Research Article

Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study

Number: 1 September 8, 2026
Aya Issa , Ghaith Wedeh , Sali Daghir , Solaiman Doba *, Moatasem Al-Janabi

Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study

Abstract

Objective: Face masks remain a central component of respiratory infection control strategies;however, concerns persist regarding their physiological effects and user comfort during prolonged wear. This study aimed to compare the physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy young adults. 
Methods: This repeated-measures crossover study included 80 healthy participants, each of whom tested surgical, cloth, and FFP2 masks on separate days for at least two hours, allowing within-subject comparison of physiological and subjective responses. Peripheral oxygen saturation (SpO₂), heart rate (HR), and self-reported symptoms were assessed before and after mask use. 
Results: Cloth masks were associated with small but statistically significant reductions in SpO₂ and HR (p<0.05), although all values remained within normal physiological ranges. No significant physiological changes were observed with surgical or FFP2 masks. However, mask type was significantly associated with breathing difficulty (p=0.009) and dry mouth (p=0.024);breathing difficulty was most frequently reported with FFP2 masks, whereas dry mouth was most frequently reported with cloth masks. No significant associations were found between mask type and itching, sweating, or headache occurrence, including among smokers. 
Conclusion: Physiological alterations were minimal across all mask types. Differences were primarily related to subjective comfort, suggesting that mask selection for prolonged use should balance protective efficiency with user tolerability.

Keywords

Face Masks, FFP2, Surgical Mask, Cloth Mask, Oxygen Saturation, Heart Rate

Supporting Institution

Latakia University, Faculty of Pharmacy, Latakia, Syria

Project Number

None

Ethical Statement

The study was approved by the Ethics Committee of Latakia University (Latakia, Syria) (approval no: 1919, date: May 19, 2023)

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APA
Issa, A., Wedeh, G., Daghir, S., Doba, S., & Al-Janabi, M. (2026). Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study. Turkish Journal of Public Health, 1. https://doi.org/10.20518/tjph.1904112
AMA
1.Issa A, Wedeh G, Daghir S, Doba S, Al-Janabi M. Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study. TJPH. 2026;(1). doi:10.20518/tjph.1904112
Chicago
Issa, Aya, Ghaith Wedeh, Sali Daghir, Solaiman Doba, and Moatasem Al-Janabi. 2026. “Physiological and Subjective Effects of Surgical, Cloth, and FFP2 Masks in Healthy Adults: A Repeated-Measures Crossover Study”. Turkish Journal of Public Health, no. 1. https://doi.org/10.20518/tjph.1904112.
EndNote
Issa A, Wedeh G, Daghir S, Doba S, Al-Janabi M (September 1, 2026) Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study. Turkish Journal of Public Health 1
IEEE
[1]A. Issa, G. Wedeh, S. Daghir, S. Doba, and M. Al-Janabi, “Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study”, TJPH, no. 1, Sept. 2026, doi: 10.20518/tjph.1904112.
ISNAD
Issa, Aya - Wedeh, Ghaith - Daghir, Sali - Doba, Solaiman - Al-Janabi, Moatasem. “Physiological and Subjective Effects of Surgical, Cloth, and FFP2 Masks in Healthy Adults: A Repeated-Measures Crossover Study”. Turkish Journal of Public Health. 1 (September 1, 2026). https://doi.org/10.20518/tjph.1904112.
JAMA
1.Issa A, Wedeh G, Daghir S, Doba S, Al-Janabi M. Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study. TJPH. 2026. doi:10.20518/tjph.1904112.
MLA
Issa, Aya, et al. “Physiological and Subjective Effects of Surgical, Cloth, and FFP2 Masks in Healthy Adults: A Repeated-Measures Crossover Study”. Turkish Journal of Public Health, no. 1, Sept. 2026, doi:10.20518/tjph.1904112.
Vancouver
1.Aya Issa, Ghaith Wedeh, Sali Daghir, Solaiman Doba, Moatasem Al-Janabi. Physiological and subjective effects of surgical, cloth, and FFP2 masks in healthy adults: A repeated-measures crossover study. TJPH. 2026 Sep. 1;(1). doi:10.20518/tjph.1904112