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

• Published in: Clinical research in cardiology Vol. 109; no. 12; pp. 1522 - 1530
• Main Authors: Fikenzer, Sven, Uhe, T., Lavall, D., Rudolph, U., Falz, R., Busse, M., Hepp, P., Laufs, U.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2020; Springer Nature B.V
• Subjects: Cardiac output; Cardiology; Discomfort; Face; Lactic acid; Masks; Maximum power; Medicine; Medicine & Public Health; Metabolic response; Original Paper; Pandemics; Physical exercise; Protective equipment; Pulmonary functions; Respiratory function; Severe acute respiratory syndrome coronavirus 2; Ventilation; Cardiopulmonary; Ventilation; Exercise capacity; FFP2/N95; Surgical masks
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-020-01704-y

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/m
2
). 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.