TY - JOUR T1 - Exercising with a Surgical Mask is Safe but Decreases Performance in Both Athletic and Non-Athletic Individuals AU - Dinçer, Şensu AU - Yakal, Sertaç AU - Taşdemir, Esin Nur AU - Devran, Sergen AU - Günver, Mehmet Güven AU - Şahinkaya, Türker AU - Erelel, Mustafa AU - Altan, Mehmet AU - Metin, Gökhan PY - 2023 DA - November JF - Koşuyolu Heart Journal PB - Kartal Koşuyolu Yüksek İhtisas EAH WT - DergiPark SN - 2149-2972 SP - 107 EP - 114 VL - 26 IS - 3 LA - en AB - Introduction: Upper respiratory tract infections (URTI) are common medical problems in athletes. Many athletes with URTI continue to train at high-levels and even compete. Using a mask as an additional measure may be beneficial to prevent the spreading of infection among teammates. However, there are many concerns about the effects of mask use on exercise safety and performance. Although some studies have investigated the effects of masks on performance in healthy individuals, studies in athletes are even more limited. Thus, we aimed to evaluate the impact of surgical masks on performance and safety during a cardiorespiratory exercise test (CPET) test applied to both athletes and non-athletes. Patients and Methods: A cross-over, non-randomized study was designed. The study was conducted in two phases. In phase 1, the CPET was performed without using a surgical mask. In phase 2, CPET was performed with a surgical mask in addition to the spiro mask 48 hours after the first test. Thirty participants aged 18-35 were included in the study. They were further divided as athletes (n= 17) and non-athletes (n= 13) subgroups. Results: Significant decreases were observed in some parameters of submaximal exercise [VEan, BFan, VE/ VO2 , VE/VCO2 (p < 0.001)] and in maximal exercise [VEmax, BFmax, TVmax, VE/VO2 , VE/VCO2 (p < 0.001)]. There were also significant decreases in VO2 levels (VO2 an, VO2 max) when compared with and without a surgical mask in both submaximal and maximal exercise (p < 0.001). Additionally, PETO2 decreased, and PETCO2 increased in maximum exercise (p < 0.001), whereas no significant changes were detected at the submaximal level. In subgroup analysis, VEan, VEmax, VO2 an, VO2 max parameters were decreased in athletes compared to non-athletes in surgical masked tests. Conclusion: Surgical masks for athletes and non-athletes decrease performance but have no detrimental effect on cardiorespiratory parameters. Athletes should be aware of this negative effect when high-level performance is demanded. KW - Mask KW - oxygen consumption KW - exercise KW - athlete CR - 1. Gałązka-Franta A, Jura-Szołtys E, Smółka W, Gawlik R. Upper Respiratory Tract Diseases in Athletes in Different Sports Disciplines. J Hum Kinet 2016;53:99-106. https://doi.org/10.1515/hukin-2016-0014 CR - 2. Bjørneboe J, Kristenson K, Waldén M, Bengtsson H, Ekstrand J, Hägglund M, et al. Role of illness in male professional football: Not a major contributor to time loss. Br J Sports Med 2016;50(11):699-702. https:// doi.org/10.1136/bjsports-2015-095921 CR - 3. Spence L, Brown WJ, Pyne DB, Nissen MD, Sloots TP, McCormack JG, et al. Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes. Med Sci Sports Exerc 2007;39(4):577-86. https:// doi.org/10.1249/mss.0b013e31802e851a CR - 4. Yao KV, Szybinski S, Varghese M, Fazekas M. Viral diseases and youth sports: How to handle common infections that sideline athletes. Pediatr Ann 2021;50(11):e454-e460. https://doi.org/10.3928/19382359- 20211017-01 CR - 5. Palmer-Green D, Fuller C, Jaques R, Hunter G. The Injury/Illness Performance Project (IIPP): A novel epidemiological approach for recording the consequences of sports injuries and illnesses. J Sports Med (Hindawi Publ Corp) 2013;2013:523974. https://doi.org/10.1155/2013/523974 CR - 6. So RC, Ko J, Yuan YW, Lam JJ, Louie L. Severe Acute Respiratory Syndrome and sport: Facts and fallacies. Sports Med 2004;34(15):1023-33. https://doi.org/10.2165/00007256-200434150-00002 CR - 7. Chandrasekaran B, Fernandes S. “Exercise with facemask; Are we handling a devil’s sword?” - A physiological hypothesis. Med Hypotheses 2020;144:110002. https://doi.org/10.1016/j.mehy.2020.110002 CR - 8. Lott A, Roberts T, Carter CW. Mask use for athletes: A systematic review of safety and performance outcomes. Sports Health 2022;14(5):632-647. https://doi.org/10.1177/19417381221111395 CR - 9. Metin G, Atukeren P, Alturfan AA, Gulyasar T, Kaya M, Gumustas MK. Lipid peroxidation, erythrocyte superoxide-dismutase activity and trace metals in young male footballers. Yonsei Med J 2003;44(6):979-86. https://doi.org/10.3349/ymj.2003.44.6.979 CR - 10. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol (1985). 1986;60(6):2020- 7. https://doi.org/10.1152/jappl.1986.60.6.2020 CR - 11. Alkan B, Ozalevli S, Akkoyun Sert O. Maximal exercise outcomes with a face mask: The effects of gender and age differences on cardiorespiratory responses. Ir J Med Sci 2022;191(5):2231-7. https://doi.org/10.1007/ s11845-021-02861-3 CR - 12. Driver S, Reynolds M, Brown K, Vingren JL, Hill DW, Bennett M, et al. Effects of wearing a cloth face mask on performance, physiological and perceptual responses during a graded treadmill running exercise test. Br J Sports Med 2022;56(2):107-13. https://doi.org/10.1136/bjsports-2020-103758 CR - 13. Shaw K, Butcher S, Ko J, Zello GA, Chilibeck PD. Wearing of cloth or disposable surgical face masks has no effect on vigorous exercise performance in healthy ındividuals. Int J Environ Res Public Health 2020;17(21):8110. https://doi.org/10.3390/ijerph17218110 CR - 14. 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):70-5. https://doi.org/10.1111/sms.13832 CR - 15. Mann T, Lamberts RP, Lambert MI. Methods of prescribing relative exercise intensity: Physiological and practical considerations. Sport Med 2013;43(7):613-25. https://doi.org/10.1007/s40279-013-0045-x CR - 16. Lässing J, Falz R, Pökel C, Fikenzer S, Laufs U, Schulze A, et al. Effects of surgical face masks on cardiopulmonary parameters during steady state exercise. Sci Rep 2020;10(1):1-9. https://doi.org/10.1038/s41598-020- 78643-1 CR - 17. Bar-On O, Gendler Y, Stafler P, Levine H, Steuer G, Shmueli E, et al. Effects of wearing facemasks during brisk walks: A COVID-19 dilemma. J Am Board Fam Med 2021;34(4):798-801. https://doi.org/10.3122/jabfm.2021.04.200559 CR - 18. 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):264-71. https://doi.org/10.1007/s00392-021-01877-0 CR - 19. Smirmaul BP, Dantas JL, Fontes EB, Altimari LR, Okano AH, Moraes AC. Comparison of electromyography fatigue threshold in lower limb muscles in trained cyclists and untrained non-cyclists. Electromyogr Clin Neurophysiol 2010;50(3-4):149-54. UR - https://dergipark.org.tr/tr/pub/khj/issue//1394047 L1 - https://dergipark.org.tr/tr/download/article-file/3551278 ER -