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      The influence of N95 and FFP2 masks on cardiorespiratory variables in healthy individuals during aerobic exercise: a systematic review and meta-analysis Translated title: A influência das máscaras N95 e PFF2 sobre variáveis cardiorrespiratórias em indivíduos saudáveis durante o exercício aeróbico: revisão sistemática e meta-análise

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          ABSTRACT

          Objective:

          In view of the current COVID-19 pandemic, the objective of this study was to determine, through a systematic review and meta-analysis, whether the use of N95/FFP2 masks during aerobic exercise has a significant impact on HR, RR, SpO 2, and blood pressure (BP) in healthy individuals.

          Methods:

          We searched the MEDLINE database for studies published in English between 2005 and 2021. To reduce bias and increase reliability, only randomized controlled trials and randomized crossover clinical trials were considered for inclusion. The selected outcomes included HR, RR, SpO 2, and BP, with perceived exertion being evaluated by means of the Borg scale.

          Results:

          Eight controlled trials were included in the meta-analysis. Seven evaluated HR (p > 0.05), five evaluated RR (p > 0.05), five evaluated SpO 2 and BP (p > 0.05 for both), and six evaluated perceived exertion, presenting controversial results such as risk ratios that were grouped for each variable.

          Conclusions:

          This study suggests that N95 and FFP2 masks do not have significant effects on HR, RR, SpO 2, and BP during aerobic exercise in healthy individuals.

          RESUMO

          Objetivo:

          Diante da atual pandemia de COVID-19, o objetivo deste estudo foi determinar, por meio de uma revisão sistemática e meta-análise, se o uso de máscaras N95/PFF2 durante o exercício aeróbico tem impacto significativo na FC, FR, SpO 2 e pressão arterial (PA) em indivíduos saudáveis.

          Métodos:

          Buscamos no banco de dados MEDLINE estudos publicados em inglês entre 2005 e 2021. Para reduzir o viés e aumentar a confiabilidade, foram considerados para inclusão no estudo somente ensaios clínicos controlados randomizados e ensaios clínicos cruzados randomizados. Os desfechos selecionados foram FC, FR, SpO 2 e PA; a percepção de esforço foi avaliada por meio da escala de Borg.

          Resultados:

          Oito ensaios controlados foram incluídos na meta-análise. Sete avaliaram FC (p > 0,05), cinco avaliaram FR (p > 0,05), cinco avaliaram SpO 2 e PA (p > 0,05 para ambas) e seis avaliaram a percepção de esforço, com resultados controversos (razões de risco agrupadas para cada variável, por exemplo).

          Conclusões:

          Este estudo sugere que as máscaras N95 e PFF2 não têm efeitos significativos na FC, FR, SpO 2 e PA durante o exercício aeróbico em indivíduos saudáveis.

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          Most cited references35

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          Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations

          Y. Li, H Tokura, Y.P. Guo … (2005)
          Aim: The study was aimed at investigating the effects of wearing N95 and surgical facemasks with and without nano-functional treatments on thermophysiological responses and the subjective perception of discomfort. Method: Five healthy male and five healthy female participants performed intermittent exercise on a treadmill while wearing the protective facemasks in a climate chamber controlled at an air temperature of 25°C and a relative humidity of 70%. Four types of facemasks, including N95 (3M 8210) and surgical facemasks, which were treated with nano-functional materials, were used in the study. Results: (1) The subjects had significantly lower average heart rates when wearing nano-treated and untreated surgical facemasks than when wearing nano-treated and untreated N95 facemasks. (2) The outer surface temperature of both surgical facemasks was significantly higher than that of both N95 facemasks. On the other hand, the microclimate and skin temperatures inside the facemask were significantly lower than those in both N95 facemasks. (3) Both surgical facemasks had significantly higher absolute humidity outside the surface than both N95 facemasks. The absolute humidity inside the surgical facemask was significantly lower than that inside both N95 facemasks. (4) Both surgical facemasks were rated significantly lower for perception of humidity, heat, breath resistance and overall discomfort than both N95 facemasks. The ratings for other sensations, including feeling unfit, tight, itchy, fatigued, odorous and salty, that were obtained while the subjects were wearing the surgical facemasks were significantly lower than when the subjects were wearing the N95 facemasks. (5) Subjective preference for the nano-treated surgical facemasks was the highest. There was significant differences in preference between the nano-treated and untreated surgical facemasks and between the surgical and N95 facemasks. Discussion: We discuss how N95 and surgical facemasks induce significantly different temperature and humidity in the microclimates of the facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.
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            Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity

            Sven Fikenzer, T. Uhe, D. Lavall … (2020)
            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.
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              Physiological impact of the N95 filtering facepiece respirator on healthcare workers.

              Raymond Roberge, Aitor Coca, W Jon Williams … (2010)
              To assess the physiological impact of the N95 filtering facepiece respirator (FFR) on healthcare workers. Ten healthcare workers each conducted multiple 1-hour treadmill walking sessions, at 1.7 miles/h, and at 2.5 miles/h, while wearing FFR with exhalation valve, FFR without exhalation valve, and without FFR (control session). We monitored heart rate, respiratory rate, tidal volume, minute volume, blood oxygen saturation, and transcutaneously measured P(CO2). We also measured user comfort and exertion, FFR moisture retention, and the carbon dioxide and oxygen concentrations in the FFR's dead space. There were no significant differences between FFR and control in the physiological variables, exertion scores, or comfort scores. There was no significant difference in moisture retention between FFR with and without exhalation valve. Two subjects had peak P(CO2) > or = 50 mm Hg. The FFR with exhalation valve offered no benefit in physiological burden over the FFR without valve. The FFR dead-space oxygen and carbon dioxide levels did not meet the Occupational Safety and Health Administration's ambient workplace standards. In healthy healthcare workers, FFR did not impose any important physiological burden during 1 hour of use, at realistic clinical work rates, but the FFR dead-space carbon dioxide and oxygen levels were significantly above and below, respectively, the ambient workplace standards, and elevated P(CO2) is a possibility. Exhalation valve did not significantly ameliorate the FFR's P(CO2) impact.
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                Author and article information

                Contributors
                Gustavo Lucas da Silva Lima:
                ORCID: http://orcid.org/0000-0001-9437-4019
                Role: study conception and designRole: statistical analysisRole: writing of the manuscriptRole: data analysis and interpretation
                Thiago Casali Rocha:
                ORCID: http://orcid.org/0000-0003-1658-9713
                Role: study conception and designRole: statistical analysisRole: writing of the manuscriptRole: data analysis and interpretation
                Gilmar Pereira de Lima da Silva Júnior:
                ORCID: http://orcid.org/0000-0002-3636-0636
                Role: study conception and designRole: statistical analysisRole: writing of the manuscriptRole: data analysis and interpretation
                Marcelo Tarcísio Martins:
                ORCID: http://orcid.org/0000-0003-2943-6433
                Role: study conception and designRole: statistical analysisRole: writing of the manuscriptRole: critical revision of the manuscript for important intellectual content
                Journal
                Journal ID (nlm-ta): J Bras Pneumol
                Journal ID (iso-abbrev): J Bras Pneumol
                Journal ID (publisher-id): jbpneu
                Title: Jornal Brasileiro de Pneumologia
                Publisher: Sociedade Brasileira de Pneumologia e Tisiologia
                ISSN (Print): 1806-3713
                ISSN (Electronic): 1806-3756
                Publication date (Electronic, pub): 02 March 2023
                Publication date (Electronic, collection): 2023
                Volume: 49
                Issue: 3
                Electronic Location Identifier: e20220143
                Affiliations
                [1 ]. Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil.
                [2 ]. Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil.
                [3 ]. Universidade Paulista - UNIP - Volta Redonda (RJ) Brasil.
                Author notes
                Correspondence to: Gustavo Lucas da Silva Lima. Alameda Salvaterra, 200, Salvaterra, CEP 36033-003, Juiz de Fora, MG, Brasil. Tel.: 55 32 2101-5000. E-mail: gustavo.lucasglsl@ 123456gmail.com

                CONFLICTS OF INTEREST: None declared.

                Author information
                http://orcid.org/0000-0001-9437-4019
                http://orcid.org/0000-0003-1658-9713
                http://orcid.org/0000-0002-3636-0636
                http://orcid.org/0000-0003-2943-6433
                Article
                Other ID: 00000
                DOI: 10.36416/1806-3756/e20220143
                PMC ID: 10171276
                PubMed ID: 36946844
                SO-VID: ae63433b-bd61-4417-af30-97eaf0197a2f
                Copyright © © 2023 Sociedade Brasileira de Pneumologia e Tisiologia
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited.

                History
                Date received : 26 April 2022
                Date accepted : 12 January 2023
                Page count
                Figures: 12, Tables: 4, Equations: 0, References: 28
                Categories
                Subject: Systematic Review and Meta-Analysis

                Keywords: n95 respirators,heart rate,respiratory rate,oxygen saturation,blood,respiradores n95,frequência cardíaca,taxa respiratória,saturação de oxigênio,sangue
                Data availability:
                Keywords: n95 respirators, heart rate, respiratory rate, oxygen saturation, blood, respiradores n95, frequência cardíaca, taxa respiratória, saturação de oxigênio, sangue

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