Document Type : Research Paper I Open Access I Released under CC BY-NC 4.0 license
Authors
1 Ph.D student in Exercise Physiology, University of Mazandaran, Babolsar, Iran.
2 Assistant Professor, Department of Exercise Physiology, Physical Education Faculty, Mazandaran University, Babolsar, Iran.
3 Department of Sports Physiology, Faculty of Physical Education and Sport Sciences, University, of Mazandaran, Babolsar, Iran.
Abstract
Background and aim: Current study aim was to examine the effects of wearing surgical and N95 facemasks on response of the physiological and electrocardiography markers include; QRS complex, QT interval, ST depression and P amplitude during exhaustive maximal exercise in middle-aged women.
Methods; In a semi- experimental protocol, 36 healthy volunteers females (mean age and BMI of 30.3 ± 3.9 years and 22.47 ± 3.1 kg/m2, respectively) randomly allocated to three groups of 12 peoples consist to; Max-N95 mask, Max-Surgical mask, and Max-Nomask). Subjects in the aforesaid groups performed a maximal Bruce protocol, while wearing a surgical mask, an N95 mask and without a mask, respectively. Physiological and electrocardiography parameters and time to exhaustion were compared. Data was analyzed to one-way ANOVA at P≤ 0.05 level.
Result: Maximal exercising with N95 mask was associated with a significant decrease in QTc interval levels, as compared to Max-Surgical mask (P<0.05) and Max-Nomask (P<0.027) groups. Although, the intergroup differences increase in heart rate and QRS following Bruce protocol were not differ significantly, very nearly significant level (P value was 0.073 and 0.075, respectively).
Conclusion: In healthy subjects, supervised maximal physical activity, particularly with a surgical mask is feasible, safe, and associated with only minor changes in ECG and physiological parameters, specifically a mild decrease in QTc. Future studies should examine impact of physical activity with various intensities, while using any mask in aged persons and or suffering from chronic inflammatory diseases.
Keywords
Main Subjects
2. Roger Chou, Tracy Dana, Rebecca Jungbauer, Chandler Weeks, Marian S. McDonagh. Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings: A Living Rapid Review. Ann Intern Med. 2020 Jun 24 : M20-3213.
3. Smith PB, Agostini G, Mitchell JC. A scoping review of surgical masks and N95 filtering facepiece respirators: Learning from the past to guide the future of dentistry. Safety Science. 2020;131:104920.
4. Lee S, Li G, Liu T, Tse G. COVID-19: Electrophysiological mechanisms underlying sudden cardiac death during exercise with facemasks. Medical Hypotheses. 2020;144:110177.
5. Ong JJ, Bharatendu C, Goh Y, Tang JZ, Sooi KW, Tan YL, et al. Headaches associated with personal protective equipment–A cross‐sectional study among frontline healthcare workers during COVID‐19. Headache: The Journal of Head and Face Pain. 2020;60(5):864-77.
6. Scheid JL, Lupien SP, Ford GS, West SL. Commentary: physiological and psychological impact of face mask usage during the COVID-19 pandemic. International journal of environmental research and public health. 2020;17(18):6655.
7. Tong PSY, Kale AS, Ng K, Loke AP, Choolani MA, Lim CL, et al. Respiratory consequences of N95-type Mask usage in pregnant healthcare workers—a controlled clinical study. Antimicrobial Resistance & Infection Control. 2015;4(1):1-10.
8. Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. American journal of infection control. 2013;41(12):1218-23.
9. Sinkule E J, Powell J B and Goss F L. (2013). Evaluation of N95 Respirator Use with a
Surgical Mask Cover: Effects on Breathing Resistance and Inhaled Carbon Dioxide. Ann.
Occup. Hyg. 2013; 57 (3), 384–398.
10. Stephen A. Busch, Sean van Diepen, Richard Roberts, Andrew R. Steele, Lindsey F. Berthelsen, Megan P. Smorschok, Cody Bourgoin, Craig D. Steinback. Short‐term hypoxia does not promote arrhythmia during voluntary apnea. Physiol Rep. 2021 Jan; 9(1): e14703.
11. Jari A. Laukkanen, Timo H. Mäkikallio, Rainer Rauramaa, Sudhir Kurl. Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study. Eur Heart J. 2009 Mar; 30(5): 558–565.
12. Neary . Marianne T., Timothy J. Mohun, Ross A. Breckenridge. A mouse model to study the link between hypoxia, long QT interval and sudden infant death syndrome. Dis Model Mech. 2013, Mar; 6(2): 503–507.
242 علوم زیستی ورزشی، دورة 13 ، شمارة 2، تابستان 1400
13. Marianne T. Neary, Timothy J. Mohun, Ross A. Breckenridge. A mouse model to study the link between hypoxia, long QT interval and sudden infant death syndrome. Dis Model Mech. 2013, Mar; 6(2): 503–507.
14. Gabriels J, Saleh M, Chang D, Kim BS, Mansoor A, Mahmood E. Effect of chloroquine, hydroxych,loroquine and azithromycin on the corrected QT interval in patients with SARS-CoV-2 infection. Circ Arrhythm Electrophysiol. 2020; Jun; 13(6): e008662. 15. Giudicessi JR, Noseworthy PA, Friedman PA, et al. Urgent guidance for navigating and circumventing the QTc prolonging and torsadogenic potential of possible pharmacotherapies for COVID-19. Mayo Clin Proc 2020. Jun; 95(6): 1213–1221. 16. Jordan M Prutkin, MD, MHS, FHRS. Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease. Jan 06, 2021. www.uptodate.com ©2021 Up To Date.
17. Andrew M. Luks, Erik R. Swenson. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc. 2020 Sep; 17(9): 1040–1046.
18. Buekers J, Theunis J, De Boever P, Vaes AW, Koopman M, Janssen EV, et al. 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. JMIR mHealth and uHealth. 2019;7(6):e12866.
19. O’Dowd K, Nair KM, Forouzandeh P, Mathew S, Grant J, Moran R, et al. Face masks and respirators in the fight against the COVID-19 pandemic: a review of current materials, advances and future perspectives. Materials. 2020;13(15):3363.
20. Zhang M, Emery AR, Tannyhill RJ, Zheng H, Wang J. Masks or N95 Respirators During COVID-19 Pandemic–Which One Should I Wear? Journal of Oral and Maxillofacial Surgery. 2020;78(12):2114-27.
21. Matuschek C, Moll F, Fangerau H, Fischer JC, Zänker K, van Griensven M, et al. Face masks: benefits and risks during the COVID-19 crisis. European journal of medical research. 2020;25(1):1-8.
22. Ellis KJ, Bell SJ, Chertow GM, Chumlea WC, Knox TA, Kotler DP, Lukaski HC, Schoeller DA. Bioelectrical impedance methods in clinical research: a follow-up to the NIH Technology Assessment Conference. Nutrition. 1999 Nov 1;15(11-12):874-80.
23. Kim K-H, Jeon KN, Kang MG, Ahn JH, Koh J-S, Park Y, et al. Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular events. The Korean Journal of Internal Medicine. 2016;31(5):880.
24. Medicine ACoS. ACSM's health-related physical fitness assessment manual: Lippincott Williams & Wilkins; 2013.
25. Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID‐19 pandemic: altruism and solidarity. Lancet. 2020. 10.1016/S0140-6736(20)30918-1.
26. Danny Epstein, Alexander Korytny, Yoni Isenberg, Erez Marcusohn, Robert Zukermann, Boaz Bishop, Sa'ar Minha, Aeyal Raz, Asaf Miller. Return to training in the COVID‐19 era: The physiological effects of face masks during exercise. Scand J Med Sci Sports. 2020 Sep 30 : 10.1111/sms.13832.
اثر دو نوع ماسک تهویۀ هوا در طی فعالیت واماندهساز در دورة پاندمی کرونا بر ... 243
27. ATSUYA OTSUKA, JUNYA KOMAGATA, YUTA SAKAMOTO . Wearing a surgical mask does not affect the anaerobic threshold during pedaling exercise. JOURNAL OF HUMAN SPORT & EXERCISE. 2020; 17(1), doi:https://doi.org/10.14198/jhse.2022.171.03.
28. Domingo Jesús Ramos-Campo, Silvia Pérez-Piñero, Juan Carlos Muñoz-Carrillo, Francisco Javier López-Román, Esther García-Sánchez and Vicente Ávila-Gandía Acute Effects of Surgical and FFP2 Face Masks on Physiological Responses and Strength Performance in Persons with Sarcopenia. Biology, 2021, 10, 213.
29. Lässing. J, R. Falz. C. Pökel. S. Fikenzer. U. Laufs. A. Schulze. N. Hölldobler. P. Rüdrich. M. Busse. Efects of surgical face masks on cardiopulmonary parameters during steady state exercise. Scientifc Reports. 2020; 10:22363
30. Gontjes KJ, Gibson KE, Lansing B, Cassone M, Mody L. Contamination of common area and rehabilitation gym environment with multidrug-resistant organisms. J Am Geriatr Soc. 2020;68:478-485.
31. Haraf RH, Faghy MA, Carlin B, Josephson RA. The Physiological Impact of Masking Is Insignificant and Should Not Preclude Routine Use During Daily Activities, Exercise, and Rehabilitation. Journal of cardiopulmonary rehabilitation and prevention. 2021 Jan;41(1):1.
32. Chan NC, Li K, Hirsh J. Peripheral oxygen saturation in older persons wearing nonmedical face masks in community settings. JAMA. 2020;324(22):2323–2324.
33. Lydia C. Boyette; Biagio Manna. Physiology, myocardial oxygen demand. Stat Pearls [Internet]. 2021 Jan. PMID: 29763072
34. Fikenzer, S.; Uhe, T.; Lavall, D.; Rudolph, U.; Falz, R.; Busse, M.; Hepp, P.; Laufs, U. Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clin. Res. Cardiol. 2020; 109(12): 1522–1530.
35. Zhang D, She J, Zhang Z, Yu M. Effects of acute hypoxia on heart rate variability, sample entropy and cardiorespiratory phase synchronization. Biomedical engineering online. 2014 Dec;13(1):1-2.
36. Epstein D, Korytny A, Isenberg Y, Marcusohn E, Zukermann R, Bishop B, Minha SA, Raz A, Miller A. Return to training in the COVID-19 era: The physiological effects of face masks during exercise. Scandinavian journal of medicine & science in sports. 2021 Jan;31(1):70-5.
37. Mourot L. Limitation of Maximal Heart Rate in Hypoxia: Mechanisms and Clinical Importance. Front Physiol. 2018 Jul 23;9:972.
38. Siebenmann, C., and Lundby, C. (2015). Regulation of cardiac output in hypoxia. Scand. J. Med. Sci. Sports 25(Suppl. 4), 53–59.
39. Roberge RJ, Coca A, Williams WJ, Powell JB, Palmiero AJ. Physiological impact of the N95 filtering facepiece respirator on healthcare workers. Respir Care. 2010;55:569-577.
40. Kyung SY, Kim Y, Hwang H, Park JW, Jeong SH. Risks of N95 face mask use in subjects with COPD. Respir Care. 2020; 65:658-664.
)