020). Effects of surgical face masks on cardiopulmonary parameters during steady state exercise. Scientific Reports, 10(1), 22363.
Lee, S., Li, G., Liu, T., & Tse, G. (2020). COVID-19: Electrophysiological mechanisms underlying sudden cardiac death during exercise with facemasks. Medical Hypotheses, 144, 110177.
Lee, H. P., & Wang, D. (2011). Objective assessment of increase in breathing resistance of N95 respirators on human subjects. The Annals of Occupational Hygiene, 55(8), 917–921.
Lesser, I. A., & Nienhuis, C. P. (2020). The impact of COVID-19 on physical activity behavior and well-being of canadians. International Journal of Environmental Research and Public Health, 17(11), 3899.
Luks, A. M., & Swenson, E. R. (2020). Pulse oximetry for monitoring patients with COVID-19 at home. Potential pitfalls and practical guidance. Annals of the American Thoracic Society, 17(9), 1040–1046.
Machogu, E. M., & Machado, R. F. (2018). How I treat hypoxia in adults with hemoglobinopathies and hemolytic disorders. Blood, 132(17), 1770–1780.
Matuschek, C., Moll, F., Fangerau, H., Fischer, J. C., Zänker, K., van Griensven, M., … & Haussmann, J. (2020). Face masks: benefits and risks during the COVID-19 crisis. European Journal of Medical Research, 25(1), 32.
Maugeri, G., Castrogiovanni, P., Battaglia, G., Pippi, R., D’Agata, V., Palma, A., … & Musumeci, J. (2020). The impact of physical activity on psychological health during Covid-19 pandemic in Italy. Heliyon, 6(6), e04315.
Narici, M., Vito, G., Franchi, M., Paoli, A., Moro, T., Marcolin, G., … & Maganaris, C. (2021). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science, 21(4), 614–635.
Noonan, V., & Dean, E. (2000). Submaximal exercise testing: clinical application and interpretation. Physical Therapy, 80(8), 782–807.
O’Dowd, K., Nair, K. M., Forouzandeh, P., Mathew, S., Grant, J., Moran, R., … & Pillai, S. C. (2020). Face masks and respirators in the fight against the COVID-19 pandemic: A review of current materials, advances and future perspectives. Materials (Basel, Switzerland), 13(15), 3363.
Ong, J., Bharatendu, C., Goh, Y., Tang, J., Sooi, K., Tan, Y. L., … & Sharma, V. K. (2020). Headaches associated with personal protective equipment - A cross-sectional study among frontline healthcare workers during COVID-19. Headache, 60(5), 864–877.
Otsuka, A., Komagata, j., Yuta, S. (2020). Wearing a surgical mask does not affect the anaerobic threshold during pedaling exercise. Journal of Human Sport and Exercise, 17(1), 1-7.
Ramos-Campo, D. J., Pérez-Piñero, S., Muñoz-Carrillo, J. C., López-Román, F. J., García-Sánchez, E., & Ávila-Gandía, V. (2021). Acute effects of surgical and FFP2 Face masks on physiological responses and strength performance in persons with sarcopenia. Biology, 10(3), 213.
Ramos-Campo, D. J., Rubio-Arias, J. A., Dufour, S., Chung, L., Ávila-Gandía, V., & Alcaraz, P. E. (2017). Biochemical responses and physical performance during high-intensity resistance circuit training in hypoxia and normoxia. European Journal of Applied Physiology, 117(4), 809–818.
Rebmann, T., Carrico, R., & Wang, J. (2013). Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. American Journal of Infection Control, 41(12), 1218–1223.
Renassia, C., & Peyssonnaux, C. (2019). New insights into the links between hypoxia and iron homeostasis. Current Opinion in Hematology, 26(3), 125–130.
Shaw, K., Butcher, S., Ko, J., Zello, G.A., & Chilibeck, P.D. (2020). Wearing of cloth or disposable surgical face masks has no effect on vigorous exercise performance in healthy individuals. International Journal of Environmental Research and Public Health, 17(21), 8110.
Scheid, J. L., Lupien, S. P., Ford, G. S., & West, S. L. (2020). Commentary: physiological and psychological impact of face mask usage during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 17(18), 6655.
Sinkule, E. J., Powell, J. B., & Goss, F. L. L. (2013). Evaluation of N95 respirator use with a surgical mask cover: effects on breathing resistance and inhaled carbon dioxide. The Annals of Occupational Hygiene, 57(3), 384–398.
Tong, P.S., Kale, A.S., Ng, K., Loke, A.P., Choolani, M.A., & Lim, C.L., … & Young, E-L. (2015). Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study. Antimicrobial Resistance and Infection Control, 4, 48.
Vainshelboim B. (2021). Retracted: Facemasks in the COVID-19 era: A health hypothesis. Medical Hypotheses, 146, 110411.
World Health Organization. (2020). Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020 (No. WHO/2019-nCoV/IPC_Masks/2020.4). World Health Organization.
Worldometer COVID-19 Coronavirus Pandemic. (2021). https://www.worldometers.info/coronavirus/ (Accessed on June 29, 2021).
Zhang, M., Emery, A.R., Tannyhill, R.J., 3rd, Zheng, H., & Wang, J. (2020). Masks or N95 respirators during COVID-19 pandemic-which one should I wear? Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons, 78(12), 2114–2127.
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