The influence of N95 and FFP2 masks on cardiorespiratory variables in healthy individuals during aerobic exercise: a systematic review and meta-analysis

Lima, Gustavo Lucas da Silva; Rocha, Thiago Casali; Silva Júnior, Gilmar Pereira de Lima da; Martins, Marcelo Tarcísio

doi:10.36416/1806-3756/e20220143

Gustavo Lucas da Silva Lima

study conception and design

statistical analysis

writing of the manuscript

data analysis and interpretation

. Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil.

. Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil.

http://orcid.org/0000-0001-9437-4019

Thiago Casali Rocha

study conception and design

statistical analysis

writing of the manuscript

data analysis and interpretation

. Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil.

. Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil.

http://orcid.org/0000-0003-1658-9713

Gilmar Pereira de Lima da Silva Júnior

study conception and design

statistical analysis

writing of the manuscript

data analysis and interpretation

. Universidade Paulista - UNIP - Volta Redonda (RJ) Brasil.

http://orcid.org/0000-0002-3636-0636

Marcelo Tarcísio Martins

study conception and design

statistical analysis

writing of the manuscript

critical revision of the manuscript for important intellectual content

. Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA - Juiz de Fora (MG) Brasil.

. Hospital Maternidade Therezinha de Jesus, Juiz de Fora (MG) Brasil.

http://orcid.org/0000-0003-2943-6433

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@gmail.com

CONFLICTS OF INTEREST

None declared.

Inclusion criteria
Design: randomized controlled trials or randomized crossover clinical trials
Language: English
Involving humans only
Intervention: use of N95/FFP2 masks
Exclusion criteria
Intervention: unclear, poorly described, or inadequate
Publishing form: abstract only
Main variables analyzed
HR
RR
Blood pressure
Oxygen saturation (SpO₂)
Perceived exertion (as assessed by the Borg scale)

Study, year	Sample	Intervention	Variables analyzed
Study, year	Sample	Intervention	BP	HR	RR	SpO₂	PE
Epstein et al., 2021⁶6 Epstein D, Korytny A, Isenberg Y, Marcusohn E, Zukermann R, Bishop B, et al. 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. https://doi.org/10.1111/sms.13832 https://doi.org/10.1111/sms.13832...	16 volunteers (men only) mean age: 34 ± 4 years cross analysis	no mask use vs. surgical mask use vs. N95 mask use Participants underwent exercise testing on a cycle ergometer with a ramp protocol. initial load of 25 W at a constant speed of 55-65 rpm The initial load was increased by 25 W every 3 min until exhaustion. six tests, with a minimum rest period of 24 h between tests A 12-lead ECG was used in order to assess HR, SaO₂, and BP. RR was noninvasively assessed by means of nasal prongs.	= BP p > 0.05	= HR p > 0.05	= RR p > 0.05	= SpO₂ p > 0.05	= PE p > 0.05
Fikenzer et al., 2020¹²12 Fikenzer S, Uhe T, Lavall D, Rudolph U, Falz R, Busse M, et al. Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clin Res Cardiol. 2020;109(12):1522-1530. https://doi.org/10.1007/s00392-020-01704-y https://doi.org/10.1007/s00392-020-01704...	12 volunteers (men only) mean age: 38.1 ± 6.2 years cross analysis	no mask use vs. surgical mask use vs. N95/FFP2 mask use Cycle ergometer with a ramp protocol at a speed of 60-70 rpm and a workload of 50 W, which was increased by 50 W every 3 min until voluntary exhaustion. An ECG and a digital spirometer were used in order to assess cardiac and pulmonary parameters, respectively.	= BP p > 0.01	= HR p > 0.01	↓ RR p < 0.05	N/A	N/A
Morishita et al., 2019¹⁷17 Morishita M, Wang L, Speth K, Zhou N, Bard RL, Li F, et al. Acute Blood Pressure and Cardiovascular Effects of Near-Roadway Exposures With and Without N95 Respirators. Am J Hypertens. 2019;32(11):1054-1065. https://doi.org/10.1093/ajh/hpz113 https://doi.org/10.1093/ajh/hpz113...	50 volunteers (32 men and 18 women) mean age: 36 ± 14 years cross analysis	use of N95 masks vs. no use of N95 masks in a clinical environment and near a highway An ECG and an HR monitor were used in order to assess variations in HR. A BP monitor was used in order to analyze variations in BP every 10 min. 2 hours of observation, 5 days a week, in two different weeks	= BP p > 0.01	= HR p > 0.01	N/A	N/A	N/A
Shi et al., 2016²³23 Shi J, Lin Z, Chen R, Wang C, Yang C, Cai J, et al. Cardiovascular Benefits of Wearing Particulate-Filtering Respirators: A Randomized Crossover Trial. Environ Health Perspect. 2017;125(2):175-180. https://doi.org/10.1289/EHP73 https://doi.org/10.1289/EHP73...	24 volunteers (13 men and 11 women). The initial sample consisted of 30 volunteers. Six volunteers withdrew from the study. mean age: 23 years cross analysis	use of N95 masks vs. no mask use 1-h walks Variations in HR were assessed by Holter monitoring during the test. Variations in BP were analyzed with an automated BP monitor. BP was measured every 15 min during the day and every 30 min at night.	= BP p > 0.05	N/A	N/A	N/A	N/A
Egger et al., 2021¹⁶16 Egger F, Blumenauer D, Fischer P, Venhorst A, Kulenthiran S, Bewarder Y, et al. Effects of face masks on performance and cardiorespiratory response in well-trained athletes. Clin Res Cardiol. 2022;111(3):264-271. https://doi.org/10.1007/s00392-021-01877-0 https://doi.org/10.1007/s00392-021-01877...	16 well-trained volunteer athletes (men only) age range: 20-34 years cross analysis	use of FFP2 masks vs. no use of FFP2 masks the Borg scale, a metabolic test system, a 12-lead ECG, and manual BP assessment initial workload of 100-150 W, increased by 50 W every 3 min on an electromagnetic cycle ergometer The test was interrupted when volunteers were unable to cycle at a minimum speed of 50 rpm for more than 10 s. an interval of at least 48 h between evaluations with and without FFP2 masks	= BP p > 0.01	= HR p > 0.01	N/A	N/A	= PE p > 0.05
Kienbacher et al., 2021²²22 Kienbacher CK, Grafeneder J, Tscherny K, Krammel M, Fuhrmann V, Niederer M, et al. The use of personal protection equipment does not negatively affect paramedics' attention and dexterity: a prospective triple-cross over randomized controlled non-inferiority trial. Scand J Trauma Resusc Emerg Med. 2022;30(1):2. https://doi.org/10.1186/s13049-021-00990-3 https://doi.org/10.1186/s13049-021-00990...	48 volunteers (44 men and 4 women) mean age: 28 ± 8 years triple-test cross analysis	use of personal protective equipment (overalls, glasses, and gloves) and FFP2 masks without an exhalation valve vs. no use of FFP2 masks climb and descend stairs at a fast pace with a backpack and oxygen cylinder, followed by 12 min of chest compressions and bag-valve-mask ventilation a rest period of 30 min between tests BP, HR, and SpO₂ were assessed with a portable monitor/defibrillator.	= BP p > 0.05	= HR p > 0.05	N/A	= SpO₂ p > 0.05	↑ PE p < 0.05
Rebmann et al., 2013²⁰20 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. https://doi.org/10.1016/j.ajic.2013.02.017 https://doi.org/10.1016/j.ajic.2013.02.0...	10 volunteer nurses (9 women and 1 man); 9 completed the study. age range: 24-48 years (mean age, 35 years)	use of N95 masks vs. use of N95 masks with a surgical mask overlay use of N95 masks for 12 h daily for 2 days Variables were analyzed every 30 min with a saturation sensor. an interval of 1 or more days between analyses	= BP p > 0.05	= HR p > 0.05	N/A	N/A	↑ PE p < 0.05
Goh et al., 2019¹⁸18 Goh DYT, Mun MW, Lee WLJ, Teoh OH, Rajgor DD. A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children. Sci Rep. 2019;9(1):18952. https://doi.org/10.1038/s41598-019-55451-w https://doi.org/10.1038/s41598-019-55451...	106 volunteer children (59 boys and 47 girls) age range: 7-14 years cross analysis	no use of masks vs. use of N95 masks without a valve vs. use of N95 mask with a valve Reading in 3 5-min intervals: 1st-no mask (control); 2nd-wearing a valveless mask; and 3rd-wearing a valved mask Nasal cannulas with a multiparameter ECG monitor and a continuous monitoring system were used in order to evaluate SpO₂, HR, and RR.	N/A	= HR p > 0.05	= RR p > 0.05	= SpO₂ p > 0.05	↑ PE p < 0.05
Kim et al., 2016¹⁹19 Kim JH, Wu T, Powell JB, Roberge RJ. Physiologic and fit factor profiles of N95 and P100 filtering facepiece respirators for use in hot, humid environments. Am J Infect Control. 2016;44(2):194-198. https://doi.org/10.1016/j.ajic.2015.08.027 https://doi.org/10.1016/j.ajic.2015.08.0...	12 volunteers (men only) mean age: 23.5 ± 1.6 years cross analysis	use of N95 FFRs or similar vs. no mask use Individuals walked for 1 h at 5.6 km/h on a treadmill at a 0% slope. temperature, 35°C; relative humidity, 50% tests performed on two different days (first without an FFR, then with an FFR) A pulse oximeter with a transcutaneous carbon dioxide sensor connected to the ear, a monitoring chest strap, and an HR monitor were used in order to evaluate SaO₂, RR, and HR, respectively.	N/A	= HR p > 0.05	= RR p > 0.05	= SpO₂ p > 0.05	= PE p > 0.05
Mapelli M et al., 2021²¹21 Mapelli M, Salvioni E, De Martino F, Mattavelli I, Gugliandolo P, Vignati C, et al. "You can leave your mask on": effects on cardiopulmonary parameters of different airway protective masks at rest and during maximal exercise. Eur Respir J. 2021;58(3):2004473. https://doi.org/10.1183/13993003.04473-2020 https://doi.org/10.1183/13993003.04473-2...	12 volunteers (6 men and 6 women) mean age: 41 ± 12.4 years cross analysis	no use of FFP2 masks vs. FFP2 mask use maximal progressive exercise testing on a cycle ergometer Spirometry and a BP monitor were used in order to analyze variables.	= BP p > 0.05	= HR p > 0.05	= RR p > 0.05	↓ SpO₂ p < 0.05

[1] 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@gmail.com

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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

ABSTRACT

Objective:

Methods:

Results:

Conclusions: