This study was supported by National Natural Science Foundation for Young Scientists of China (No.81902281); General Guidance Project of Guangzhou Health and Family Planning Commission (No.20191A0011091 and 20201A011108), Guangdong Provincial Department of Education (No. 2019KQNCX119) and Guangzhou Key Laboratory Fund (No.201905010004). This study also thanks Lixin Zhang, Peilin Ruan, Kaihang Ji, and Gulifeiya Tuerxun from Guangzhou Medical University for data collection.

The clinical project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University (No. KY01-2020-06-06) and has been registered at the China Clinical Trial Registration Center (No. ChiCTR2000033449) and entitled &#34;The effects of masks on cardiopulmonary and lower limb function&#34;.
1. Participant recruitment
<ol>
	<li>Include subjects between 18 and 26 years old: who can pass the PAR-Q test6; are physically health...

<ol>
	<li>Davies, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Testing+the+Efficacy+of+Homemade+Masks:+Would+They+Protect+in+an+Influenza+Pandemic.">Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic.</a> Disaster Medicine and Public Health Preparedness. 7 (4), 413-418 (2013).</li><li>Fikenzer, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+surgical+and+FFP2/N95+face+masks+on+cardiopulmonary+exercise+capacity.">Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity.</a> Clinical Research in Cardiology. , (2020).</li><li>MacIntyre, C. R., Chughtai, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rapid+systematic+review+of+the+efficacy+of+face+masks+and+respirators+against+coronaviruses+and+other+respiratory+transmissible+viruses+for+the+community,+healthcare+workers+and+sick+patients.">A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients.</a> International Journal of Nursing Studies. 108, 103629 (2020).</li><li>Esposito, S., Principi, N., Leung, C. C., Migliori, G. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Universal+use+of+face+masks+for+success+against+COVID-19:+evidence+and+implications+for+prevention+policies.">Universal use of face masks for success against COVID-19: evidence and implications for prevention policies.</a> European Respiratory Journal. 55 (6), (2020).</li><li>Yao, B. G., Wang, Y. X., Ye, X. Y., Zhang, F., Peng, Y. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+structural+features+on+dynamic+breathing+resistance+of+healthcare+face+mask.">Impact of structural features on dynamic breathing resistance of healthcare face mask.</a> Science of the Total Environment. 689, 743-753 (2019).</li><li>Jal Duncan, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+the+impact+of+obtaining+medical+clearance+to+participate+in+a+randomised+controlled+trial+examining+a+physical+activity+intervention+on+the+socio-demographic+and+risk+factor+profiles+of+included+participants.">What is the impact of obtaining medical clearance to participate in a randomised controlled trial examining a physical activity intervention on the socio-demographic and risk factor profiles of included participants.</a> Trials. 17 (1), 580 (2016).</li><li>American Thoracic, S., American College of Chest, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ATS/ACCP+Statement+on+cardiopulmonary+exercise+testing.">ATS/ACCP Statement on cardiopulmonary exercise testing.</a> American Journal of Respiratory and Critical Care Medicine. 167 (2), 211-277 (2003).</li><li>Costa, D. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+the+Wasserman+equation+in+optimization+of+the+duration+of+the+power+ramp+in+a+cardiopulmonary+exercise+test:+a+study+of+Brazilian+men.">Use of the Wasserman equation in optimization of the duration of the power ramp in a cardiopulmonary exercise test: a study of Brazilian men.</a> Brazilian Journal of Medical and Biological Research. 48 (12), 1136-1144 (2015).</li><li>Borg, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychophysical+bases+of+perceived+exertion.">Psychophysical bases of perceived exertion.</a> Medicine &amp; Science in Sports &amp; Exercise. 14 (5), 377-381 (1982).</li><li>Groslambert, A., Mahon, A. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perceived+exertion+:+influence+of+age+and+cognitive+development.">Perceived exertion : influence of age and cognitive development.</a> Sports Medicine. 36 (11), 911-928 (2006).</li><li>Al-Shair, K., Kolsum, U., Singh, D., Vestbo, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Effect+of+Fatigue+and+Fatigue+Intensity+on+Exercise+Tolerance+in+Moderate+COPD.">The Effect of Fatigue and Fatigue Intensity on Exercise Tolerance in Moderate COPD.</a> Lung. 194 (6), 889-895 (2016).</li><li>Zhang, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Effects+of+Transcranial+Direct+Current+Stimulation+Versus+Electroacupuncture+on+Working+Memory+in+Healthy+Subjects.">The Effects of Transcranial Direct Current Stimulation Versus Electroacupuncture on Working Memory in Healthy Subjects.</a> Journal of Alternative and Complementary Medicine. 25 (6), 637-642 (2019).</li><li>Suzuki, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relations+between+strength+and+endurance+of+leg+skeletal+muscle+and+cardiopulmonary+exercise+testing+parameters+in+patients+with+chronic+heart+failure.">Relations between strength and endurance of leg skeletal muscle and cardiopulmonary exercise testing parameters in patients with chronic heart failure.</a> Journal of Cardiology. 43 (2), 59-68 (2004).</li><li>Bouwsema, M. M., Tedjasaputra, V., Stickland, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Are+there+sex+differences+in+the+capillary+blood+volume+and+diffusing+capacity+response+to+exercise.">Are there sex differences in the capillary blood volume and diffusing capacity response to exercise.</a> Journal of Applied Physiology. 122 (3), 460-469 (2017).</li></ol>

CPET provides valuable insights into the comprehensive functions of cardiovascular, ventilation, and skeletal muscle systems13. We proposed a CPET protocol on mask-on and mask-off conditions to explore the effect of the surgical mask on the cardiopulmonary function in healthy young subjects.
The design of this protocol was based on three main points. First, we recruited young healthy college students as the subjects for the study due to relatively high intensityof CPET ...

Wearing a face mask in public areas might impede the spread of an infectious disease by preventing both the inhalation of infectious droplets and their subsequent exhalation and dissemination1. Although the effect of reducing the risk of transmission of respiratory viruses remains controversial, wearing masks remains one of the major ways people in the community have chosen to prevent the spread of droplets among individuals in daily life2,3,4.
Different types of masks have different effects on increasing expiratory resistance and inspiratory resistance5. Meanwhile, during a respiratory disease pandemic, people (including healthy people and patients with cardiopulmonary diseases) might need to wear masks for a long time to perform daily activities. However, there are few studies on the effect of wearing a mask on cardiopulmonary function.
Cardiopulmonary exercise testing (CPET) is an important means of cardiovascular rehabilitation risk assessment by reflecting various parameters of the body&#39;s cardiopulmonary function during exercise with increasing load and is considered to be the gold standard for cardiopulmonary reserve testing2. We use CPET under different conditions (mask-on and mask-off) to study the changes in cardiopulmonary function parameters of healthy young subjects, to evaluate the interference of masks objectively and quantitatively on cardiorespiratory reserve and exercise endurance from a novel methodological perspective to guide the application of masks in particular respiratory infectious disease pandemic. Although FFP2/N95 has been suggested to be more efficacious than surgical masks at reducing exposure to viral infections, medical-surgical masks are more convenient and common to obtain and use than FFP2/N95 face masks. Thus, this study focuses only on the effects of medical surgical masks on cardiopulmonary function.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Cardiopulmonary test system</td>
			<td>COSMED Srl - Italy</td>
			<td>K4b2</td>
			<td>Pulmonary Function Equipment</td>
		</tr>
		<tr>
			<td>Cycle for CPET</td>
			<td>COSMED Srl - Italy</td>
			<td>ergoline 100P</td>
			<td>cycle ergometer 100 P w/BP</td>
		</tr>
		<tr>
			<td>Eectrocardiograph&#160;</td>
			<td>COSMED Srl - Italy</td>
			<td>Quark T12x</td>
			<td>12-Channel ECG Street Test Unit</td>
		</tr>
		<tr>
			<td>Mask</td>
			<td>COSMED Srl - Italy</td>
			<td>Small,Medium,Large</td>
			<td>V2 Mask</td>
		</tr>
		<tr>
			<td>Software</td>
			<td>COSMED Srl - Italy</td>
			<td>PFT SUITE</td>
			<td>PC Software</td>
		</tr>
		<tr>
			<td>Surgical masks</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

effects of surgical masks on cardiopulmonary function in healthy subjects

We study the effect of surgical masks on cardiopulmonary function based on a cardiopulmonary exercise test (CPET). This study shows that surgical masks reduce cardiopulmonary exercise capacity and ventilation in healthy young subjects and wearing masks might affect aerobic exercise capacity more in female subjects than in male subjects.

Ten subjects (five males and five females) from the Department of Rehabilitation Medicine at Guangzhou Medical University were recruited in this pilot study. The participants had similar baseline characteristics, such as age (mean age: male 21.00 &#177; 1.58 years; female 21.20 &#177; 0.45 years) and physical fitness [sports activity and body mass index (BMI)]. There were no significant differences in age, height, or BMI between the male and female groups. Moreover, for the spirometry, th...

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Effects of Surgical Masks on Cardiopulmonary Function in Healthy Subjects

We study the effect of surgical masks on cardiopulmonary function based on a cardiopulmonary exercise test (CPET). This study shows that surgical masks reduce cardiopulmonary exercise capacity and ventilation in healthy young subjects and wearing masks might affect aerobic exercise capacity more in female subjects than in male subjects.

We study the effect of surgical masks on cardiopulmonary function based on a cardiopulmonary exercise test (CPET). This study shows that surgical masks ...

Wearing a mask in public areas might impede the spread of the infection disease by preventing both the inhalation of infectious droplets and their subsequent exhalation and dissemination. However, there are few studies on the effect of wearing a mask on cardiopulmonary function. Different types of masks have different effects on increasing expiratory resistance and inspiratory resistance.During a respiratory disease pandemic, people may need to wear masks for extended period of time to perform daily activities. Cardiopulmonary exercise testing is a important means of the cardiovascular rehabilitation mask assessment by reflecting variable parameters of the body's cardiopulmonary functioning during exercise with increasing load. We use CPET to evaluate the interference of masks on cardiorespiratory reserve and exercise endurance, which can guide the application of masks during a respiratory infectious disease pandemic.Xiaoyue Zhao will demonstrate biometry evaluation. Yongchun Jiang and Siqing Wang will demonstrate the CPET test. Weijie Lin will be our subject model for the presentation.Begin by setting the room temperature to 25 degrees Celsius and preparing the first aid equipment. Ask the subject to sit upright without leaning on the back of the chair with their feet on the ground. Ask them to keep their head at a natural level or slightly tilted upwards, but to avoid bending their head down or bending over.To perform the forced vital capacity test, ask the subject to breathe calmly for five seconds. Then inhale strongly, and then exhale strongly for six seconds. Finally, ask them to inhale back and keep breathing calmly.Perform the whole procedure under the guidance of a doctor or a formally trained exercise physiologist. To perform the maximum voluntary ventilation test, ask the subject to breathe calmly four or five times. Then repeat the breath continuously for 12 or 15 seconds at the maximum breathing amplitude and the fastest breathing speed.Briefly tell the subject about the procedure. Then scrape the body hair at the position of the electrocardiograph electrodes. And use 75%alcohol to remove extra dander and grease.Place the ECG electrodes and attach them to the 12-lead ECG wires. Fix the ECG machine to the chest using a strap. Choose a mask that fits the size of the subject's face and attach it firmly to the face, making sure that there is no gap between the mask and the face.Fix the flowmeter on the vent and the K4 device onto the vest. Ask the subject to sit on the seat, step on the pedals and adjust the height of the handlebars to a comfortable position for the subject. Have them grab the handlebar with both hands.Place a blood pressure cuff on the subject's upper right arm for dynamic blood pressure recording. Then place a finger pulse oxygen on the left index finger for the dynamic recording of blood oxygen. Calculate the subject's exercise resistance parameters and set the progressive resistance plan for the exercise phase.Click on the start button to activate the cycle ergometer. Ask the subject to keep a static sitting posture for two minutes, then start cycling for two minutes. Ask the subject to continue cycling until they can't maintain the pace.Then ask them to cool down for three minutes. When finished, have the subject keep the static sitting posture for three minutes for observation of vital signs. Then remove data acquisition equipment, face mask, vest and ECG electrodes.Use the rating of perceived exertion scale to measure physical activity intensity levels that are apparently related to the heart rate during exercise. Then use BORG'S scale to evaluate the exertion of resistance training. A score of six represents resting activity with no effort, and a score of 20 represents exhaustive exercise.After a 48-hour washout period, select a mask that fits the size of the subject's face and attach it firmly to the face, ensuring that there is no gap between the mask and the face. The 10 participants recruited in this pilot study had similar baseline characteristics such as age and physical fitness. There were no significant differences in age, height or BMI between the male and female groups.For the spirometry, the female group showed lower FVC, lowered forced expiratory volume in one second, lower MVV and lowered peak expiratory flow compared with the male group. The results of CPET under different conditions are shown here. For exercise tolerance and cardiac function, both male and female groups showed a significant decrease in anaerobic threshold per kilogram and oxygen pulse during the mask-on condition, but no significant differences in the oxygen uptake related to work rate.The male group also showed a significant decrease in resting heart rate, and the female group showed a significant decrease in peak oxygen uptake per kilogram during the mask-on condition. For ventilatory function, both male and female groups showed a significant decrease in tidal volume while wearing a mask, but no differences were found in the breathing reserve percentage. Both groups showed a significant decrease in ventilation during the mask-on condition, and no difference was found in total CPET performance.When performing this protocol, subjects should be encouraged to exercise to their maximum endurance, or until the practitioner ends the exercise due to symptoms, such as asthmatic ECG trends, complete apathy, or second or third degree heart block.

Effects of Surgical Masks on Cardiopulmonary Function in Healthy Subjects

Abstract