EFFECTS AND SAFETY OF FACEMASK USE ON HEALTHY INDIVIDUALS DURING EXERCISE: A SYSTEMATIC REVIEW AND ANALYSIS

V.I. Dones¹, M.C. San Jose², M.A. Serra¹, I.T. Cabaluna³, F.A. San Jose¹, K.L. Matheson¹, L.A. Embile¹, L.J. Alejandrino¹, C.D. Aniciete¹, A.M. Baybay¹, J.A. Macaraeg¹, A.P. Palima¹

¹University of Santo Tomas, Physical Therapy, Manila, Philippines, ²University of the Philippines, Department of Neurosciences College of Medicine, Manila, Philippines, ³University of the Philippines, Institute of Clinical Epidemiology, National Institutes of Health, Manila, Philippines

Background: Wearing facemasks during exercise might have safety concerns and negatively affect exercise performance.

Purpose: We aimed to determine the effect of wearing a facemask during exercise among healthy adults on its tolerability, physiologic impact, and effect on COVID-19 incidence.

Methods: This systematic review and meta-analysis was conducted according to the PRISMA guidelines. We performed a systematic search of electronic databases covering randomized studies investigating tolerability, physiologic effects, and the impact on SARS-COV₂incidenceof commercially-available facemasks compared to no-facemask during exercise of healthy adults and was published from the earliest date to January 31, 2022. Outcomes of interest were facemask tolerability, and objective cardiopulmonary, gas exchange, and metabolic responses. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence interval (CI) were calculated overall, and for subgroups using RevMan software (version 5.4.1.). Random-effects meta-analysis was used to compute pooled and subgroup estimates. Chi-squared test, I² statistics, and visual analysis were used to assess heterogeneity. The GRADE approach was used to assess the certainty of evidence.

Results: Of the 570 studies identified, 29 Randomized Clinical Trials RCTs involving 860 participants were included. Twenty-seven studies reported perceptual responses during physical activity while 28 studies reported physiologic measures. None assessed impact on the incidence of COVID-19.
Using facemask clinically and significantly increased during exercise the humidity (MD 2.36, [95% CI: 1.45, 3.28]), thermal sensation (MD 2.89, [95% CI: 2.07, 3.71]), breathing resistance (MD 4.77, [95% CI: 4.02, 5.51]), misfit (MD 2.28, [95% CI: 0.98, 3.58]), fatigue (MD 3.35, [95% CI: 2.39, 4.31]), and overall discomfort (MD 3.17, [95% CI: 2.29, 4.05]) of healthy individuals compared to those not wearing facemasks. The use of facemask increased during exercise the rate of perceived exertion (SMD 0.47, [95% CI: 0.31, 0.62]), itchiness (MD 0.74, [95% CI: 0.44, 1.91]), tightness (MD 0.85, [95% CI: 0.44, 2.14]), saltiness (MD 1.41, [95% CI: 0.61, 2.22]), and odor (MD 0.45, [95% CI: 0.38, 1.28]) of healthy individuals compared to those not wearing facemasks. Using facemask increased during exercise the systolic blood pressure (MD 0.99, [95% CI: -2.15, 4.13]), end-tidal carbon dioxide tension (MD 3.48, [95% CI: 2.36, 4.61]), and blood lactate level (MD 0.04, [95% CI: -0.15, 0.23]) of healthy individuals compared to those not wearing facemasks. Albeit not clinically significant, wearing a facemask during exercise decreased the heart rate (MD -1.04, [95% CI: -2.44, 0.36]), diastolic blood pressure (MD -0.33, [95% CI: -2.15, 1.50]), respiration rate (MD -3.60, [95% CI: -5.28, -1.92]), oxygen saturation (MD -0.31, [95% CI: -0.49, -0.12]), tidal volume (MD -0.07, [95% CI: -0.15, 0.01]), and maximum rate of oxygen consumption (MD -1.90, [95% CI: -3.43, -0.36]) of healthy individuals compared to those not wearing facemasks.

Conclusions: Facemask use during exercise was associated with a clinically significant increase in humidity, thermal sensation, breathing resistance, misfit, fatigue, and overall discomfort in exercising healthy individuals. In contrast, the effects on physiologic changes were small and not clinically significant.

Implications: Although associated with discomfort, facemask use is safe even during maximal exercise among healthy young adults.

Funding acknowledgements: Metro Manila Health Research and Development Consortium of the Department of Science and Technology of the Republic of the Philippines

Keywords:
Facemasks
Exercise
Physiologic parameters

Topics:
Cardiorespiratory
COVID-19
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? No

Reason: The SR and meta-analysis is a secondary research not needing ethical approval.