Does Mask Use During Activity Affect the Hemodynamic Response?

Abstract

Introduction: The widespread adoption of mask usage has raised concerns about potential effects on the cardiopulmonary system during physical activity, possibly leading to increased work of breathing and dyspnea. This study aimed to investigate the influence of mask use on hemodynamic responses during physical activity. Materials and Methods: A cross-over clinical study was conducted, involving healthy young subjects aged 18-25 years. Participants were randomly assigned to either the Mask Group, which wore masks during exercise, or the Non-mask Group, which did not use masks. Both groups performed treadmill exercises at 60% of their maximum heart rate. Following the first exercise set, a wash-out period of the same duration was given before repeating the exercise sets with the groups crossed over. Blood pressure, oxygen saturation, heart rate were measured before and after each exercise set, and breathlessness levels were scored using the Modified Borg Scale. Results: The study included 52 subjects (68% male, 32% female), with a mean age of 21.75 years. Statistically significant changes in hemodynamic parameters were observed from pre to post exercise in both groups (p0.05). Conclusions: In healthy young individuals, physical exercise induced an increase in heart rate, blood pressure, dyspnea, and fatigue, accompanied by a decrease in oxygen saturation. Surprisingly, the presence or absence of a mask during exercise did not have a statistically significant impact on the hemodynamic parameters. Nevertheless, further research in similar settings is warranted to confirm these findings.

Keywords

• mask
• dyspnea
• exercise
• hemodynamic

Does Mask Use During Activity Affect the Hemodynamic Response?

Abstract

References

1. Farah W, Abusalih MF, Hasan B, Lees EH, Fleti F, Elkhatib WY, et al. Safety implications of mask use: a systematic review and evidence map. BMJ Evid Based Med 2025;30(2):91–103.
2. Santos-Silva PR, Greve JMD, Pedrinelli A. During the coronavirus (Covid-19) pandemic, does wearing a mask improve or worsen physical performance? Revista Brasileira de Medicina do Esporte 2020;26(4):281-284.
3. 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.
4. Chandrasekaran B, Fernandes S. “Exercise with facemask; Are we handling a devil’s sword?” – A physiological hypothesis. Med Hypotheses. 2020;144:110002.
5. Alkan B, Özalevli S, Sert ÖA. Wearing a surgical mask: Effects on gas exchange and hemodynamic responses during maximal exercise. Clin Physiol Funct Imaging 2022;42(4).
6. Grant S, Aitchison T, Henderson E, Christie J, Zare S, McMurray J, et al. A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and likert scales in normal subjects during submaximal exercise. Chest 1999;116(5):1208-1217.
7. Bourassa S, Bouchard PA, Lellouche F. Impact of gas masks on work of breathing, breathing patterns, and gas exchange in healthy subjects. Respir Care. 2018;63(11):1350–9.
8. 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): 2231-2237.

9. Zhang G, Li M, Zheng M, Cai X, Yang J, Zhang S, et al. Effect of Surgical Masks on Cardiopulmonary Function in Healthy Young Subjects: A Crossover Study. Front Physiol. 2021;12:710573.
10. 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 individuals. Int J Environ Res Public Health. 2020;17(21):8110.
11. 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): 107-113. Poon ETC, Zheng C, Wong SHS. Effect of Wearing Surgical Face Masks During Exercise: Does Intensity Matter? Front Physiol. 2021;12: 775750.
12. Hopkins SR, Dominelli PB, Davis CK, Guenette JA, Luks AM, Molgat-Seon Y, et al. Face Masks and the Cardiorespiratory Response to Physical Activity in Health and Disease. Annals of the American Thoracic Society 2021; 18(3):399-407.
13. Glänzel MH, Barbosa IM, Machado E, Prusch SK, Barbosa AR, Lemos LFC, et al. Facial mask acute effects on affective/psychological and exercise performance responses during exercise: A meta-analytical review. Vol. 13, Frontiers in Physiology 2022;13:994454.
14. Zheng C, Poon ETC, Wan K, Dai Z, Wong SHS. Effects of Wearing a Mask During Exercise on Physiological and Psychological Outcomes in Healthy Individuals: A Systematic Review and Meta-Analysis Sports Medicine 2023;53(1):125-150.
15. Odey AF, Arikpo II, Meremikwu J, Otonkue MA, Chukwu NN, Ita-Lincoln F. Tolerability of facemask during physical exercises during COVID-19 pandemic: A systematic review. J Public Health Afr 2025;16(2);610.
16. Vogt G, Radtke K, Jagim A, Peckumn D, Lee T, Mikat R, et al. Effect of Face Masks on Physiological and Perceptual Responses during 30 Minutes of Self-Paced Exercise in Older Community Dwelling Adults. Int J Environ Res Public Health 2022;19(19):12877.
17. Amput P, Wongphon S. Effects of Wearing Face Masks on Cardiorespiratory Parameters at Rest and after Performing the Six-Minute Walk Test in Older Adults. Geriatrics 2022;7(3):62.
18. Salles-Rojas A, Guzmán-Valderrábano C, Madrid WA, González-Molina A, Silva-Cerón M, Rodríguez-Hernández C, et al. Masking the 6-minute walking test in the covid-19 era. Annals of the American Thoracic Society 2021;18(6):1070-1074.